TUCSON — The family of David Cutler, 23, believes he would still be alive today if first responders gave him water and shade instead of handcuffs and ketamine, which is a powerful sedative and painkiller.
Ketamine has become a controversial sedative, which can be used as a chemical restraint for someone experiencing “excited delirium,” and it is tied to several police in-custody deaths across the nation.
DISCOVERED IN THE DESERT
In June 2017, David was in Tucson to visit his brother. The 23-year-old was discovered wandering in the desert after a jeep crash.
Pima County Sheriff’s deputies detained David on a hilltop. They were unable to get him off the hill, so a Rural/Metro paramedic arrived and injected the young man with Ketamine to subdue him.
David died a short time later.
“David is locked in time,” said his dad, Robert Cutler. “We can only imagine what he'd be like, and that has been taken from us.”
David partied the night before, and relatives and authorities say he had taken LSD. Its effects were unclear on the morning of June 5. Robert said his son woke up that day, took pictures of Tucson, then he drove across the city to go off-roading in a desert area.
David hit a tree, and the Jeep burst into flames. First responders put out the fire, but David was missing for two more hours.
A nearby resident spotted him on a hilltop and called 911.
It was midday and approximately 98 degrees outside when Pima County Sheriff's Deputy Keith Barnes responded.
“He said [David] was hot - red as a firebox,” said Robert.
There is no body cam footage because Pima County deputies don’t wear cameras. However, one deputy took cellphone video after David was handcuffed and his feet were restrained.
Deputy Barnes had called for the Rural/Metro Fire Department to send paramedics, saying “maybe they can give him something,” according to court records.
“He’s still delusional and combative with us,” one deputy said on the video, “We still need some assistance up here.”
“He mislabeled [David] ‘combative’ continually,” Robert said.
David's dad believes he was dehydrated, suffered from heat exhaustion, and may have sustained a head injury from the jeep crash.
KETAMINE USES, SIDE EFFECTS
The Arizona Department of Health Services allows paramedics to inject ketamine to patients exhibiting agitated, violent, or uncooperative behavior or are a danger to self or others, according to ADHS’s Triage, Treatment, and Transport Guidelines updated in 2019.
The guidelines caution not to use ketamine on people with head trauma, low blood sugar, or similar health conditions. There is also a warning about respiratory distress or compromise.
The medical examiner ruled David died of hyperthermia, overheating. His body temperature was measured at 102.9 degrees. The medical examiner indicated the LSD in David’s system contributed to his death, but he did not list ketamine as a factor.
Current Arizona guidelines also say the maximum initial dose of ketamine is 250 milligrams. Back in 2017, David Cutler was given approximately 300 milligrams, according to the Rural/Metro paramedic’s court filings, which also said he followed the “protocol” for “excited delirium.”
ADHS guidelines recommend paramedics injecting ketamine should hook the patient to a cardiac monitor as soon as possible and use an electronic breathing monitor, known as a EtCO2, if possible.
Phoenix Fire Capt. Rob McDade, who is also a paramedic, defends the use of ketamine for people exhibiting delirium due to drug use or behavioral health crisis.
“We've given it tens of thousands of times,” McDade said, “without having anybody have a cardiac arrest, or go into respiratory arrest.”
McDade said police do not influence Phoenix paramedics on when to inject the drug, and two paramedics always confer about ketamine use and the appropriate dosing.
“They feel this is the safest, most effective route, to get somebody into a position where they can't harm themselves,” McDade said. “We don't just find somebody and then power it all into them.”
McDade said paramedics also make sure they are protecting the patient’s airway and monitoring vital signs.
COLORADO'S KETAMINE LAW
Across the country, other young men in police custody have died shortly after receiving ketamine. The most notable case is Elijah McClain from Aurora, Colorado.
In 2019, McClain, 23, was walking home when Aurora officers stopped him. McClain struggled with the officers. He was put in a carotid neck hold and was handcuffed.
When the ambulance arrived, a paramedic gave a shot with 500 milligrams of ketamine, which was more than the maximum dose recommended for Elijah’s 140-pound body.
Elijah became unresponsive and died three days later. The coroner listed his cause of death as “undetermined” but could not rule out ketamine.
“Arresting someone and using ketamine should not be something that is seen as gentle or easy," said Colorado state Rep. Leslie Herod. “It is a violent and dangerous drug, and it is killing people.”
Herod, a Denver Democrat, sponsored state legislation this year to ensure ketamine and other chemical restraints are only allowed in emergency situations when medics can monitor the vital signs and weigh the individual to ensure accurate dosage.
The bill also prohibits peace officers from using, or influencing the use, of a chemical restraint. There are civil and criminal consequences.
“There are other ways to subdue someone," Herod said. "Quite frankly, in a lot of these cases, there was no resisting arrest. There was no need to subdue.”
Colorado's governor signed the bill into law last month.
“In my opinion, it's not acceptable for law enforcement to administer, EMS personnel be administering ketamine to subdue a person under arrest outside a hospital setting,” Rep. Neguse told Denver’s KMGH in June.
QUALIFIED IMMUNITY IN ARIZONA CASE
In their lawsuit, the Cutlers claimed the deputy failed to provide common sense first aid, like water, to someone in his custody. They also claimed the paramedic was negligent in administering ketamine without due consideration of David's medical condition.
“It's an issue with the police and the EMT - disregard for the people you're supposed to help,” Robert said. He supports Colorado’s law that restricts ketamine use and thinks Arizona should consider similar legislation.
Late last month a federal judge tossed out the case against Pima County and the sheriff's deputy saying his actions were protected by qualified immunity.
PCSD also told ABC15 in a statement, “We do not have a chemical restraint policy as we do not administer chemical restraint medication. We also do not direct or advise medical personnel in the use of medication.”
The lawsuit continues against the paramedic. There’s a hearing next month. A Rural/Metro spokesman said they could not comment due to the pending case.
That department continues to supply its paramedic kits with ketamine.