Peter Cichuniec on Friday was sentenced to five years in prison. But Cichuniec was not the officer who first physically accosted McClain within 10 seconds of exiting a patrol car, despite that no crime had been reported and that McClain had no weapon.... Nor was Cichuniec one of the two officers who joined Woodyard shortly thereafter, helping him forcibly subdue and arrest McClain, notwithstanding the fact that they had not met the constitutionally required standard to do so....Cichuniec, who didn't arrive until about 11 minutes later, was the lead paramedic, ultimately administering too large a dose of a sedative after miscalculating McClain's size and hearing from police that McClain was allegedly experiencing "excited delirium".... while it remains unclear what exactly caused McClain to go into cardiac arrest, an amended autopsy attributes McClain's death to "complications of ketamine administration following forcible restraint."
So, we can't say for sure that his action caused the death; the action was at most an error; the error was brought on by poor information given him by responding officers; and those officers had also assaulted the victim.
I realize that being able to administer drugs is a significant responsibility, but this seems to me like an extraordinary injustice. Paramedics work extremely hard to receive a credential that merely allows them to work harder than nurses in worse conditions for less money. They are a crucial link the chain of emergency medicine, the difference between basic and advanced life support while you are being transported to a hospital.
We should not be sending them to prison for mistakes, which is not to say that there shouldn't be accountability for mistakes. Accountability need not entail sending a paramedic to prison for having screwed up a dosage because he was given bad information at a chaotic scene.
The Reason article notes that the police received far less accountability for their actions, which has been a hot button for some years now. I'll leave the police issue to the side. This isn't how a decent society should treat a paramedic even if he made a deadly error.
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Although I am inclined to side with the paramedics here, I am very interested to know more details. I know journalists regularly get things wrong, but in trying to find out more I ran across this from CBS News. After being giving ketamine:
"He went into cardiac arrest in an ambulance a few minutes later and died three days after that. ...
"[Jason Slothouber, one of the prosecutors,] said Cichuniec knew he gave Elijah McClain too much ketamine and was the senior-most medical professional at the scene the night McClain was taken to the hospital. ...
"In 2018, Colorado state regulators had approved the drug for someone who was in an "agitated state" and showing signs of "excited delirium." The defense for both men argued that was the case -- that they were following their training by giving ketamine to McClain because he was showing an unusual amount of strength as he was being restrained and was acting in a strange way, they said."
https://www.cbsnews.com/colorado/news/aurora-colorado-paramedic-peter-cichuniec-sentenced-elijah-mcclain/
Colorado Public Radio (CPR) adds:
"Cichuniec had never forcibly administered ketamine before he decided to knowingly give an unarmed 23-year-old Black massage therapist, who had just violently struggled with police and was nearly catatonic, an overdose of the sedative.
"In December 2023, an Adams County jury convicted Cichuniec, 51, of criminally negligent homicide and second-degree assault with the unlawful distribution of drugs for his role in McClain’s death. A forensic pathologist for Adams County said that if it wasn’t for that big dose of ketamine for McClain’s 143-pound body weight, he would have lived."
https://www.cpr.org/2024/03/01/aurora-paramedic-peter-cichuniec-sentencing-prison-elijah-mcclain-death/
So, the prosecutors are saying he knowingly gave an overdose. That makes me curious how they argued that before the jury. Was the medic's weight estimate HUGELY out of line? Or is a weight estimate even needed? I need to know more about ketamine.
Also, this happened in 2019, so it's no surprise that the paramedics had never given ketamine for excited delirium before; Colorado only approved it for that in 2018. After legal approval, each service's medical director has to evaluate the drug and, if he/she wants to authorize it, write the protocols for EMS and then implement training for paramedics. All that takes time, so ketamine was new for everyone. That makes me lean a little more toward honest mistake.
Also, if the patient was nearly catatonic, how could he be dangerous to others and require forceful administration of ketamine? That bit doesn't seem to make immediate sense. Bad journalism?
Firehouse adds:
"Prosecutor Shannon Stevenson criticized the paramedics for never asking McClain any questions, never touching him before they injected the ketamine and for failing to monitor his breathing after the men injected McClain with the maximum dose of ketamine, a dose much larger than it should have been. She also took aim at the paramedics’ prior testimony in the trial; both took the stand in their own defenses."
https://www.firehouse.com/careers-education/news/53081231/aurora-co-paramedics-found-guilty-of-criminally-negligent-homicide-in-patients-death
This gives us a somewhat clearer picture of what happened (maybe - it's journalism). Now I need to know more about ketamine. I'll come back.
According to this EMS1 article, weight estimates are needed. For this use, it seems 2-4 mg / kg is the dosage, so a weight estimate is needed. Of course, the paramedics will follow whatever protocol their medical director put in place, but that gives us an idea.
https://www.ems1.com/pharmacology/articles/understanding-prehospital-ketamine-dosing-to-drawbacks-4Gkj3ly6gBunzeHX/
This is a hard situation for Cichuniec. Presumably, officers were holding Elijah McClain down, and also McClain was probably still struggling. You can't just ask the cops to let him go and stand back so you can conduct an independent assessment; that can get you hurt when the patient flies up and attacks you. So, Cichuniec has to take the cops' word for this, and guestimate McClain's weight from what he can see. (If he'd been able to lift McClain first to put him in the ambulance, he'd have more to go on for weight estimation.) What's more, ketamine was just newly approved for excited delirium in Colorado, so this is his first time using it.
Ketamine for excited delirium is given via intramuscular injection, so Cichuniec does the math, decides the dose, and gives it probably in the shoulder or leg. What I've read leads me to believe a minute later McClain was probably calm. So they load him into the ambulance and head to the ER. Minutes later, McClain goes into cardiac arrest.
So, it seems like the medics DID monitor their patient. How would we know he went into cardiac arrest a few minutes after ketamine administration unless the medics were monitoring him? And he survived for 3 days, and the prosecutor didn't make a fuss about it, so I'm guessing the medics treated the cardiac arrest appropriately.
Yeah, this looks like a conviction for one questionable decision in a difficult situation.
Of course, I'm basing this on quick research and journalism, so there are likely things we don't know here.
Don't like the sound of this at all.
The CPR article I linked above has some other interesting things in it. Quoting:
The Cichuniec and Cooper convictions are a rare example of paramedics being charged in the death of a patient — there is not a case like this anywhere in the U.S.
Aurora Fire Rescue said the criminal prosecutions had a chilling effect on the inside. Out of 236 firefighters and medics, 25 have submitted paperwork to not be medics anymore on the job since the convictions of their colleagues.
During the December trial, Cichuniec said he knew he was giving McClain too much ketamine at the time but he was worried about “underdosing” him.
Hours of police body-worn camera tape never showed Cichuniec and Cooper, the two ranking medical professionals on the scene, checking McClain’s vital signs or making sure he was OK, even though he was in obvious medical distress.
Judge Warner addressed this on Friday.
“Should there have been a better medical assessment?” he said. “Yes.”
Speaking in his own defense during the trial, Cichuniec told the jury that McClain was exhibiting signs of “excited delirium” which has since been struck from all law enforcement training documents in Colorado and has been called a false diagnosis by medical professionals.
Body camera footage of McClain’s interactions never showed any signs of “superhuman strength” or unnatural combative behavior. But Cichuniec doubled down during the trial.
“In this case with excited delirium, it could kill you. And if we don’t work fast, he could die,” he said to the jury. “And I don’t want to under-medicate someone.”
After McClain’s death, the state legislature greatly restricted the use of ketamine outside of hospital settings and prohibited law enforcement on a scene from influencing EMTs or paramedics from giving ketamine. Hours of body-worn camera footage show officers talking about ketamine and McClain’s behavior.
On Friday, Dr. Eric Hill, the medical director of Aurora Fire Rescue, spoke to the judge before the sentencing taking some responsibility for Cichuniec’s actions that night.
“The fire department-sanctioned training was problematic,” Hill acknowledged.
He said two different trainings were at odds with each other and the communication to all paramedics for ketamine administration was not entirely clear.
“It was confusing,” he said. “And Pete had only one chance to get it right.”
...“excited delirium” which has since been struck from all law enforcement training documents in Colorado and has been called a false diagnosis by medical professionals.
OK, but that's akin to prosecuting someone for doing something that was legal when they did it, but that became illegal later. Except that it's worse than that, because they're prosecuting him for doing what the rulebook indicated to do when he did it, rather than what the rulebook merely permitted.
So, it seems Cichuniec admitted he knew he was giving too much ketamine at the time. Of course, I'd like to know his actual words instead of CPR's paraphrase of them.
But also the medical director went on the record saying the training Cichuniec received was confusing.
The facts that the state legislature later restricted ketamine use for EMS and that law enforcement later took excited delirium out of their training documents should not be relevant for this case.
The CBS reporting says McClain went into cardiac arrest a few minutes after being given ketamine, and he was in the ambulance when that happened. So, I assume they gave the ketamine, the patient calmed down, and they pretty quickly moved him to the ambulance. However, the CPR reporting talks about hours of police body-cam video. Presumably, if you had 4 cops on the scene, every 15 minutes would be an hour of video to review. Also, some of that would have been before the medics showed up and probably some of it after they left.
Then, on camera, they say McClain didn't show "superhuman strength" or "unnatural combativeness," but I'm not sure what that would look like on camera. When I was working (way back when), two or three big guys could hold anyone down. Being held down, someone could be very combative and strong, but not look like it. When you've got a big guy on each shoulder and one on the legs, you aren't going to move much even if you're struggling mightily. I've never seen this on video, so I'm not sure how to evaluate that claim.
But when the writer says Cichuniec "doubled down," notice that Cichuniec was only talking about the danger to the patient himself from being in a state of excited delirium, not that the patient was combative or super strong. I don't see that as doubling down.
Also, later, "medical professionals" started saying excited delirium isn't a real thing, but that's irrelevant to the case. Cichuniec based his decisions on his training, which treated excited delirium as a real thing. That's what paramedics have to do. If your medical director (a doctor and medical professional) has laid down protocols for it, you can't just decide on your own that X is not a real thing so you're not going to treat it. That would be negligence and get you fired, at least. No medical director wants a paramedic going rogue; medics work under their medical director's license and the medical director has some legal liability here as well.
I should add that I haven't worked as a paramedic in more than 20 years, so I am way out of date on my knowledge of all this, but that's my quick assessment, for what it's worth.
Yes, Grim, you're right. I was still writing my comment when you posted and didn't see it.
Thinking about this over the last couple of days, the idea that this medic actually said he knew he was giving too much ketamine at the time rings false to me. I have a very hard time imagining a medic saying, "Yeah, I knew I was overdosing him, but ..." I suspect CPR is playing fast and loose with the facts in the trial. That's must my sense of it, though.
Also, when I said that the fact that the state, law enforcement, and medical authorities had revamped their policies on ketamine and ExDS was irrelevant, I was wrong. Those changes would seem to indicate a recognition that the protocols Cichuniec was required to follow were bad, which should add more weight to his innocence. If the protocols were bad, then the resulting death of McClain is more likely the fault of the protocols.
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