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Elijah McClain case: Witness for the defense, with decades of experience as a paramedic, testifies on protocol

Posted: 1:24 PM, Dec 15, 2023
Updated: 2023-12-19 17:48:42-05
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.

Advocates call for change after officer acquitted in McClain's death returns to work

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. 15 proceedings.

Friday, Dec. 15

Gary Ludwig, a Missouri-based expert with 46 years of experience as a paramedic, was brought back to the stand Friday for the defense to finish its direct examination.

Defense attorney Michael K. Pellow, who represents paramedic Cooper, asked Ludwig to define the acronym "SOAP" used by paramedics.

It's a process paramedics learn for what to do when they arrive on scene, according to Ludwig. "S" stands for gather "subjective" information you have been told by others— dispatchers, law enforcement on the scene and witnesses if there are any. "O" stands for collect "objective" information— what you are seeing and information or data you are gathering on scene. "A" stands for make a final "assessment" of what's going on with the patient, and "P" stands for make a plan of what you will do based on that assessment.

Ludwig expounded on his testimony from Thursday that Cooper did not approach the patient to gather objective information— after initially asking law enforcement if he spoke English— out of safety for the patient.

"You can provoke somebody by engaging an agitated patient," Ludwig said.

Pellow had Ludwig clarify there were no other witnesses on the scene of McClain's arrest, other than the Aurora police officers, to provide subjective information to the paramedics. And Ludwig testified the details that officers did tell Cooper and Cichuniec were "clearly" symptoms of excited delirium— the basis for which the paramedics cited their reasoning to administer Ketamine to McClain.

One of the main points of debate in this case is the dose of Ketamine that McClain received based on his weight. The paramedics overestimated McClain's weight and gave him more than the 5 mg/kg dose that is prescribed in the Aurora Fire Rescue protocols.

After Pellow had Ludwig review the body-worn camera video of McClain's arrest in preparation for the trial, the defense attorney asked the witness if it appeared Cooper and Cichuniec had a scale on scene.

"I don't know anyone who carries a sale on a firetruck. There's no way of weighing patients in the field," Ludwig answered.

He elaborated that there were extenuating circumstances making it difficult to estimate McClain's weight at the scene, including it was dark, there were officers on top of him and Ludwig described McClain as wearing a "bulky" coat.

Pellow went through AFR protocols, showing Ludwig a diagram given to paramedics instructing them what to do if a patient is exhibiting signs of excited delirium. The recommendation is give the patient Ketamine.

"It's not optional. It's what the medical director wants them to do," Ludwig testified.

Throughout this case, the prosecution has called into question why the paramedics didn't reassess McClain by hooking him up to medical equipment before moving him to the ambulance.

Going through the AFR protocols during direct examination of Ludwig, Pellow asked Ludwig if the protocols specified where the reassessment must be done. To which Ludwig responded, "No, it does not."

Ludwig testified, the paramedics waiting to get vital signs until McClain was on the stretcher and back in the ambulance was "the optimal way to handle this situation." He said it would take multiple steps to leave him and get the equipment you need. Whereas you could just take him to the ambulance where all the equipment's at. "It's a well-lit environment. It's a controlled environment," Ludwig said.

And according to Ludwig's testimony, the AFR protocols direct paramedics using Ketamine to put on medical devices once the patient is sedated.

Cichuniec's defense attorney, Michael Lowe, asked Ludwig about what protocols dictate when it comes to who's responsible for scene safety when paramedics appear on scene and who that person was the night McClain was arrested. To which Ludwig answered, "Cichuniec."

The prosecution has drawn attention to Cichuniec appearing in BWC video down the street, not near McClain throughout the case.

When Lowe brought up the issue during his direct examination of Ludwig, the witness said, "I saw him [Cichuniec] observing the overall scene... The scene officer always has to maintain situational awareness."

After a quick break, Prosecutor Jason Slothouber conducted a cross examination of Ludwig, drawing on Ludwig's earlier testimony about the assessment of the patient paramedics perform.

He asked Ludwig about "therapeutic communication techniques" taught to paramedics to build rapport with their patient.

"I teach them to ask open-ended questions. Be compassionate," Ludwig said.

When pressed on whether Cooper or Cichuniec asked McClain open-ended questions, he replied, "If the patient's not making sense, there's no point asking."

The court took a mid-morning break just before 10:15 a.m. and returned at 10:30 a.m.

Slothouber revisited the protocol diagram the defense discussed with Ludwig, pointing to the step before administer Ketamine, which he said was "reasonably address the patient's concerns." The prosecutor pushed Ludwig to answer whether Cooper or Cichuniec addressed any medical conditions with McClain, which he confirmed they hadn't.

Ludwig was excused as the court took a break for lunch. The judge ordered everyone to return at 1:15 p.m.

After the break, the defense called on Dr. Srikanth Sundaram, a cardiologist with expertise in cardiac electrophysiology (the electrical functioning of the heart) at South Denver Cardiology.

Dr. Sundaram was asked to provide an anatomy lesson of the heart to jury and was asked about Dr. Cina's previous autopsy reports — the first he published and the amended autopsy report — and was asked by Pellow if Cina ever referenced a problem with McClain's left anterior descending artery (otherwise known as LAD). Sundaram said that Cina did note in his autopsy report, noting McClain's LAD was narrowed, "between 50%-75% of normal," according to Sundaram.

The defense then questioned Dr. Sundaram about heart spams and whether it could affect someone with a narrowed LAD.

"It basically mimics as a heart attack," the doctor said. "The patient will have the same exact symptoms."

As more questioning surrounding McClain's heart after the encounter with police and paramedics proceeded, Dr. Sundaram testified that McClain's troponin levels (a test to see how much damage the heart has suffered after an injury) showed signs consistent with a "very small heart attack or consistent with a cardiac spasm."

In cross examination, prosecutor Ann Joyce tried to poke holes in Dr. Sundaram's expert opinion after reading reports and opinions of other doctors and not because of a "medical degree of certainty."

"In your report, your opinion is based on the 'most likely' cause of death. It does not state to a 'reasonable degree of medical certainty.' In fact, your opinions are all stated in 'likely,' 'possibly.'

"Correct," Dr. Sundaram replied.

Joyce then questioned Dr. Sundaram if he asked to see microscopic slides of McClain's heart or whether he ever spoke to Dr. Cina himself to form his expert opinion about McClain's heart condition before the arrest and after the deadly encounter with police.

"I didn’t know I could do that nor would I do that without the court’s permission," he said.

Joyce then asked the doctor if the findings in the autopsy report eve show that there was a narrowing of the coronary artery.

"The findings don’t even mention wraparound LAD?" she asked. "Correct," replied. "You also mention that McClain did not have collateral blood vessels?" she asked. Where in the reports, does it have this statement?"

"It does not have this statement," he replied.

On trying to poke holes at his testimony that McClain could have had a coronary spam, Joyce asked if McClain any of the main risks for coronary spams, which include being older, having diabetes or a high blood pressure.

Sundaram replied that McClain had none of these factors.

"You have no knowledge of McClain ever suffering from a coronary spam, do you?" Joyce asked.

"Correct," Dr. Sundaram replied.

"In your entire review of the UCHealth records, none of them say he had a coronary spam?" Joyce asked again. "Correct," he replied. "And you’re the only one who says he had a coronary spam?"

"Yes," Dr. Sundaram said.

In the redirect, defense attorneys for Cichuniec asked about McClain's breathing and whether having a history of congenital heart problems can lead to breathing issues, to which Dr. Sundaram said heart spams is one of the issues he would look like from a patient complaining of difficulty breathing.

The witness was excused and the court then went on recess for the weekend. Testimony is expected to resume Monday at 8:30 a.m.



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