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Elijah McClain case: Pulmonary critical care physician analyzes McClain's decline in police, paramedic care

Posted: 1:01 PM, Dec 01, 2023
Updated: 2023-12-01 20:01:49-05
Elijah McClain

Two paramedics are at the center of the third and final trial in the case of Elijah McClain's 2019 death, and both defendants face charges of reckless manslaughter, criminally negligent homicide and assault, plus sentence enhancers.

McClain, 23, was stopped by officers with the Aurora Police Department (APD) on Aug. 24, 2019 and following a violent encounter, died a few days later.

Aurora Fire Rescue paramedics Peter Cichuniec and Jeremy Cooper are accused of injecting a significant amount of ketamine into McClain. Medical experts have previously testified that he was given a higher dose of ketamine than recommended for somebody of his size. In previous trials, prosecutors said the carotid hold, which was applied by police before paramedics arrived, played a key role in his death, while defense attorneys argued that the cause of death was only the ketamine, and McClain would have survived the police encounter without the injection. The ketamine led to cardiac arrest. McClain was declared brain dead and died Aug. 30, 2019.

Trial for Elijah McClain could affect all health care workers

Previously, a jury found APD Officer Randy Roedema guilty of criminally negligent homicide and third-degree assault, and former APD Officer Jason Rosenblatt, who was fired by the department less than a year after McClain's death, was acquitted of all charges. In the second trial, defendant APD Officer Nathan Woodyard was also found not guilty.

The trial for Cichuniec and Cooper is expected to last about a month.

Scroll down to read updates from the Dec. 1 proceedings.

Friday, Dec. 1

On day three of this trial, Dr. David Beuther, a pulmonary critical care physician at National Jewish Health, returned to the stand to continue questioning by prosecutors, which started on Thursday afternoon.

Beuther also testified on Sept. 22 and 26 during the first trial in the McClain case and again on Oct. 19, in the second trial.

Beuther described how in a hospital setting, medical personnel would not give ketamine or a sedative to somebody who was vomiting, since that causes stomach contents to come up through a person's throat and any medicine that alters the person's consciousness could impede their awareness of needing to cough and clear their airway. He added that without knowing a person's oxygen levels, doctors should be more cautious about administering that kind of sedative — he compared it to driving without being able to see through the windshield.

“Without some basic assessment, you would not want to proceed," he said.

He added that based on his opinion, he saw opportunities for the paramedics to perform an assessment that could include oxygen levels, awareness and basic vital signs, which was not done, according to prosecutors.

Regarding the ketamine injection, Beuther said a weight-based dosage is used to determine how much should be administered. It's about 5 mg per kilogram. In the field, where an exact weight isn't always available, a reasonable estimate is OK to use, he said. McClain, who was 140 pounds, was given 500 mg of ketamine, which is a suitable amount for a person who is 220 pounds.

Just before the ketamine injection, McClain was ill and progressively less responsive, Beuther said. This was a "stark change" when compared to his behavior earlier, he said. He said he would have expected paramedics to ask McClain some questions to analyze his response.

Between 90 and 120 seconds after the injection, McClain was even less responsive, he said. Around the two-minute mark, as he was loaded onto the gurney, he didn't appear to be breathing at all and was completely unresponsive, Beuther said. The BWC did not show any paramedics checking his vital signs or oxygen levels. Beuther stressed that it is very important to monitor a person after a sedative is given, because people can respond differently.

When prosecutor Joyce asked how significant the "event on the stretcher" was, Beuther responded: “It was most significant of all of my review of the video because I had, for once, a really good look from a medical perspective but also, it was a time he was clearly in trouble.”

The first time medical professionals learned he did not have a pulse was inside the ambulance, Beuther said. At that point, there was a "sudden and comprehensive assessment" of McClain underway, as detailed in the EMS record, he said. They learned he did not have a pulse and was not breathing, but were able to get the heartbeat back and inserted a breathing tube. The physician said they did a "remarkably good job" given the circumstances.

Beuther said there were six minutes between the ketamine injection and when he was in the back of the ambulance.

After McClain had died, Beuther looked over the toxicology report, which found the ketamine in his blood system and also marijuana. He said he looked to see if marijuana was a contributing factor in McClain's death, and ruled it was not. He also ruled out an allergic reaction and McClain's asthma. He ruled that McClain had suffered from a respiratory arrest followed by cardiac arrest. He also clarified that McClain did not have signs of a heart attack, which is different from a cardiac arrest.

Prosecutor Joyce then walked the jury through multiple body-worn camera videos that showed the interaction between McClain and officers in chronological order, and asked Beuther to analyze McClain's medical status in each instance.

Based on what he could see and hear in the videos, Beuther described how McClain appeared to be deteriorating and his sentences, which were full and strong initially, became shorter and quieter. Full sentences became one or two words, or grunts.

One of the final chronological clips showed McClain on the gurney and he was heard snoring. Beuther said he was in deep sedation at this point, and wasn't responding to stimuli.

“This is a situation where there is a significant reduction in the ability to cough, get material out of the lungs or breathe adequately," he said.

Prosecutor Joyce asked if Beuther had an opinion on what would have happened if the paramedics had never arrived. He responded that it was difficult to say, as McClain needed urgent medical attention, even before the ketamine injection. He said he would have called 911 if he saw somebody in that state, and that the "right answer" was not to not call paramedics, but rather to not have given the ketamine.

This ended the prosecutor's questions and defense attorney Shana Beggan, who represents Cooper, walked to the stand for a cross-examination of the pulmonary critical care physician.

Beggan went over Beuther's education and medical school training, while confirming that he is not board certified in various fields, such as pre-hospital care, toxicology, forensic pathology, and cardiology. Beuther also explained that while McClain had been previously hospitalized for his asthma, it was not recent. He added there was no record of any "significant heart issues" for him.

When asked, Beuther said he looked over various documents and evidence connected to this case, including medical records, transcriptions of interviews with McClain’s loved ones, BWC footage, intubation videos, Children’s Hospital records for McClain before August 2019, the coroner’s report and revised report, and the mask that McClain had vomited in during the police encounter.

Just before the court broke for lunch, defense attorney Beggan asked Beuther about his thoughts on what happened in the ambulance after the ketamine injection.

Beuther once again commended the medical professionals who worked to try to revive McClain. He said it was one of the hardest situations to be in and was very difficult. On the stand, he said he almost felt anxious for them, adding again that they did a great job.

The court broke for lunch at 11:52 a.m.

After the lunch break, Beggan continued the cross examination of Dr. Beuther with questions a research study about masks and whether they work to ease asthmatic symptoms of patients who use them, as McClain had been previously diagnosed with asthma and was described as a "casual runner."

In the redirect by prosecutor Joyce, questions to Beuther focused on whether he took any of McClain's previous conditions like asthma, his heart murmur, a collapsed lung he had as a teenager and an enlarged heart as considerations in his reports about the circumstances that led to his death.

"Yes, those were all taken into consideration," Beuther said. But the findings in the case "were overwhelmingly supportive of a global injury to the heart due to low oxygen that we commonly see after a respiratory arrest" that had nothing to do with previous diagnoses, he told the prosecution.

He also testified that McClain would have survived the acidosis, aspiration and hypoxia — which all were found to have contributed in his death — had he received medical treatment like oxygen support, antibiotics, respiratory therapy, administration of IV fluids, monitoring, and "a thorough assessment you can only do in a hospital."

Dr. Beuther was then excused from the bench and the next witness was called: Daniel de Jesus, a firefighter with Aurora Fire Rescue.

At the time of McClain's arrest in 2019, de Jesus was a basic EMT firefighter but has since been promoted to a fire medic. The prosecution started their line of questioning asking him about how the department responds to calls of service and who is assigned to what on any given day and went over what kind of health kits firefighters keep in their rigs as they respond to call.

Some of the kits include an orange trauma kit, a black kit used for airway care, a blue kit used for oxygen support, as well as a cardiac monitor.

De Jesus said the night of McClain's arrest, paramedics grabbed all of those kits because "we don't know what we'll be dealing with" at any particular call.

Questioning by prosecutors then focused on the role of Cooper and Chichuniec that night.

"Did anyone in the crew asked how they could help? If he had taken medications? His name? "No," De Jesus said.

"Did Cooper attempt to take a pulse? Did he ask to get more equipment? Was there anything done to check his airway?" "No," De Jesus again replied.

After several minutes of more lines of questioning and the showing of body-worn camera video that day, De Jesus was questioned on what was happening in relation the paramedics response the nigh of the arrest, which De Jesus walked through on several occasions.

Court was adjourned for the day and the judge told everyone inside he expected them to be in by 9:30 a.m. Monday.



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