人兽性交

The 43-year-old was surrounded by police who arrested him after responding to a trespassing call in a Wisconsin parking lot. Officers had shocked him with a Taser and pinned him as he pleaded that he couldn鈥檛 breathe. Now he sat on the ground with hands cuffed behind his back and took in oxygen through a mask.

Then, officers moved Jackson to his side so a medic could inject him with a potent knockout drug.

鈥淚t鈥檚 just going to calm you down,鈥� an officer assured Jackson. Within minutes, Jackson鈥檚 heart stopped. He never regained consciousness and died two weeks later.

聽illustrates an often-hidden way fatal U.S. police encounters end: not with the firing of an officer鈥檚 gun but with the silent use of a medical syringe.

The practice of giving sedatives to people detained by police has spread quietly across the nation over the last 15 years, built on questionable science and backed by police-aligned experts,聽. Based on thousands of pages of law enforcement and medical records and videos of dozens of incidents, the investigation shows how a strategy intended to reduce violence and save lives has resulted in some avoidable deaths.

At least 94 people died after they were given sedatives and restrained by police from 2012 through 2021, according to findings by the AP in collaboration with FRONTLINE (PBS) and the Howard Centers for Investigative Journalism. That鈥檚 nearly 10% of the聽聽of people subdued by police in ways that are not supposed to be fatal. About half of the 94 who died were Black, including Jackson.

Behind the聽聽is a disputed medical condition called聽, which fueled the rise of sedation outside hospitals. Critics say its purported symptoms, including 鈥渟uperhuman strength鈥� and high pain tolerance, play into racist stereotypes about Black people and lead to biased decisions about who needs sedation.

The use of sedatives in half these incidents has never been reported, as scrutiny typically focuses on the actions of police, not medics.聽聽2019 death in Aurora, Colorado, was a rare exception: Two paramedics were convicted of giving McClain an overdose of聽, the same drug given to Jackson. One聽聽and the second was sentenced to probation Friday.

It was impossible to determine the role sedatives may have played in each of the 94 deaths, which often involved the use of other potentially dangerous force on people who had taken drugs or consumed alcohol. Medical experts told the AP their impact could be negligible in people who were already dying; the final straw that triggered heart or breathing failure in the medically distressed; or the main cause of death when given in the wrong circumstances or mishandled.

While sedatives were mentioned聽as a cause or contributing factor in a dozen official death rulings, authorities often didn鈥檛 even investigate whether injections were appropriate. Medical officials have traditionally viewed them as mostly benign treatments. Now some say they may be playing a bigger role than previously understood and deserve more scrutiny.

Time and time again, the AP found, agitated people who were held by police facedown, often handcuffed and with officers pushing on their backs, struggled to breathe and tried to get free. Citing combativeness, paramedics administered sedatives, further slowing their breathing. Cardiac and respiratory arrest often occurred within minutes.

Paramedics drugged some people who were not a threat to themselves or others, violating treatment guidelines. Medics often didn鈥檛 know whether other drugs or alcohol were in people鈥檚 systems, although some combinations cause serious side effects.

Police officers sometimes improperly encouraged paramedics to give shots to suspects they were detaining.

Responders occasionally joked about the medications鈥� power to knock their subjects out. 鈥淣ight, night鈥� is heard on videos before deaths in California, Tennessee and Florida.

Emergency medical聽workers,聽"if they aren鈥檛 careful, can simply become an extension of the police鈥檚 handcuffs, of their weapons, of their nightsticks,鈥� said Claire Zagorski, a paramedic and an addiction researcher at the University of Texas at Austin.

Supporters say sedatives enable rapid treatment for drug-related behavioral emergencies and psychotic episodes, protect front-line responders from violence and are safely administered聽聽annually to get people with life-threatening conditions to hospitals. Critics say forced sedation should be strictly limited or banned, arguing the medications, given without consent, are too risky to be administered during police encounters.

Ohio State University professor Dr. Mark DeBard was an important early proponent of sedation, believing it could be used in rare cases when officers encountered extremely agitated people who needed rapid medical treatment. Today, he said he鈥檚 frustrated officers still sometimes use excessive force instead of treating those incidents as medical emergencies. He鈥檚 also surprised paramedics have given unnecessary injections by overdiagnosing excited delirium.

Others say the premise was flawed, with sedatives and police restraint creating a dangerous mix. The deaths have left a trail of grieving relatives from coast to coast.

鈥淭hey鈥檙e running around on the streets administering these heavy-duty medications that could be lethal,鈥� said Honey Gutzalenko, a nurse whose husband died after he was injected with midazolam in 2021 while restrained by police near San Francisco. 鈥淚t鈥檚 just not right.鈥�

鈥業鈥檓 begging you to stop鈥�

Jackson was standing on a truck outside a radio station on the border of the small Wisconsin cities of Eau Claire and Altoona. An employee called 911 before dawn on Oct. 8, 2021, hoping officers could shoo away a stranger who 鈥渄oesn鈥檛 seem to be a threat, but not normal either.鈥�

Police video and hundreds of pages of law enforcement and medical records show how the incident escalated.

An Altoona police officer met Jackson in the parking lot. Jackson appeared uneasy and paranoid, looking around and talking softly. He had taken聽, which a psychiatrist said he used to self-medicate for schizophrenia. He鈥檇 been in and out of jail and living on the streets, with frequent visits to the emergency room seeking a place to rest.

The officer, joined by a second Altoona officer and a sheriff's deputy, told him he could leave if he gave his name. Jackson refused.

Police identified him through his tattoos, learning he was on probation for meth possession. They noticed the truck had minor damage and decided to arrest him.

Jackson took off running. The officers chased Jackson, who stopped seconds later and staggered toward the first officer. Body-camera video shows she fired her Taser, its darts striking Jackson in the stomach and thigh. He screamed after the electrical shock and collapsed.

When officers couldn鈥檛 handcuff Jackson, she fired additional darts, striking Jackson in the back as he lay on the ground. Officers from the Eau Claire Police Department forced Jackson onto his stomach to be handcuffed and restrained him in what鈥檚 known as the prone position.

鈥淚鈥檓 begging you to stop,鈥� Jackson said. 鈥淚 can鈥檛 breathe.鈥�

After a couple of minutes, officers moved him to his side and then sat him up, trying to improve his breathing.

An officer wondered aloud whether Jackson had 鈥渆xcited delirium鈥� and asked a colleague if paramedics were 鈥済oing to stand around and do nothing.鈥� He voiced approval when one arrived with ketamine, adding Jackson would not like it 鈥渨hen he gets poked.鈥�

The Eau Claire Fire Department鈥檚 excited delirium protocol advises, 鈥淩apid sedation is the key to de-escalation!!!!!鈥� The medic measured 400 milligrams after estimating the 6-foot-tall Jackson weighed 175 pounds, enough to immobilize someone within minutes. He injected the medicine into Jackson鈥檚 buttocks.

Five medical experts who reviewed the case for AP said Jackson鈥檚 behavior did not appear to be dangerous enough to justify the intervention.

鈥淚 don鈥檛 believe he was a candidate for ketamine,鈥� said Connecticut paramedic Peter Canning, who said he supports sedating truly violent patients because they stop fighting and are sleeping by the time they get to the hospital.

Minutes later, Jackson stopped breathing on the way to Sacred Heart Hospital. He鈥檇 suffered cardiac arrest and, after he was resuscitated, had no brain function.

Jackson鈥檚 mother, Rita Gowens, collapsed while shopping at an Indiana Walmart when she learned her oldest son was hospitalized and not expected to survive.

Gowens rushed to the hospital 500 miles away, where she was told he鈥檇 been injected with ketamine. She searched online and was stunned to read it鈥檚 used to tranquilize horses.

Gowens spoke to Jackson, held his hand and hoped for a miracle. She eventually agreed to remove him from a ventilator after his condition didn鈥檛 improve, singing into his ear as he took his final breaths: 鈥淵ou鈥檝e never lost a battle, and I know, I know, you never will.鈥�

She still has nightmares about how police and medics treated her son, whom she recalls as a happy boy with chunky cheeks that inspired the nickname 鈥淢eatball.鈥� There are few days when she doesn鈥檛 ask, 鈥淲hy did they give him an animal tranquilizer?鈥�

Ketamine moves to the streets

The practice of using ketamine to subdue people outside hospitals began in 2004 when a disturbed man scaled a fence, cut himself with a broken bottle and paced along a narrow strip of concrete on a Minneapolis highway bridge.

The man was in danger of falling into traffic below when officers reached through the fence and grabbed him.

Dr. John Hick, who worked with first responders, heard the emergency radio chatter while driving and rushed to the scene with an idea. Hick gave the man two shots of ketamine, started an IV and kept him breathing with an air mask.

The man stopped struggling, and responders lowered him to safety.

Paramedics had occasionally used other sedatives to calm combative people since the 1980s. Hick and his Hennepin County Medical Center colleague Dr. Jeffrey Ho believed ketamine worked faster and had fewer side effects, showing promise to avert fatal police encounters.

Ho was a leading researcher on Taser safety and an expert witness for the company in wrongful death lawsuits. In a 2007 deposition in one such case, he argued for a potentially 鈥渓ife-saving tactic鈥� of having sedative injections quickly follow Taser shocks, saying the combination could shorten struggles that, if prolonged, might end in death.

Some doctors at his public hospital in Minneapolis were using 鈥渟omething called ketamine, which is an analog to LSD,鈥� he said. 鈥淚t鈥檚 sort of an animal tranquilizer.鈥�

The drug became more common outside the hospital in 2008 when Hennepin County paramedics were given permission to use it.

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An American College of Emergency Physicians panel that included Ho said in 2009 that ketamine had shown 鈥渆xcellent results and safety鈥� while acknowledging no research proved it would save lives.

In time, its use became standard from Las Vegas to Columbus, Ohio, to Palm Beach County, Florida. The earliest death involving ketamine documented in AP鈥檚 investigation came in 2015, when 34-year-old聽聽was injected after struggling with police in the Dallas suburb of Garland, Texas.

Shortly after ketamine became authorized for such use in Arizona in 2017, deputies who were restraining聽聽facedown in handcuffs in the scorching desert asked a paramedic to sedate him.

The medic testified he was surprised when Cutler stopped breathing, although the dose was larger than recommended for someone weighing 132 pounds. He said he had been trained that ketamine didn鈥檛 impact respiration. Cutler鈥檚 death was ruled an accident due to heat exposure and LSD 鈥� though that was disputed by experts hired by Cutler鈥檚 family, who said heat stroke along with ketamine caused his death.

In Minneapolis, an oversight agency found the use of ketamine during police calls rose dramatically from 2012 through 2017 and body-camera video showed instances of officers appearing to pressure paramedics to use ketamine and joking about its power. The department told officers they could never 鈥渟uggest or demand鈥� the use of sedation.

Facing criticism, Hennepin Healthcare halted a study examining the effectiveness of ketamine on agitated patients. The Food and Drug Administration later found the research failed to protect vulnerable, intoxicated people who had not given consent.

By 2021, the American College of Emergency Physicians warned ketamine impacted breathing and the heart more than previously believed.

鈥淜etamine is not as benign as we might have hoped it to be,鈥� a co-author of the new position, Dr. Jeffrey Goodloe, said on the group鈥檚 podcast in 2022.

He said the practice of giving large doses of ketamine, sometimes too much for smaller patients, had spread nationwide as agencies copied each other鈥檚 protocols with little independent review.

But the AP鈥檚 findings show risks of sedation go beyond ketamine, which was used in at least 19 cases.

Roughly half of the 94 deaths documented by the AP came after the use of midazolam, which has long been known to heighten the risk of respiratory depression. Many came during police encounters in California, where ketamine is not widely used. Midazolam, a common pre-surgery drug known by the brand name Versed, is also part of聽聽used in some states to execute prisoners.

Other cases involved a range of other drugs, including the antipsychotic medications haloperidol and ziprasidone, which can cause irregular heartbeats.

The need for monitoring side effects is often laid out for paramedics in written guidelines, many of which are based on the disputed belief that excited delirium can cause sudden death.

The history of 鈥榚xcited delirium鈥�

The theory of excited delirium was troubling from the start.

In the 1980s, with cocaine use soaring, Dr. Charles Wetli, a Miami forensic pathologist, coined the term to explain a handful of deaths of violent cocaine users, many of whom had been restrained by police. Wetli, who died in 2020, also blamed excited delirium for the mysterious deaths of more than a dozen Black women. He said cocaine and sexual activity triggered the fatal condition.

The women鈥檚 deaths eventually were attributed to a serial killer. Wetli鈥檚 theory survived. And over time, symptoms described by Wetli and others 鈥� 鈥渟uperhuman strength,鈥� animal-like noises and high pain tolerance 鈥� became disproportionately assigned to Black people. The terms spread to police and emergency medical services to describe certain agitated people 鈥� and explain sudden deaths.

By the mid-2000s, police were encountering more drug users and mentally ill people as stimulant use increased and psychiatric hospitals closed. Departments adopted Tasers as a less-lethal alternative to firearms, but there was a problem 鈥� hundreds died after being jolted.

Supporters of Wetli鈥檚 research, including the medical examiner in Miami-Dade County, ruled again and again that excited delirium was the cause of these deaths, not the effects of the weapons and other physical force. Executives at Taser鈥檚 manufacturer agreed, promoting excited delirium to medical examiners around the country and retaining experts who explained the concept to juries in wrongful death lawsuits.

In 2006, a grand jury that investigated Taser-related deaths in Miami-Dade recommended an untested treatment that it said could save people before they died from excited delirium: squirting midazolam up their noses to cause 鈥渁lmost immediate sedation.鈥� Its report acknowledged they 鈥渕ay experience difficulty in breathing.鈥� Miami-Dade paramedics adopted this treatment.

But key medical groups didn鈥檛 recognize excited delirium, and activists were calling for limits on Taser use. What happened next would help promote sedation alongside Tasers as tools to gain control.

In 2008, the biggest names in excited delirium research gathered at a Las Vegas hotel for a three-day meeting organized by a group with ties to Taser鈥檚 manufacturer.

鈥淎 lot of talk took place on chemical sedation because the cops didn鈥檛 know what to do with these people,鈥� recalled John Peters, president of the Institute for the Prevention of In-Custody Deaths, which sponsored the meeting. 鈥淛eff Ho had done some work up in Minnesota. He said, 鈥楲ook. I鈥檝e been using ketamine. It knocks them out quicker.鈥欌��

The timing was fortuitous: The American College of Emergency Physicians would soon form a task force to study excited delirium and how police and medics should respond.

The 19-member panel included Ho, who became Taser鈥檚 medical director under an arrangement in which the company paid part of his hospital salary; Dr. Donald Dawes, a Taser research consultant; and University of Miami researcher Deborah Mash, who testified for Taser about several deaths she blamed on excited delirium. At least two other panelists were routinely retained by officers and their departments as expert witnesses.

The panel鈥檚 2009 paper disclosed none of these relationships. It found excited delirium was real, could result in death regardless of whether someone was shocked with a Taser and called for 鈥渁ggressive chemical sedation鈥� to treat the symptoms.

DeBard, the now-retired Ohio doctor who chaired the panel, told AP he recruited relevant experts to join and that disclosure of conflicts wasn鈥檛 required by the ER doctors group then. He said Taser didn鈥檛 influence the outcome, which reflected the panel's consensus. Mash said she had no conflict because Taser didn鈥檛 fund her research. Dawes declined an interview request. Ho didn鈥檛 return messages.

Taser rebranded itself in 2017 as Axon. A spokesperson for the company declined interview requests and did not respond to written questions.

Dr. Brooks Walsh, an emergency physician in Connecticut who was not on the panel, said the 2009 paper reinforced racial bias as it formalized 鈥渓oaded terms鈥� used to describe excited delirium, influencing how the diagnosis would be applied.

Ho and other Taser- and police-aligned experts joined a federally sponsored panel in 2011 that built on the work, recommending four actions on a checklist for officers and paramedics: Identify excited delirium symptoms; control (with a Taser if necessary); sedate; and transport to a hospital.

No test measures for excited delirium, so paramedics faced a judgment call: Which patients were so agitated, strong, impervious to pain and dangerous that they needed to be sedated?

DeBard said the symptoms were based on medical observations, not race. 鈥淚f you鈥檝e got somebody that鈥檚 delirious, irrational, aggressive, hyperactive, running around naked, I mean, it鈥檚 really pretty easy" to recognize, he said.

Yet, over time, prominent medical groups and some experts pointed to overuse of sedation during police encounters and a disproportionate impact on Black people. Even supporters of the practice have acknowledged that the wrong patients at times have been injected.

The deaths of Black men in police custody, including the聽, put pressure on the medical community to re-examine excited delirium. The ER doctors group in 2023 withdrew approval of the 2009 paper and said excited delirium shouldn鈥檛 be used in court testimony. Some doctors called that decision political and note the group still recognizes a similar condition 鈥� hyperactive delirium with severe agitation 鈥� that can be treated with sedation. But today no major medical association legitimizes excited delirium.

鈥楥onvenient for law enforcement鈥�

In more than a dozen cases reviewed by AP, police asked for or suggested the use of sedatives, calling into question whether medics were working for law enforcement or in patients鈥� interests. Officers often suggested their detainees had excited delirium.

University of California, Berkeley, law and bioethics professor Osagie Obasogie, who has studied excited delirium and sedation, said officers should be banned from influencing medical care.

鈥淲e need to be sure that folks are treated in a way that meets their medical needs and not simply given a chemical restraint because it鈥檚 convenient for law enforcement,鈥� he said.

Officers are told not to dictate medical treatment but 鈥渟ome knuckleheads鈥� have done otherwise, said Peters, whose group hosted the 2008 Las Vegas meeting that focused on excited delirium.

Paramedics say they make medical decisions independently from police, following guidelines that call for sedating people who may be dangerous. But in several cases AP found, people were injected though they had calmed down or even passed out after struggles with police.

, a 47-year-old father, was struggling to breathe as two officers restrained him in Richmond, California. Gutzalenko told the officers they were hurting him, and bucked to try to get one off his back.

A paramedic viewed Gutzalenko鈥檚 action as aggression, and went to his ambulance to get a 5-milligram dose of midazolam. When he returned three minutes later, Gutzalenko lay motionless. 鈥淗e鈥檚 faking like he鈥檚 unconscious,鈥� an officer said.

The medic plunged the聽needle into his bicep. Gutzalenko鈥檚 heart stopped. He was declared dead at a hospital. A pathologist testified that midazolam was given to 鈥渜uiet him down鈥� during an episode of excited delirium but did not contribute to the death, which he blamed on prone restraint and meth use.

His wife said Gutzalenko, a former critical care nurse, would never have consented to receive midazolam that day.

鈥淚 know from being a registered nurse since 2004, you don鈥檛 administer a sedative to someone who is clearly already in respiratory distress,鈥� she said, adding that his death has been devastating to their two teenage children.

Dr. Gail Van Norman, a University of Washington professor of anesthesiology and pain medicine, said it鈥檚 dangerous for officers to put pressure on the backs and necks of detainees before and after they鈥檙e injected with sedatives.

鈥淚t鈥檚 a recipe for disaster, because you may have created a situation in which you are impeding a person鈥檚 ability to get oxygen,鈥� she said.

鈥淚f we don鈥檛 change the training, change the protocols, change the leadership to make the system safer, then we all bear responsibility for future deaths.鈥澛犫�� Paramedic Eric Jaeger

The AP investigation found half who died following sedation had been shocked with a Taser and the majority had been restrained facedown.

Their blood acid levels may already have been spiking from drugs, adrenaline and pain while oxygen levels may have been plummeting 鈥� life-threatening conditions called acidosis and hypoxia.

Sedatives can dull the instinct to compensate by breathing quickly and heavily to blow off carbon dioxide, essential for the heart to beat, said Dr. Christopher Stephens, a UTHealth Houston anesthesiologist and former paramedic.

Under sedation, he said, the body doesn鈥檛 respond as efficiently to the buildup of carbon dioxide. 鈥淵our brain doesn鈥檛 care as much about it,鈥� Stephens said. 鈥淎nd they can go into respiratory and cardiac arrest.鈥�

Paramedics usually have no idea whether their patients have alcohol, opioids or other depressants in their bodies that increase sedatives鈥� effects on breathing.

More than a dozen who died had been drinking, including聽, 29, a Colorado Springs, Colorado, mother of five young children.

She was stressed about family finances, husband Anthony LaCour recalled, when deputies found her trespassing at a trucking company.

鈥淕uess who gets ketamine?鈥� paramedic Jason Poulson of AMR, the nation鈥檚 largest ambulance company, said as LaCour was restrained on a gurney, according to body-camera footage.

An EMT said in a report that she told Poulson that LaCour had calmed and didn鈥檛 need ketamine, and later warned that LaCour was no longer breathing. In a disciplinary agreement with state regulators, Poulson admitted he was unsuccessful in protecting LaCour鈥檚 airway despite multiple attempts, mishandled the syringe and failed to document the ketamine use properly. His state certification was put on probation.

AMR and Poulson denied responsibility for LaCour鈥檚 death in court filings, arguing LaCour was experiencing excited delirium and ketamine was appropriate. This week they settled a long-pending wrongful death lawsuit, LaCour family attorney Daniel Kay said Friday. He said the settlement amount was confidential and the proceeds would help her children. AMR didn鈥檛 immediately respond to a request for comment and a man who answered a cellphone number listed for Poulson hung up on a reporter.

After death, sedation goes unquestioned

When people died, the use of sedation often went unacknowledged publicly and unquestioned by investigators.

After Jackson鈥檚 death in Wisconsin, police press releases said nothing about ketamine. State police redacted mention of the drug from investigation records and blurred video of the prone restraint and injection, saying his family鈥檚 privacy outweighed the public interest in disclosure.

The fire department, which declined comment, blacked out the information in its incident report. But when AP uploaded the document, redactions disappeared, revealing Jackson was given 400 milligrams of ketamine.

An autopsy concluded Jackson died from complications caused by meth. The report said Jackson鈥檚 ketamine dose was 100 milligrams, a quarter of what the fire department report said.

Two longtime forensic pathologists who reviewed the case for AP said meth use wasn鈥檛 the only factor. Dr. Joye Carter said she believed the police altercation and ketamine caused the death, saying the sedative can cause heart problems when given to a meth user.

Dr. Victor Weedn said the level of meth in Jackson鈥檚 blood was high but generally not lethal. He said Jackson likely died from high blood acid levels, with police restraint and possibly ketamine contributing.

The autopsy was performed in Ramsey County, Minnesota. A county spokesperson defended the findings from a now-retired medical examiner, saying the discrepancy on the ketamine dose wasn鈥檛 significant.

Citing the autopsy鈥檚 finding that meth was the cause, Eau Claire County District Attorney Peter Rindal ruled Jackson鈥檚 case was not an 鈥渙fficer-involved death鈥� under Wisconsin law and closed the investigation.

In nearly 90% of the deaths examined by AP, coroners and medical examiners did not list sedation as a cause or contributing factor. Some autopsy reports failed to document that the deceased had been sedated.

The most common ruling was an accidental death in which other drugs, often meth or cocaine, were causes or contributing factors. More than a quarter were at least partially attributed to excited delirium.

Medical examiners view sedatives as safe treatments to control patients and wouldn鈥檛 question their use unless there was a grievous error, said Dr. James Gill, the chief medical examiner of Connecticut and past president of the National Association of Medical Examiners.

鈥淕enerally we鈥檙e going to default then back to what鈥檚 the underlying disease or injury that started this chain of events,鈥� Gill said.

He said sedatives rarely cause deaths by themselves but additional studies could look at whether they play a role in fatal police struggles where many factors are involved.

Even when autopsies implicated sedatives, investigations didn鈥檛 always follow.

In LaCour鈥檚 case, the coroner found she died from 鈥渞espiratory arrest associated with acute alcohol and ketamine intoxication.鈥� The district attorney鈥檚 office said it had no record of reviewing her death.

Nine miles from LaCour鈥檚 injection, a paramedic injected 26-year-old聽聽with ketamine as officers held him facedown in the dirt outside his Colorado Springs home in September 2020.

Retired postal worker聽Mark Barr had called 911 for help controlling his son, who he said wasn鈥檛 violent but was having a bad reaction to LSD. He watched as a medic gave two injections just minutes apart. He said he couldn't figure out why the second injection was necessary, saying his son was subdued. Hunter Barr became unconscious on the way to a hospital and died within hours.

The coroner ruled Barr died from the effects of ketamine. The Colorado Springs Police Department closed the case as 鈥渘on-criminal鈥� and the DA鈥檚 office again had no review.

When deaths were investigated, inquiries usually focused on whether police used excessive force. In audio and video reviewed by AP, investigators seemed uninterested in how sedation may have contributed.

鈥淚鈥檓 not trying to get in the weeds with a whole bunch of that,鈥� an investigator told a paramedic explaining the ketamine injection he gave 18-year-old聽聽before Berne鈥檚 heart stopped in Palm Bay, Florida, in 2016.

Berne鈥檚 sister, Christina,聽said the family didn鈥檛 know he had been given ketamine until contacted by AP years later, but 鈥渨e knew something bad happened in the ambulance.鈥� A medical examiner ruled that Berne died of excited delirium.

The death of McClain, 23, in Colorado is the only one that resulted in charges against paramedics. Prosecutors argued Aurora paramedics Jeremy Cooper and Peter Cichuniec didn鈥檛 assess McClain, gave him too much ketamine for someone his size and didn鈥檛 monitor him afterward.

聽shook the EMS field, whose leaders say treatment mistakes shouldn鈥檛 be criminalized. Defense attorneys argued the paramedics followed their training on excited delirium and ketamine.

A judge gave Cichuniec five years in prison while Cooper is scheduled to be sentenced Friday.

Civil liability is also rare, in聽part because deaths have multiple causes and some courts have ruled that unwilling injections aren鈥檛 excessive force even when they cause harm.

That hasn鈥檛 stopped families from trying: A number of wrongful death lawsuits involving sedation are pending.

Lawmakers in Colorado banned excited delirium as a justification for using ketamine and put other restrictions on the drug, but changes in the law elsewhere have been few.

Paramedic reformers are working to address the failures that increase the risk of sedatives contributing to deaths.

Paramedic Eric Jaeger helped rewrite New Hampshire鈥檚 protocols and, at a fire station in Hooksett, recently used Jackson鈥檚 death as a training scenario after evaluating the case for AP. He questioned whether sedation was necessary.

He said medics failed to thoroughly evaluate Jackson and should have had monitoring equipment ready before any injection.

He said he had been aware of a handful of deaths but the number found by AP 鈥渄ramatically increases鈥� the scope.

鈥淚f we don鈥檛 change the training, change the protocols, change the leadership to make the system safer,鈥� Jaeger said, 鈥渢hen we all bear responsibility for future deaths.鈥澛�

Lethal restraint investigation

Many more people have died after police subdued them than the American public knows. The AP found that over a decade,聽聽after police subdued them with physical force that is not supposed to be lethal. Explore the聽: