Elijah McClain Case: Use of Ketamine Sedation and ‘Excited Delirium’

Photo Source: Stefano Bianchetti/Corbis

In 2019, Elijah McClain, a 23-year-old African American man, was forcibly restrained by police in Aurora, Colorado. While restrained, McClain was injected with a fatal dose of ketamine by paramedics. The prosecutors argued the injection was unlawfully administered. 

The Office Of The Coroner confirmed the ketamine injection, used to sedate McClain,  was the cause of his death. The decision to sedate McClain was an on-the-scene diagnosis of “excited delirium,” a controversial diagnosis used in describing police encounters. Major medical organizations have since rejected it as a legitimate diagnosis.

According to the Justice Department’s description of ketamine, it has been associated with serious problems—both mental and physical. Ketamine can cause depression, delirium, amnesia, impaired motor function, high blood pressure, and potentially fatal respiratory problems in its use to incapacitate.

A 2021 independent review panel led by Jonathan Smith, civil rights attorney and former head of special litigation for the DOJ Civil Rights Division, Dr. Melissa Costello who served as the medical and emergency medicine expert, evaluating the actions of first responders and the administration of the sedative ketamine, and Roberto Villaseñor, a law enforcement and police practices expert, found McClain suffered cardiac arrest shortly after receiving ketamine. Although he was resuscitated, he was declared brain dead days later.

When paramedics Peter Cichuniec and Jeremy Cooper from Aurora Fire Rescue arrived, McClain was handcuffed and on the ground. The panel found personnel did not meaningfully assess McClain before administering ketamine and that there was no clear transfer of care from police to EMS.

The panel also found paramedic Cooper diagnosed McClain with “excited delirium” largely based on officers’ descriptions rather than an independent evaluation. It also noted McClain had not moved or made sounds for about a minute before the injection.

According to CBS News, the trial of Cooper and Cichuniec focused on their decision to administer ketamine and the 500-milligram dose. Cichuniec testified, “In this case, with excited delirium, it could kill you. If we don’t work fast, he could die… Time is of the essence, I went off training and went up to 500 (milligrams).”

The autopsy report concluded that the 500 mg ketamine dose injected into Elijah McClain was an overdose that caused fatal ketamine toxicity, according to Colorado Public Radio and NBC News.

CBS News reported that “excited delirium” is not recognized as a legitimate medical diagnosis by most major medical organizations. It is not included in the standard psychiatric diagnostic manual, has no diagnostic code, and cannot be confirmed through blood tests or medical examinations.

In 2023, the National Association of Medical Examiners rejected excited delirium as a cause of death, and the American College of Emergency Physicians, ACEP, withdrew its 2009 white paper supporting the diagnosis. Critics argued the theory lacked scientific evidence and was often used to attribute deaths in police custody to medical conditions rather than force, including tasers, chokeholds, or restraints.

The withdrawn ACEP paper described people with excited delirium as possessing “superhuman strength,” being impervious to pain, behaving aggressively, and making guttural sounds. Critics argued these descriptions reflected long-standing racial stereotypes about Brown men.

A Virginia Law Review article found that at least 56% of police custody deaths attributed to excited delirium between 2010 and 2020 involved African and Latino victims, with most occurring during physical restraint. 

The Associated Press, AP, identified excited delirium as a disputed diagnosis that contributed to increased sedation outside hospitals. It found sedative use was not reported in about half of examined cases and identified a pattern in which restrained people struggled to breathe while paramedics administered sedatives that further slowed breathing, sometimes followed by cardiac or respiratory arrest.

In April 2024, Colorado Governor Jared Polis signed HB24-1103 into law, making Colorado the second state after California to prohibit law enforcement, first responders, and coroners from using the term “excited delirium,” according to PHR.org.

The law prohibits first responder training from including excited delirium except when discussing its history in EMS training. Officers may not use the term in reports, and coroners may not list it as a cause of death on death certificates.

The Colorado Court of Appeals overturned the criminally negligent homicide convictions of Aurora Fire Rescue paramedics Peter Cichuniec and Jeremy Cooper on June 4, 2026. Both had originally been found guilty by a jury in December 2023 in connection with the 2019 death of Elijah McClain.

Adeelah Ahmad