Manslaughter, criminally negligent homicide and other felony charges laid against paramedics in a Denver suburb will offer the public a close look at not only the stress on medical first responders, but also of the complacency of too many people become a crucial part of the health care melee under fiscal pressures.
The case against Aurora Fire and Rescue paramedics Jeremy Cooper and Lt. Peter Cichuniec offers a grim view of municipal emergency medical services.
A grand jury, appointed by the state attorney general, indicted city paramedics and two Aurora police officers on a series of charges in the 2019 death of 23-year-old black man Elijah McClain . He was walking home from a convenience store one August evening, wearing a ski mask because, according to his parents, he was anemic, idiosyncratic and often cold.
The police insisted that his behavior was suspicious. They used increasingly brutal tactics to arrest and apprehend McClain, a slim, bespectacled massage therapist. Attempts by officers to restrain included “carotid artery strangulation” prohibited by law enforcement in many areas. After Officers Nathan Woodyard and Randy Roedema pushed McClain to the ground and handcuffed him, he was vomiting and complaining that he couldn’t breathe.
A police complaint of a suspect with “excited delirium”
Investigators say paramedics arrived and did not respond to McClain’s urgent medical distress. Instead, police told them McClain was suffering from “excited delirium.” This is a very controversial description of an unproven condition in which individuals can exert extreme resistance to the police during an arrest.
Paramedics responded to police comments by giving the 140-pound McClain 500 milligrams of ketamine – more than 1.5 times the recommended dose, based on his weight, of a drug better known as an animal tranquilizer. and sometimes as a much abused party drug. . As NPR reports:
âFirefighters are allowed to use the drug to put combative or aggressive people to sleep, but there is a lack of police training, conflicting medical standards, and non-existent protocols that have resulted in hospitalizations and even deaths when used during meetings with the police. Within five minutes, according to a federal lawsuit from McClain’s family, he stopped breathing. He died six days later after being declared brain dead and removed from the intensive care system.
The grand jury indictment led to charges against the paramedics for assault, “in addition to the counts of reckless bodily harm with a deadly weapon – the sedative ketamine,” NPR reported, adding : “In addition, paramedics face assault counts related to ‘intentionally causing stupor, unconsciousness or other physical or mental impairment or injury’ by administering ketamine to McClain without his consent, for a purpose other than legal medical treatment. “
The independent, nonprofit Marshall Project on Criminal Justice reported on excited delirium:
âSyndromes with similar characteristics but different names have appeared in scientific papers since the 1850s, according to the limited research available. Excited delirium did not become a common diagnosis until the 1980s, with the increase in cocaine use. Some supporters of its use as a diagnosis say it is a syndrome that first responders should be trained to recognize because it can cause people to die suddenly, leaving police wrongly charged with excessive force. But here is where the problem becomes even more problematic … When authorities call in medical first responders, aka paramedics, should they administer potent drugs in contexts that are often harassed, emotionally charged and in which they may be lacking? time or expertise to make a difficult and comprehensive assessment of an individual’s health?
NBC News noted earlier:
“In Colorado, emergency medical service providers are licensed to use ketamine for pain management and to treat a syndrome known as ‘excited delirium’, but they must first obtain a waiver of the drug. state health department. It’s not uncommon for doctors to use ketamine outside of hospitals to treat patients who appear restless and may injure themselves or others, depending on the condition. Statewide, 427 people received ketamine for agitation from August 2017 to July 2018, and about 20% of patients required intubation in a hospital, the Denver Post reported.
These numbers may seem high. They may reflect not only weak or poor health treatment choices by medically trained personnel, but also the enormous pressures currently placed on them. These have only increased dramatically due to the coronavirus pandemic.
Emergency medical intervention isn’t like it used to be
Medical first responders have undergone big changes in recent times, as reported by ProPublica, the Pulitzer Prize-winning survey site. Of course, in many areas, taxpayers have footed the bills for the rising costs of emergency care, paying sometimes high salaries for highly trained paramedics in the police or fire department. Governments, such as the District of Columbia, have also struggled with misuse and abuse of this costly emergency response, including 911 callers asking for help with minor issues such as rashes. , cough or a twisted ankle.
For many jurisdictions, however, a much different financial response has emerged – the privatization of emergency medical response, as ProPublica has seen in parts of sprawling Los Angeles County and elsewhere:
âIn Los Angeles County, like many parts of the United States, there are for-profit companies operating the ambulance system. The contract for the northern part of LA is held by American Medical Response, the largest ambulance company in the country. Along with paramedics from the fire department, paramedics employed by American Medical Response handle all emergency medical calls in this “exclusive operating zone”, an area of ââapproximately 1,500 square miles that includes the towns of Palmdale and Lancaster, a handful of quarries and aerospace factories; and swathes of the Mojave Desert. Spending as little as possible is crucial for all parties involved. The government, which pays for the majority of ambulance trips in many parts of the country, wants to save money. And AMR, of course, does more if it cuts costsâ¦ Los Angeles County requires ambulances to reach patients within 8 minutes and 59 seconds. To meet this deadline while maintaining profit margins, private companies deploy a slim fleet of ambulances, pay low wages (private sector paramedics in California earn 39% less than their public sector counterparts), and strategically rearrange staff. vehicles under their command. AMR’s software suggests that vehicles âpostâ near the busiest areas so that they are more likely to encounter transportation opportunities. On busy days, dispatchers maneuver crews like chess pieces. “
The pandemic has pushed already lean private services to the brink, overwhelming their already restless health worker workforce with overwhelming stress, especially to cope with huge workloads and limited resources, including medical supplies. Even seasoned first responders have struggled to cope with so many people in such a desperate state and trying to do so with such urgency, ProPublica reported.
Here is what added to the disheartening but essential toil: Emergency medical services salaries, in a private operation, ranged from $ 15.88 to $ 17.89 an hour – far less than the government wage that qualified personnel could reduce and could extend up to six annual figures. wages. Health workers in private companies also know that their companies are themselves multibillion-dollar subsidiaries owned by hedge funds worth hundreds of billions.
Patients also take a hit with emergency care and transportation
By the way, patients and their loved ones were terribly affected if they required emergency medical attention. The treatment and ground transportation they received have too often resulted in âsurprise medical bills,â large and unexpected costs that insurers have refused to cover.
As Congress crafted its own surprise ban on most surprise medical bills in late 2020 – holding patients hostage in what had been a brutal battle between medical providers and insurers – lawmakers did not tackle services ambulance. This is because they are so fragmented nationwide, with neighbors in a community able to benefit from free or low-cost municipal service, while a few blocks away private companies are charging. very expensive patients.
Policymakers have heard a lot about the confusion and skyrocketing costs in this area, including the worrying increase in the number of patients using carpooling services to get to urgently needed medical services.
Not good. In my practice, I see not only the main harms patients suffer when seeking medical services, but also their enormous difficulties in accessing and affording safe, effective and excellent medical care. It has become an ordeal due to the increasing complexity, uncertainty and costs of treatments and prescription drugs, too many of which turn out to be dangerous drugs.
We have a lot of work to do at many different levels to make sure that ordinary people can have 100% confidence that when they need emergency interventions – be it law enforcement or healthcare. medical and transportation – they will be there for them, at a reasonable cost and with excellent benefits. Most of the people who serve as first responders do so with admirable energy, commitment, and ability.
We must eliminate those who do not. This is true in emergency medical care and law enforcement, including when they unfairly and overzealously target people of color and underserved communities. At the same time, we cannot accept the destructive and extremist assaults such as that which occurred on January 6 in the national capital against the democratic rule of law and law enforcement officials acting responsibly in the exercise of their functions, in particular in the protection of human life and precious goods. . The past few months have shown us how confrontational and difficult it will be to ensure that all people are treated fairly and fairly in difficult circumstances. Doing so is an essential part of who we are as Americans.