Dozens of deaths in the US reveal risks of injecting sedatives into people restrained by police

Dozens of deaths in the US reveal risks of injecting sedatives into people restrained by police
In this image from Richmond Police Department body-camera video, a paramedic, left, holds a syringe as he prepares to inject Ivan Gutzalenko, 47, with the sedative midazolam in Richmond, California, on March 10, 2021. When the paramedic returned three minutes after the injection, Gutzalenko lay motionless. He was declared dead at a hospital. (AP)
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Updated 27 April 2024
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Dozens of deaths in the US reveal risks of injecting sedatives into people restrained by police

Dozens of deaths in the US reveal risks of injecting sedatives into people restrained by police
  • Joint media probe finds at least 94 people died in the US, half of them blacks, after they were given sedatives and restrained by police from 2012 through 2021
  • That’s nearly 10 percent of the more than 1,000 deaths identified during the investigation of people subdued by police in ways that are not supposed to be fatal

Demetrio Jackson was desperate for medical help when the paramedics arrived.

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’t 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.
“It’s just going to calm you down,” an officer assured Jackson. Within minutes, Jackson’s heart stopped. He never regained consciousness and died two weeks later.
Jackson’s 2021 death illustrates an often-hidden way fatal US police encounters end: not with the firing of an officer’s gun but with the silent use of a medical syringe.




In this image from Colorado Springs Police Department body-camera video, police restrain Hunter Barr outside his father's home in Colorado Springs, Colorado, on Sept. 25, 2020. Retired postal worker Mark Barr had called 911 for help controlling his son, who he said wasn't violent but was having a bad reaction to LSD. He watched as a medic gave two injections. His son was dead within hours. (AP)

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, an investigation led by The Associated Press has found. 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’s nearly 10 percent of the more than 1,000 deaths identified during the investigation 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 racial disparity is a disputed medical condition called excited delirium, which fueled the rise of sedation outside hospitals. Critics say its purported symptoms, including “superhuman strength” 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. Elijah McClain’s 2019 death in Aurora, Colorado, was a rare exception: Two paramedics were convicted of giving McClain an overdose of ketamine, the same drug given to Jackson. One was sentenced last month to five years in prison and the other was sentenced Friday to 14 months in jail and probation.
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.




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While sedatives were mentioned as a cause or contributing factor in a dozen official death rulings, authorities often didn’t 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’t know whether other drugs or alcohol were in people’s 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’ power to knock their subjects out. “Night, night” is heard on videos before deaths in California, Tennessee and Florida.
Emergency medical workers, “if they aren’t careful, can simply become an extension of the police’s handcuffs, of their weapons, of their nightsticks,” said Claire Zagorski, a former 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 thousands of times 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’s frustrated officers still sometimes use excessive force instead of treating those incidents as medical emergencies. He’s 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.
“They’re running around on the streets administering these heavy-duty medications that could be lethal,” said Honey Gutzalenko, a nurse whose husband died after he was injected with midazolam in 2021 while restrained by police near San Francisco. “It’s just not right.”
‘I’m begging you to stop’
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 “doesn’t seem to be a threat, but not normal either.”
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 methamphetamine, which a psychiatrist said he used to self-medicate for schizophrenia. He’d 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’t 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’s known as the prone position.
“I’m begging you to stop,” Jackson said. “I can’t breathe.”
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 “excited delirium” and asked a colleague if paramedics were “going to stand around and do nothing.” He voiced approval when one arrived with ketamine, adding Jackson would not like it “when he gets poked.”
The Eau Claire Fire Department’s excited delirium protocol advises, “Rapid sedation is the key to de-escalation!!!!!” 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’s buttocks.
Five medical experts who reviewed the case for AP said Jackson’s behavior did not appear to be dangerous enough to justify the intervention.
“I don’t believe he was a candidate for ketamine,” 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’d suffered cardiac arrest and, after he was resuscitated, had no brain function.
Jackson’s mother, Rita Gowens, collapsed while shopping at an Indiana Walmart when she learned her oldest son was hospitalized and not expected to survive.




This image provided by Rita Gowens shows her son, Demetrio Jackson. Gowens remembers him as a happy boy with chunky cheeks that inspired the nickname "Meatball." (Courtesy Rita Gowens via AP)

Gowens rushed to the hospital 500 miles away, where she was told he’d been injected with ketamine. She searched online and was stunned to read it’s 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’t improve, singing into his ear as he took his final breaths: “You’ve never lost a battle, and I know, I know, you never will.”
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 “Meatball.” There are few days when she doesn’t ask, “Why did they give him an animal tranquilizer?”
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 “life-saving tactic” 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 “something called ketamine, which is an analog to LSD,” he said. “It’s sort of an animal tranquilizer.”
The drug became more common outside the hospital in 2008 when Hennepin County paramedics were given permission to use it.
An American College of Emergency Physicians panel that included Ho said in 2009 that ketamine had shown “excellent results and safety” 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’s investigation came in 2015, when 34-year-old Juan Carrizales 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 David Cutler 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’t impact respiration. Cutler’s death was ruled an accident due to heat exposure and LSD — though that was disputed by experts hired by Cutler’s 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 “suggest or demand” 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.
“Ketamine is not as benign as we might have hoped it to be,” a co-author of the new position, Dr. Jeffrey Goodloe, said on the group’s 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’s protocols with little independent review.
But the AP’s 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 a three-drug cocktail 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 ‘excited delirium’
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’s deaths eventually were attributed to a serial killer. Wetli’s theory survived. And over time, symptoms described by Wetli and others — “superhuman strength,” animal-like noises and high pain tolerance — became disproportionately assigned to Black people. The terms spread to police and emergency medical services to describe certain agitated people — 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 — hundreds died after being jolted.
Supporters of Wetli’s 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’s 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 “almost immediate sedation.” Its report acknowledged they “may experience difficulty in breathing.” Miami-Dade paramedics adopted this treatment.
But key medical groups didn’t 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’s manufacturer.
“A lot of talk took place on chemical sedation because the cops didn’t know what to do with these people,” recalled John Peters, president of the Institute for the Prevention of In-Custody Deaths, which sponsored the meeting. “Jeff Ho had done some work up in Minnesota. He said, ‘Look. I’ve been using ketamine. It knocks them out quicker.’”
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’s 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’s 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 “aggressive chemical sedation” 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’t required by the ER doctors group then. He said Taser didn’t influence the outcome, which reflected the panel’s consensus. Mash said she had no conflict because Taser didn’t fund her research. Dawes declined an interview request. Ho didn’t 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 “loaded terms” 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. “If you’ve got somebody that’s delirious, irrational, aggressive, hyperactive, running around naked, I mean, it’s 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 2020 killing of George Floyd, 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’t be used in court testimony. Some doctors called that decision political and note the group still recognizes a similar condition — hyperactive delirium with severe agitation — that can be treated with sedation. But today no major medical association legitimizes excited delirium.
‘Convenient for law enforcement’
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’ 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.
“We 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’s convenient for law enforcement,” he said.
Officers are told not to dictate medical treatment but “some knuckleheads” 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.
Ivan Gutzalenko, 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’s 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. “He’s faking like he’s unconscious,” an officer said.
The medic plunged the needle into his bicep. Gutzalenko’s heart stopped. He was declared dead at a hospital. A pathologist testified that midazolam was given to “quiet him down” 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.
“I know from being a registered nurse since 2004, you don’t administer a sedative to someone who is clearly already in respiratory distress,” 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’s dangerous for officers to put pressure on the backs and necks of detainees before and after they’re injected with sedatives.
“It’s a recipe for disaster, because you may have created a situation in which you are impeding a person’s ability to get oxygen,” she said.
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 — 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’t respond as efficiently to the buildup of carbon dioxide. “Your brain doesn’t care as much about it,” Stephens said. “And they can go into respiratory and cardiac arrest.”
Paramedics usually have no idea whether their patients have alcohol, opioids or other depressants in their bodies that increase sedatives’ effects on breathing.
More than a dozen who died had been drinking, including Jerica LaCour, 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.
“Guess who gets ketamine?” paramedic Jason Poulson of AMR, the nation’s 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’t 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’s 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’s 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’t 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’s 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’s 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’s 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’t 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’s 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’t significant.
Citing the autopsy’s finding that meth was the cause, Eau Claire County District Attorney Peter Rindal ruled Jackson’s case was not an “officer-involved death” under Wisconsin law and closed the investigation.
In nearly 90 percent 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’t 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.
“Generally we’re going to default then back to what’s the underlying disease or injury that started this chain of events,” 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’t always follow.
In LaCour’s case, the coroner found she died from “respiratory arrest associated with acute alcohol and ketamine intoxication.” The district attorney’s office said it had no record of reviewing her death.
Nine miles from LaCour’s injection, a paramedic injected 26-year-old Hunter Barr with ketamine as officers held him facedown in the dirt outside his Colorado Springs home in September 2020.
Retired postal worker Mark Barr had called 911 for help controlling his son, who he said wasn’t 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 “non-criminal” and the DA’s 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.
“I’m not trying to get in the weeds with a whole bunch of that,” an investigator told a paramedic explaining the ketamine injection he gave 18-year-old Giovani Berne before Berne’s heart stopped in Palm Bay, Florida, in 2016.
Berne’s sister, Christina, said the family didn’t know he had been given ketamine until contacted by AP years later, but “we knew something bad happened in the ambulance.” 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’t assess McClain, gave him too much ketamine for someone his size and didn’t monitor him afterward.
Their convictions shook the EMS field, whose leaders say treatment mistakes shouldn’t 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 was sentenced Friday to 14 months in jail and probation.
Civil liability is also rare, in part because deaths have multiple causes and some courts have ruled that unwilling injections aren’t excessive force even when they cause harm. That hasn’t 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’s protocols and, at a fire station in Hooksett, recently used Jackson’s 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 “dramatically increases” the scope.
“If we don’t change the training, change the protocols, change the leadership to make the system safer,” Jaeger said, “then we all bear responsibility for future deaths.”


Rwanda-backed M23 rebels occupy a 2nd major city in Congo’s mineral-rich east

Rwanda-backed M23 rebels occupy a 2nd major city in Congo’s mineral-rich east
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Rwanda-backed M23 rebels occupy a 2nd major city in Congo’s mineral-rich east

Rwanda-backed M23 rebels occupy a 2nd major city in Congo’s mineral-rich east
BUKAVU: Rwanda-backed rebels have occupied a second major city in mineral-rich eastern Congo, the government said Sunday, as M23 rebels confirmed they were in the city to restore order after it was abandoned by Congolese forces.
The Congo River Alliance, a coalition of rebel groups that includes the M23, said in a statement that its fighters “decided to assist the population of Bukavu” in addressing its security challenges under the “old regime” in the city of 1.3 million people.
“Our forces have been working to restore the security for the people and their property, much to the satisfaction of the entire population,” alliance spokesperson Lawrence Kanyuka said in a statement.
The rebels saw little resistance from government forces against the unprecedented expansion of their reach after years of fighting. Congo’s government vowed to restore order in Bukavu but there was no sign of soldiers. Many were seen fleeing on Saturday alongside thousands of civilians.
The M23 are the most prominent of more than 100 armed groups vying for control of eastern Congo’s trillions of dollars in mineral wealth that’s critical for much of the world’s technology. The rebels are supported by about 4,000 troops from neighboring Rwanda, according to the United Nations experts.
The fighting has displaced more than 6 million people in the region, creating the world’s largest humanitarian crisis.
Rebels vow to ‘clean up’ disorder

Bernard Maheshe Byamungu, one of the M23 leaders who has been sanctioned by the UN Security Council for rights abuses, stood in front of the South Kivu governor’s office in Bukavu and told residents they have been living in a “jungle.”
“We are going to clean up the disorder left over from the old regime,” Byamungu said, as some in the small crowd of young men cheered the rebels on to “go all the way to Kinshasa,” Congo’s capital, nearly 1,000 miles away.
Congo’s communications ministry in a statement on social media acknowledged for the first time that Bukavu had been “occupied” and said the national government was “doing everything possible to restore order and territorial integrity” in the region.
One Bukavu resident, Blaise Byamungu, said the rebels marched into the city that had been “abandoned by all the authorities and without any loyalist force.”
“Is the government waiting for them to take over other towns to take action? It’s cowardice,” Byamungu added.
Fears of regional escalation
Unlike in 2012, when the M23 briefly seized Goma and withdrew after international pressure, analysts have said the rebels this time are eyeing political power.
The fighting in Congo has connections with a decadeslong ethnic conflict. The M23 says it is defending ethnic Tutsis in Congo. Rwanda has claimed the Tutsis are being persecuted by Hutus and former militias responsible for the 1994 genocide of 800,000 Tutsis and others in Rwanda. Many Hutus fled to Congo after the genocide and founded the Democratic Forces for the Liberation of Rwanda militia group.
Rwanda says the militia group is “fully integrated” into the Congolese military, which denies it.
But the new face of the M23 in the region — Corneille Nangaa — is not Tutsi, giving the group “a new, more diverse, Congolese face, as M23 has always been seen as a Rwanda-backed armed group defending Tutsi minorities,” according to Christian Moleka, a political scientist at the Congolese think tank Dypol.
Congo’s President Felix Tshisekedi, whose government on Saturday asserted that Bukavu remained under its control, has warned of the risk of a regional expansion of the conflict.
Congo’s forces were being supported in Goma by troops from South Africa and in Bukavu by troops from Burundi. But Burundi’s president, Evariste Ndayishimiye, appeared to suggest on social media his country would not retaliate in the fighting.
The conflict was high on the African Union summit’s agenda in Ethiopia over the weekend, with UN Secretary-General António Guterres warning it risked spiraling into a regional conflagration.
Still, African leaders and the international community have been reluctant to take decisive action against M23 or Rwanda, which has one of Africa’s most powerful militaries. Most continue to call for a ceasefire and a dialogue between Congo and the rebels.

Taliban delegation visits Japan in rare trip outside region

Taliban delegation visits Japan in rare trip outside region
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Taliban delegation visits Japan in rare trip outside region

Taliban delegation visits Japan in rare trip outside region
  • The Taliban government makes regular visits to neighboring and regional countries

KABUL: A Taliban government delegation was visiting Japan for the first time on Monday, in a rare diplomatic visit outside of the region.
The Afghan delegation left Kabul on Saturday, in a visit that local media said would last one week and included officials from the higher education, foreign affairs, and economy ministries.
“We seek dignified interaction with the world for a strong, united, advanced, prosperous, developed Afghanistan and to be an active member of the international community,” Latif Nazari, a deputy minister at the ministry of economy who is part of the delegation, tweeted on Saturday.
The Taliban government makes regular visits to neighboring and regional countries, including in Central Asia, Russia and China.
However, it has only officially visited Europe for diplomacy summits in Norway in 2022 and 2023.
Japan’s embassy in Kabul temporarily relocated to Qatar after the fall of the previous foreign-backed government and the takeover by the Taliban in 2021.
However, it has since reopened and resumed diplomatic and humanitarian activities in the country.


North Korea’s Kim makes rare visit to father’s tomb, says devoted to ‘sacred struggle’

North Korea’s Kim makes rare visit to father’s tomb, says devoted to ‘sacred struggle’
Updated 17 February 2025
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North Korea’s Kim makes rare visit to father’s tomb, says devoted to ‘sacred struggle’

North Korea’s Kim makes rare visit to father’s tomb, says devoted to ‘sacred struggle’
  • Kim Jong Il’s birthday, which falls on February 16, is widely celebrated as a major holiday in North Korea
  • The Kim dynasty that has ruled North Korea since its founding after World War Two

SEOUL: North Korean leader Kim Jong Un has paid his respect at a family mausoleum to mark the birthday of his late father and former leader Kim Jong Il, state media KCNA said on Monday, pledging to continue the “sacred struggle” for prosperity and security.
Kim Jong Il’s birthday, which falls on February 16, is widely celebrated as a major holiday in North Korea, called the Day of the Shining Star.
But it was the first time in four years that the young Kim visited the Kumsusan Palace of Sun in the capital Pyongyang, which houses the embalmed bodies of his father and grandfather, for the anniversary.
Accompanied by Kim Yo Jong, his sister and a senior ruling Workers’ Party official, among other aides, Kim Jong Un paid homage “in the humblest reverence,” KCNA said.
“He expressed his solemn will to devote himself to the sacred struggle for the eternal prosperity of the country, the security of the people and the promotion of their well-being,” it said.
The Kim dynasty that has ruled North Korea since its founding after World War Two and has sought to strengthen their grip on power by building cults of personality around them, though Kim Jong Un has shown signs of increasingly trying to stand more on his own feet without relying on his predecessors.
In another dispatch, KCNA said Kim attended a groundbreaking ceremony on Sunday for the final phase of his pet project to build 50,000 new homes in Pyongyang.
The ambitious initiative was launched in 2021 as part of Kim’s five-year plan to boost the economy, and designed to distribute at least 10,000 new apartments in Pyongyang each year, though some analysts have questioned its feasibility amid international sanctions and economic woes.
Photos and a video released by KCNA showed Kim receiving thunderous applause from thousands of people many wearing protective helmets attending the ceremony, against a backdrop showing images of modern apartments and high-rises.
Koo Byoung-sam, a spokesperson for South Korea’s unification ministry handling inter-Korean affairs, said North Korea appears to be focusing on producing tangible outcomes by mobilizing manpower and material where they can relatively easily make progress, such as housing construction.
During the ceremony, Kim lauded construction workers and officials for achieving nearly 400 percent progress last year compared to 2020, and pledged another plan to continue expanding the city.
The project would “usher in a new era of prosperity of Pyongyang in which the ideal streets of the people to be proud of in the world are built every year,” KCNA said.


Trump attends the Daytona 500 and says the spirit of NASCAR will ‘fuel America’s Golden Age’

Trump attends the Daytona 500 and says the spirit of NASCAR will ‘fuel America’s Golden Age’
Updated 17 February 2025
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Trump attends the Daytona 500 and says the spirit of NASCAR will ‘fuel America’s Golden Age’

Trump attends the Daytona 500 and says the spirit of NASCAR will ‘fuel America’s Golden Age’
  • “Daytona 500 is a timeless tribute to the speed, strength and unyielding spirit that make America great,” Trump said in a message on Sunday
  • During his Jan. 20 inaugural address, Trump said that “the golden age of America begins right now”

WEST PALM BEACH, Florida: Donald Trump, attending Sunday’s Daytona 500, for the second time as president, called the opening event of the NASCAR series a unifying event that possesses a spirit that will “fuel America’s Golden Age” — which he has said would happen under his leadership.
In a presidential message released as he flew to Daytona Beach, Florida, Trump said the Daytona 500 brings together people from all walks of life in a “shared passion for speed, adrenaline and the thrill of the race.”
“From the roar of the engines on the track to the echo of ‘The Star-Spangled Banner’ soaring through the stands, the Daytona 500 is a timeless tribute to the speed, strength and unyielding spirit that make America great,” Trump said. “That spirit is what will fuel America’s Golden Age, and if we harness it, the future is truly ours.”
Trump said in his Jan. 20 inaugural address that “the golden age of America begins right now.”
Air Force One buzzed the Daytona International Speedway before it landed. Trump traveled from West Palm Beach, Florida, airport with several guests, including his son Eric, his wife, grandson Luke, Transportation Secretary Sean Duffy and Interior Secretary Doug Burgum and his wife, Kathryn, the White House said. Several members of Congress are traveled with Trump.
His motorcade arrived at the speedway by driving onto a portion of the track. Trump’s limousine later led drivers on two ceremonial laps and he went on the radio to urge them to have fun and be safe.
“This is your favorite president. I’m a big fan. I am a really big fan of you people. How you do this I don’t know, but I just want you to be safe,” Trump said. “You’re talented people and you’re great people and great Americans. Have a good day, have a lot of fun and I’ll see you later.”
Trump was at the race in 2020 while running for a second term. He was given the honor of being grand marshal of NASCAR’s biggest and most prestigious event of the year and delivered the command for drivers to start their engines. Air Force One did a flyover and his limousine drove on the speedway back then, too.
Sunday’s race got underway in front of a sold-out crowd but was halted about an hour later after eight laps because of heavy rain that was expected to cause a lengthy delay. The sport’s fans are seen as leaning conservative and many in the stands on Sunday wore red caps that said “MAGA” for Trump’s “Make America Great Again” slogan. Trump, who watched the race from a suite, also wore a MAGA cap.
Trump, a sports fan, left the race during the rain delay but slightly ahead of when he was scheduled to depart. He is an avid golfer and attends college football games and UFC matches.
Last weekend, the Republican made history as the first sitting president to attend the Super Bowl.


In Ukraine, a potential arms-for-minerals deal inspires hope and skepticism

In Ukraine, a potential arms-for-minerals deal inspires hope and skepticism
Updated 17 February 2025
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In Ukraine, a potential arms-for-minerals deal inspires hope and skepticism

In Ukraine, a potential arms-for-minerals deal inspires hope and skepticism
  • Ukraine has vast reserves of ilmenite — a key element used to produce titanium — along the country’s embattled east
  • Much of it, as with all of Ukraine’s critical minerals industry, is underdeveloped because of war as well as onerous state policies

KIROVOHRAD REGION, Ukraine: The mineral ilmenite is extracted from mounds of sand deep in the earth and refined using a method that summons the force of gravity, resulting in a substance that glimmers like a moonlit sky.
Ukraine boasts vast reserves of ilmenite — a key element used to produce titanium — in the heavy mineral sands that stretch for miles along the country’s embattled east.
Much of it, as with all of Ukraine’s critical minerals industry, is underdeveloped because of war as well as onerous state policies.
That is poised to change if US President Donald Trump’s administration agrees to a deal with Ukraine to exchange critical minerals for continued American military aid.
In the central region of Kirovohrad, the ilmenite open-pit mine is a canyon of precious deposits that its owner is keen to develop with US companies. But many unknowns stand in the way of turning these riches into profit: cost, licensing terms and whether such a deal will be underpinned by security guarantees.
Ukrainian President Volodymyr Zelensky said Saturday at the Munich Security Conference that he did not permit his ministers to sign a mineral resource agreement with the US because the current version is not “ready to protect us, our interests.”
Ukrainian businessmen with knowledge of the minerals industry also privately expressed skepticism about whether a deal is viable. The capital-intensive industry is unlikely to yield results in years, if not decades, as geological data is either limited or classified. Many question what conditions American companies are willing to risk to build up the industry and whether existing Ukrainian policies that have so far deterred local businessmen will accommodate foreign investors.
“The main thing we can gain is certain security guarantees obtained through economic means, so that someone stronger than us has an interest in protecting us,” said Andriy Brodsky, CEO of Velta, a leading titanium mining company in Ukraine.
The question of security guarantees
A deal, which would essentially barter one resource for another, could help strengthen Kyiv’s relationship with the Trump administration.
The United States is a major consumer of critical raw earth minerals such as lithium and gallium, two elements that Ukraine has in proven reserves. Trump has specifically mentioned rare earth elements, but these are not well researched, industry experts told The Associated Press.
Titanium, used in aerospace, defense and industry, is also high in demand and the US is a leading importer of ilmenite. Sourcing the minerals from Ukraine would reduce future reliance on Russia and China.
In exchange, Kyiv would continue to receive a steady stream of American weaponry that offers leverage against Moscow and without which Ukraine cannot ward off future Russian aggression in the event of a ceasefire.
The question of security guarantees is a sticking point for companies, Ukrainian businessmen and analysts said. A senior Ukrainian official, speaking anonymously to describe private conversations, told the AP that US companies expressed interest in investing but needed to ensure their billions will be safeguarded in the event of renewed conflict. But once invested in Ukraine, the presence of American business interests alone might act as a guarantee, Brodsky said.
“If this process starts, it will continue,” Brodsky said. “Once the investment figures exceed hundreds of billions, the Americans, a highly pragmatic people, will protect their profits earned on Ukrainian soil. They will defend their interests against Russia, China, Korea, Iran and anyone else. They will protect what they consider theirs.”
Growing American interest
Brodsky, who just returned from a trip to Washington and New York, said the conversation among US businesses is changing in Kyiv’s favor.
“A lot of people in very serious and wealthy offices are saying that now, we — our country and my company — are in the right place and doing exactly what needs to be done at this moment,” he said.
Velta has worked with American partners for many years. Brodsky has begun negotiating with companies he believes could be a partner in the event of a deal.
Ukraine has never been attractive to foreign investors because of prohibitive government policies — not offering incentives to attract foreigners, for instance. Brodsky believes that international companies will need to pair up with local partners to flourish.
American companies have several ways to enter the market, explained Ksenia Orynchak, director of the National Association of Extractive Industries of Ukraine, but would require traversing “certain circles of hell” in Ukraine’s bureaucracy. Teaming up with an existing Ukrainian license owner is possibly the most straightforward.
She said more exploration is needed in the field and hinted existing data may have been acquired through ulterior motives. Under the Soviet system, geologists stood to gain if they claimed to have found large reserves.
“Someone did it so that Moscow would praise Ukrainian geologists or Soviet geologists,” she said.
She advises American investors to lower existing thresholds for exploration because bidding can take place in areas where reserves are only presumed, not proven.
“I believe, and so does the expert community, that this is not right. In fact, we are selling a pig in a poke,” she said.
A historically untapped sector
At the extraction site, the air is dense with ilmenite dust. When the afternoon sun’s rays pierce the darkened space, they sparkle and dance in the air. The soot covers the faces of workers who spend hours inside every day extracting the precious material from sand.
The gravity separation method removes unwanted elements in the ore and water separated from the mineral rains down through metal-lined floors. Workers are used to getting wet and don’t bat an eye. Titanium is developed from the purified ilmenite at a different facility.
Velta began in the form of an expired license for geological exploration and a business plan for $7 million when Brodsky acquired the company. It would be eight years and many millions more invested before he could even think about production capacity.
The deal also does not factor in a crucial element that could prove challenging later: The position of Ukrainian people themselves. According to the Constitution, the subsoil where extraction would take place belongs to Ukraine.
“I am very afraid that they (Ukrainian people) already had disapproving reviews, that everything is being given away. Who allowed him? He had no right? And so on,” Orynchak said.
Those sensitivities were echoed among workers at the Velta mine. Speaking anonymously to voice his true thoughts, one said: “If you have a vegetable garden in your home, do you invite a foreigner to take it?”
The high risk often is a key reason that some Ukrainian businessmen privately express skepticism about the deal.
When one businessman of a major group of companies heard about the arms-for-minerals deal, his first impression was: “This is just hot air,” he said, speaking on condition of anonymity to speak freely about his thoughts. “This is a very capital intensive industry. Just to take ground from an open pit will cost you billions. Not millions, billions.”