Minnesota Paramedic Speaks Out Against Police Use of Ketamine Injections

A former paramedic with the Emergency Medical Services in Woodbury, a suburb of St. Paul, Minnesota, has filed a whistleblower lawsuit claiming that police pressured him to administer ketamine, a fast-acting sedative, during an arrest. He claims that the incident is part of a larger trend among the region’s law enforcement. The paramedic, 32-year-old Joseph Baker, said that he hopes to take a stand against police using ketamine “to gain compliance.”

“It’s not an appropriate use of our jobs as paramedics,” he told The Intercept, in his first interview since the lawsuit was filed on August 17, in the District Court of Minnesota. In Woodbury, the police, EMS, and firefighters all collaborate as part of the city’s Public Safety Department.

The lawsuit also addresses several alleged instances of falsified EMS training credentials that Baker claims to have found among former colleagues in the department.

Baker said he felt pushed out of his job after refusing to administer ketamine in an incident in September 2019. Prior to that, he had to give ketamine injections on three other occasions as part of Woodbury EMS and recalled a trigger-happy mentality in the department around the drug.

“The dispatchers would say: Get your ketamine ready, bring your ketamine,” he said. His lawsuit claims that the “symbiotic relationship between EMS and police officers has created room for police officers to coerce paramedics like Plaintiff Baker to administer Ketamine on unwilling subjects.”

“If a ruling like this comes from Minnesota, establishing that it is unlawful for paramedics to be coerced to use sedatives, all cops will think twice about this.”

Baker’s is the first whistleblower complaint in the country to directly address ketamine-induced sedation in policing. There is not yet strong national data on ketamine use in police arrests, but it is a relatively recent phenomenon. In Minnesota’s Hennepin County — which includes Minneapolis and is adjacent to Washington County, which includes Woodbury — a civilian oversight board conducted a sweeping report on “Pre-Hospital Sedation” in 2018 and found that ketamine use by the Minneapolis Police Department had sharply increased in just a few years. Before 2015, there were an average of about four mentions of ketamine per year in police reports of detainees, but in 2017, there were 62. (Minneapolis’s Deputy Police Chief Art Knight told The Intercept that since the report came out, police leadership had been informally recommending all officers in the force not to request sedatives from paramedics, though he was not sure how strict officers’ compliance has been since then.) The most high-profile ketamine-related incident to date is the death of Elijah McClain, a 23-year-old Black massage therapist, in Colorado last year. Officers placed him in a chokehold during his arrest and then injected him with a very large dose of ketamine, which rapidly led him into cardiac arrest. He died a few days later in a hospital.

Kenneth Udoibok, a Minneapolis-based lawyer who specializes in police brutality and is representing Baker, said his case could set a precedent in conceptualizing ketamine-induced sedation as a kind of excessive force. Usually, Udoibok said, “the actual victims of ketamine injections cannot make a strong case.” Police officers outsource the injections to paramedics, and paramedics can plausibly claim that arrestees were being “belligerent” or that they presented “safety concerns,” he explained. “What’s different now is that someone on the other side has come forward.”

“There are so many instances across the country now of police officers pressuring paramedics to administer ketamine,” said Udoibok. “If a ruling like this comes from Minnesota, establishing that it is unlawful for paramedics to be coerced to use sedatives, all cops will think twice about this.”

Joseph Baker at the Woodbury Public Safety building on July 2019.

Baker resigned from his post at Woodbury EMS in December, after about 18 months on the job. He now lives in the suburb of Inver Grove Heights with his wife and daughter and works as a paramedic for a private health services company in Minneapolis. He grew up in Maryland and became a volunteer emergency medicine technician when he was 16, he said, speaking from his home via Zoom. Baker served in the military as a police officer from 2007 to 2012, including a deployment in Baghdad from 2009 to 2010. After the military, he went back to school for emergency medical care.

Coincidentally, one of the assignments he completed for his bachelor’s degree from Eastern Kentucky University last year was writing up a protocol for “Continuous Communication and De-escalation during Behavioral Emergencies.” Thus, Baker has been somewhat unusually focused on deescalation as a way to deal with detained people and patients, which he said put him in conflict with the workplace culture of the Woodbury EMS and the Woodbury police.

“As a military police officer, they referred to deescalation as ‘verbal judo,’” he said. “It sounds cliché, but my ability to communicate is my most powerful weapon. I can convince people to communicate about 90 percent of the time.” He said he tries to humanize himself to excitable patients by talking about his family or bringing up light topics like sports. “I was also aware that my uniform was very similar to that of a police officer, which is inherently stressful, especially to patients with mental illness,” he added.

When Baker responded to a call on September 22, 2019,  according to the lawsuit,Sgt. Tom Ehrenberg and other police officers pressured Baker to administer ketamine. Baker said in an interview that the man being detained clearly had a mental illness but that he also did not resist any directives to a degree that seemed to require sedation. “He was on his feet and complied with all the officer’s orders … and even had a conversation with me about the Vikings,” Baker recalled. He refused to sedate him, and the man was eventually released.

“I was also aware that my uniform was very similar to that of a police officer, which is inherently stressful, especially to patients with mental illness.”

“You shouldn’t just jump to sedation because there are plenty of situations where people will appear combative or disordered, but they are actually hypoxic, or their blood sugar is low,” said Baker. “Ketamine is especially concerning because when you administer it, it takes away the patient’s ability to cooperate with you. And we should be giving patients every opportunity to cooperate.”

That day, said Baker, Ehrenberg waited for him at the station and berated him for not cooperating with the request.

Baker soon felt pressure to leave his post. He was placed on a “progressive improvement plan” in November, which he was told was in response to his “insubordination,” and it included a list of check-ins and behavioral interventions that were to continue for an indefinite period of time. He decided to quit instead.

His lawsuit names the city of Woodbury, as well as the city’s fire chief and two EMS commanders. Attorneys for the city told The Intercept that “with regard to the administration of any medications, such as ketamine, a medical professional determines whether the intervention is medically warranted under the circumstances. No employee of the City of Woodbury improperly administered any such medications. Mr. Baker was never disciplined or subject to retaliation and we categorically deny the allegations in the complaint.”

Ketamine, a synthetic drug discovered in 1962, is a fast-acting general anesthetic that is typically used in humans as a sedative before surgeries. It has been marketed in the U.S. as an anesthetic for both humans and animals since the 1970s, according to the Drug Enforcement Administration, and is also used recreationally for its dissociative effects. Its side effects include severe confusion, hallucinations, loss of bladder control, and shallow breathing. In a 2017 medical study conducted by several Twin Cities doctors on “ketamine as primary therapy for prehospital profound agitation,” 57 percent of the patients had to get intubated after their ketamine injection. A 2016 study comparing ketamine to haloperidol, an antipsychotic medication also used to treat delirium, found that complications occurred in 49 percent of patients receiving ketamine, compared to only 5 percent for the haloperidol group. It concluded that while ketamine is a faster-acting sedative, it is “associated with more complications and a higher intubation rate.”

“Of course there are other, less intrusive drugs, but ketamine is fast-acting and powerful,” said Udoibok. “And it has been heavily marketed both to paramedics and law enforcement.”

The typical dose of ketamine is based on a person’s weight, explained Baker. “The rule of thumb is 5 mg per kilogram of bodyweight, so you typically start at 250 mg and give more doses if needed.” It is usually delivered as an intramuscular shot to the butt or forearm. But it’s possible to go overboard, said Baker. Elijah McClain, for instance, who was roughly 140 pounds, immediately received a 500 mg shot and incurred a heart attack shortly thereafter.

“I’m not anti-ketamine,” said Baker. “There are a few situations where it is appropriate, like where a patient is actively trying to get out of restraints. … But even still, many other sedatives that are available, like Ativan, don’t run such a high risk of people going unconscious or dissociating.”

“The City of Woodbury allowed the custom of stifling any form of reporting wrongdoings by employees at the EMS, no matter the context.”

Beyond the ketamine incident, part of Baker’s whistleblower lawsuit deals with a number of falsified credentials he found among his colleagues, which he claims threaten public safety. After Baker signed up to give refresher emergency medicine courses last year, he alleges in his lawsuit, he learned that other emergency medicine certifications obtained by several of his colleagues had misleading attendance records behind them. Meaning that people got their credentials — which allowed them to receive higher salaries —without actually attending all the required classes, which violates a Minnesota statute. He escalated the complaint to his superiors but said it was “swept under the rug” for months. (The city of Woodbury’s attorney said that a review had been conducted and concluded “no training records were falsified and Mr. Baker’s complaints were properly addressed.”) An email provided to The Intercept between Baker’s colleagues, dated November 2019, shows that Baker was placed on a punitive progressive improvement plan in response to his “being a ‘whistle blower’ for the EMS education matter.’”

Udoibok connects the two parts of the lawsuit as part of a general “climate of cutting corners” at the EMS that ranges from improper certifications to overzealous calls for sedation. “The City of Woodbury,” per the lawsuit, “allowed the custom of stifling any form of reporting wrongdoings by employees at the EMS, no matter the context.”

So far, Baker has been pleasantly surprised by the reception from his previous colleagues at Woodbury EMS. “I thought I was going to get pushback, but it’s the reverse,” he said. “So many people have messaged me and said thank you for speaking out.”

Update: Aug. 25, 2020, 4:48 p.m. ET
This article has been updated to clarify Baker’s perspective on the likelihood of a ketamine injection resulting in an overdose.