When Medicine Serves the Police: A Cautionary Tale from Burning Man

Last year a woman went into respiratory failure when a medic shot her with ketamine to help cops subdue her.

The Burning Man festival, that week long experiment in temporary art-centered community in Nevada's difficult Black Rock desert, is in full swing as of yesterday. (And my book about the event's history and culture, in a conveniently updated 10th anniversary e-book edition, is for sale for $4.99 for your Kindle.)

Reason

A series of documents made public recently document a grim incident from the event last year that spotlights the crummy things that can happen when medical care is mixed with law enforcement.

In a letter in my possession sent in May by the state's Division of Public and Behavioral Health, a medic who worked the event last year was put on warning for, as the letter stated, administering ketamine (a powerful tranquilizer that is also sometimes used recreationally) unasked for to a Burning Man attendee "as necessary for the overall safety of law enforcement officials who were in contact with the attendee." (The state later rescinded the warning, on the stated grounds that their investigation had happened too late after the actual event being investigated, though the letter rescinding the warning said nothing to suggest the event she was originally warned for had not happened.)

In a letter sent earlier this month from Harley Dubois, a member of Burning Man's board of directors, to Mel Hummel, president of the board of trustees of Humboldt General Hospital who supplied the medic in question, she noted the woman shot with the ketamine was 110 pounds, had been drinking alcohol, and as a result of the ketamine injection the woman "went into respiratory failure—twice—and nearly died."

The Reno Gazette-Journal reported on the incident in the context of wranglings between Burning Man, Humboldt General Hospital, and law enforcement last week over how to set and obey protocols for medical issues at Burning Man moving forward. The medic injected the ketamine "while serving as a special reserve deputy under Pershing County Sheriff's Office, according to contracts with the Pershing County Sheriff's Office," reported the Gazette-Journal.

Like ketamine and alcohol, medical care and police work can be a very dangerous combination. See my previous reporting on hospitals who decide to conduct unasked for anal probes to help cops search for drugs, and then bill the unwilling "patient"/victim.

My 2000 Reason cover story on the event's fractious relationship with government authorities. My reporting from last year on the fruitless and aggravating practice of the Bureau of Land Management law enforcement running mail sent to Burning Man by drug dogs.

Comments

[Citizen X]

I hope waffles has been building up a tolerance for Special K this year.

[Libertarian]

"(The state later rescinded the warning, on the stated grounds that their investigation had happened too late after the actual event being investigated, though the letter rescinding the warning said nothing to suggest the event she was originally warned for had not happened.)"

In other words, the gov't can't even investigate a problem in a timely matter and can't issue a warning in a timely manner. But it's okay, it can handle our health care.

[All-Seeing Monocle]

The medic injected the ketamine "while serving as a special reserve deputy under Pershing County Sheriff's Office

What could go wrong?

[sarcasmic]

Did the officers go home safely? Because that is all that matters.

[Contrarian P]

Although rare, Ketamine can cause respiratory depression when given for agitation, but it's transient and easily managed. If the patient does stop breathing after Ketamine is given, the medic should just deliver oxygen via a bag-valve mask until they start breathing again. I'm not sure if the medic didn't have oxygen equipment available or what, but it sounds like there is a lot more to the story and I suspect that it may be a big bunch of nothing.

Ketamine by EMS almost always prevents harm rather than causes any. It has been extensively studied. If you have a psychotic person or someone who is so intoxicated they are a threat to others, ketamine is much safer than such alternatives as tasers, attempting to wrestle the patient down to place them in physical restraints, and so forth. The conflating of the use of a sedative with the forceful sodomy of a patient isn't the same thing at all. Come on, Doherty, you can do better.

The actual issue here is that the medic was working as a special deputy for law enforcement rather than as a medic. I'm confused as to why she had Ketamine with her or who authorized its administration if she was not operating under the command of the hospital (as stated in the article), as working under a physician is the only way a paramedic can practice. They are not independent providers, unless Nevada has some very unusual laws. I have never practiced there, so I can't say for sure.

[Broswater]

Ehhhh maybe I'm old fashion but I would still rather get a few bruises and maybe some broken bones / teeth than having something injected into my vein if I ever need to get restrained.

And do remember we don't know what the person was doing that was a ''safety concern'' for the officers involved. I'm pretty sure doormen deal with drunken and dangerous people every weekend, never heard of any of them needing to carry around Ketamine to feel safe.

[Contrarian P]

They don't inject it into your vein. It goes into a muscle group, generally the thigh. It's much safer for you and for the people dealing with you.

EMS and ER people deal with extremely violent and agitated individuals all the time. Most of the time, these people are intoxicated, but they can also have extremely serious problems like bleeding into the brain or low blood sugar. If your problem is a brain bleed, would you still like to get the crap beaten out of you while being wrestled to the ground, which could worsen the bleed to the point of killing you?

Also, if you're swinging at me, you don't get to vote on how I take you down.

I am well aware that we don't know the exact circumstances of the incident. I find it very bizarre that a medic was working as a law enforcement officer and the article doesn't say what specific threat the person was exhibiting. My point was that the article made it out like Ketamine is some sort of unusually dangerous drug when used for agitation by a medic. It isn't. It's used that way all the time.

[R C Dean]

I'm not sure if the medic didn't have oxygen equipment available or what, but it sounds like there is a lot more to the story and I suspect that it may be a big bunch of nothing.

Tranking people with ketamine to pacify them for law enforcement is a very big deal, full stop.

[R C Dean]

That medic committed aggravated assault, full stop. My policy for our providers is that they are health care providers, and should never do anything to a person that isn't either (a) consented to or (b) emergency health care treatment.

If somebody in my hospital had tranked a "patient"* for law enforcement, I would have their ass.

*Not really a patient, because they aren't getting treated for anything.

[Contrarian P]

We don't know the circumstances, RC, so it's not fair to say the medic tranked the person. All we know is that they were "resisting" and that they were intoxicated, which I'm sure was established after the fact.

If the police get called for a violent person, often they need medical help, not arrest. If that's what happened here, that the person was drunk and violent, it would have been perfectly reasonable for police to request medical assistance in subduing the person. If they were just being an asshole who didn't want to go to jail, then yes, that's completely inappropriate to use medicines to knock them out.

[Diane Reynolds (Paul.)]

Is the only option for dealing with a drunk and belligerent person to inject them with a substance? Surely there's some other method that can result in everyone (including the drunk and belligerent person) to go home safely?

[Contrarian P]

No, there are plenty of options. You start with the least aggressive, talking to the person, and then go from there. But if the person starts swinging at you, a sedative is frequently the safest way to subdue them until you can get them restrained. It's much safer than a Taser or entering into combat with them.

[Diane Reynolds (Paul.)]

How do you inject someone with a sedative when you don't have control of them?

If I can inject you with a sedative, I'm guessing I've got you down. Or are they literally pacing around in front of each other, the medic wielding a syringe like a Westside Story scene, and then *STRIKE* the Medic, with his cat-like reflexes lunges in like a leopard upon his prey, injecting the violent, out-of-control perpetrator before he can react?

I mean, I'm not really keen on the way policing is done in this country and yes, there's far too much unnecessary violence perpetrated by officers, but there are a lot of violent, belligerent people that cops seem to successfully restrain and take to the pokey without the use of a sedative injection.

[Contrarian P]

No, you have some help, generally three or four people, and grab the person just long enough to get the medicine in, then let them go until it takes effect. You don't have to get them to the ground. There's a big difference between that and getting the person to the ground and obtaining complete control over them, which exposes both you and them to the possibility of severe injury. The sedative has the great advantage of also keeping the person under control for some time, as opposed to physical restraints which can be broken or wiggled out of.

Yes, police are able to restrain people and get them to jail, but frequently the person doesn't need to go to jail, but to a hospital, which is a completely different environment. Also, if the person is not being charged criminally, the police will not be coming to the hospital with them, so if they go nuts again it's just the two guys in the back of the rig or the ED doctor, nurses, and techs who have to figure out what to do.

[Diane Reynolds (Paul.)]

No, you have some help, generally three or four people, and grab the person just long enough to get the medicine in, then let them go until it takes effect.

i know some people in law enforcement, and I worked in Medical for almost 30 years and have family members who work in the ER. I've never, EVER heard of this process where you tranq someone like a wild boar and stand back until they collapse.

[Contrarian P]

That's not how it works. When you give someone a dissociative agent they don't collapse. Ketamine works within 3-5 minutes. You wait until the person starts to calm and then guide them to your stretcher. It's not a tranquilizer the way you're thinking of it. If you've ever seen Haldol given, it's similar. You give the Haldol then sit back and wait for the antipsychotic effect.

[R C Dean]

But if the person starts swinging at you, a sedative is frequently the safest way to subdue them until you can get them restrained.

"Frequently"? What are you talking about? The use of sedatives to subdue people for arrest just doesn't happen, outside of, perhaps, a vanishingly rare emergency detention for mental health purposes. And I've seen a fair number of people who were ED'd for being a danger to self or others, and they never come in tranquilized. While they are detained and in a mental health facility, sure, they might be tranked, but that's done in the hospital, not on the street.

[Contrarian P]

Ketamine has been the subject of multiple RCTs for field use for agitated patients. It's a part of prehospital protocols in some areas. The military uses it in the field for pain management. There is a ton of literature on its use prehospital.

And again, we do not know if the person in this case was being subdued for arrest or not. We would need for information before making that claim.

Look, I'm as suspicious of law enforcement as anyone here, but in cases like this it's a really good idea to have more than a few paragraphs of information to go on. Remember Michael Brown? When the initial story broke, I, along with many posters here, was ready to crucify the officer. Then the facts came out. The witnesses were full of crap. The officer was justified in shooting. Let's not make wild accusations before all the facts are out.

[Contrarian P]

"more information", not "for information". Sorry.

[R C Dean]

We don't know the circumstances, RC, so it's not fair to say the medic tranked the person.

He injected a tranquilizer. Damn close enough.

If that's what happened here, that the person was drunk and violent, it would have been perfectly reasonable for police to request medical assistance in subduing the person.

No, its not. Health care providers do health care. Subduing a person is not health care. If they are being treated for something and are violent, they can be restrained as part of the larger treatment plan. But drugging someone solely to subdue them for law enforcement is not health care, and should not be done by a health care provider.

Here's the bind - this medic can't inject anyone with anything unless they are operating as a health care provider under the supervision of a physician. That's a license violation. Can a cop inject someone with a tranquilizer? Nope, because you have to have some kind of medical license to do that. There's a reason cops don't carry tranquilizer guns, you know.

Generally speaking, you can only use chemical restraints on someone for behavioral purposes if you have a court order or the person is being involuntarily committed under an emergency detention. There wasn't any of that here. This was illegal from any angle.

[Contrarian P]

We don't know that the person in this case was subdued solely for law enforcement. There's not enough information given. That's my point. The medic has not been criminally charged and even the letter of reprimand was rescinded, so let's not jump the gun here.

If I get a call from a medic who has been called to a scene for a severely agitated person who does not have capacity to refuse care and who appears to need medical attention, it is completely reasonable to order medication in the field to assist in transporting that person so that I can medically evaluate them. If that's what happened here, then you are completely off base in accusing the medic of assault.

And yes, I made the point upthread that I was confused under what authority the medic was operating.

[Diane Reynolds (Paul.)]

*Not really a patient, because they aren't getting treated for anything.

They're getting treated for bein' an asshole! That's a condition!

[Diane Reynolds (Paul.)]

The state later rescinded the warning, on the stated grounds that their investigation had happened too late after the actual event being investigated, though the letter rescinding the warning said nothing to suggest the event she was originally warned for had not happened.)

If the Union said it didn't happen, it didn't happen.