Amid growing attention to the use of deadly force by police, the danger of using forced sedation to restrain people in police custody has largely gone unrecognized.
Associated Press journalists Ryan Foley, a reporter based in Iowa City, Iowa, and medical writer Carla Johnson, along with AP video journalist Shelby Lum, broke ground by documenting how the practice of giving sedatives to people detained by police has proliferated in the last 15 years.
Their work was part of the “Lethal Restraint” project led by AP in collaboration with PBS’s “Frontline” and the Howard Centers for Investigative Journalism. The project found that, over a decade, more than 1,000 people died after police subdued them with physical holds, stun guns, body blows and other means that are not supposed to be lethal.
At least 94 people — nearly 10% — had been given sedatives. In some cases, the team reported, police requested or suggested that paramedics administer a sedative, “calling into question whether medics were working for law enforcement or in patients’ interests.”
Journalists can read the team’s methodology and takeaways about chemical restraint and watch a Frontline documentary.
Foley and Johnson shared some of their insights from the project. Their comments have been edited.
What was the genesis of this project?
Foley: After the death of George Floyd in 2020, The Associated Press realized that nobody was tracking how often similar cases have occurred and decided to try to answer that question. As we started researching these cases, we decided to also track how often chemical sedation was used. The death of Elijah McClain had raised awareness about EMS use of powerful sedatives during arrests, and we were surprised when we started seeing it show up in more cases than had previously been reported.
What was your role in the reporting?
Foley: As I worked with AP’s team to gather primary source documentation on hundreds of deaths, I saw that in a fair percentage the person had suffered cardiac or respiratory arrest within several minutes of being injected with a sedative. This angle had previously been largely unexplored by both the media and research communities.
Johnson: I’ve written about health care for many years, so my role involved reading the medical literature, interviewing doctors and paramedics, reviewing protocols and getting a handle on how the nation’s EMS system works.
Your team found that police narratives such as news releases and even autopsies often don’t disclose the use of a sedative when a person dies in police custody. How did the AP find and document these cases?
Foley: We filed thousands of FOIA requests for police and prosecutor reports, autopsy reports, toxicology reports and body-cam footage. We uploaded this trove of records into DocumentCloud, read them and searched them for keywords. Ultimately, the autopsy and police reports, EMS records and statements collected by police investigators, and the videos helped us unearth many of these previously unreported sedation cases.
Did your reporting provide insights on why some paramedics were willing to defy medical guidelines at the request of police?
Johnson: Police and paramedics must work together in dangerous and chaotic situations, so the lines get blurred. Paramedics need to get information from police if officers are the first to arrive at the scene, but paramedics are supposed to have the final say on patient safety. Paramedics are supposed to follow the protocols of their local EMS agencies. Often, these protocols, which specify using sedatives when a patient is violent, use the term “excited delirium,” which has been disavowed by medical groups in recent years. Leaders in the EMS field are beginning to call for more training on the risks of sedation and clearer lines between officers and paramedics. Some are reconsidering “excited delirium.”
Foley: We found that police can taint the EMS response simply by suggesting the use of chemical sedation. Whether or not the injection was ultimately justified, there’s an appearance of influence when an officer is seen on video telling a medic to give someone a shot to calm them down while they are in handcuffs. In rare cases, we saw paramedics asking officers whether they should sedate someone.
We also found several instances where people obviously did not meet the medical guidelines for sedation at the time of injections, which generally say the person must be an immediate danger to themselves or others. In some cases, they were already calm or even passed out or unresponsive.
Are there sources that you found especially helpful?
Johnson: The National Association of State EMS Officials has a model protocol, which recommends close monitoring after sedation and warns against transporting a patient facedown.
Foley: We talked to some doctors and paramedics early on who had been closely following what can go wrong during these incidents, and they gave us a good idea of things to look for. Could the situation have been de-escalated? Did the patient have another drug or substance in their system that could react poorly when mixed with a sedative? Was the dosing potentially problematic?
What questions should journalists ask when someone dies during a police encounter? Are there red flags that a chemical sedative might have been involved?
Foley: When you see a police press release about a death that may involve the use of a Taser or physical restraint, it might mention that paramedics provided unspecified treatment before the person became unresponsive. That’s a red flag to ask whether the treatment was chemical sedation. Police departments are not covered by HIPAA, so ask for details. And file a FOIA request for the autopsy report when it’s available.
What angles of this story still need to be explored?
Foley: The recent sentences of incarceration given to the two paramedics responsible for injecting Elijah McClain with ketamine were unprecedented. How do they impact the EMS field? With a growing awareness about the risks of chemical sedation, especially when mixed with prone restraint, what steps do state and local policymakers take in response?
Anything else that you think is important to mention?
Foley: An important finding is that the potential risks of chemical sedation go beyond any one drug. Ketamine got most of the attention before our project, but we found that midazolam (brand name Versed) was given in about half of the deaths. And several other drugs, each with their own side effects, were administered in these incidents.
Johnson: Paramedics told us it’s crucial to have monitoring equipment on a sedated patient to be able to quickly respond to problems. If you want to gain a paramedic’s respect, ask about capnography monitoring, which measures carbon dioxide in exhaled breath.
