CITY OF MINNEAPOLIS MPD Involvement in Pre-Hospital Sedation Office of Police Conduct Review Civil Rights Department July 26, 2018 1
OPCR PCOC Office of Police Conduct Review Police Conduct Oversite Committee ~ MDCR Staff ~ ~ Public Appointed ~ MCO 172.80 MCO 172.90 Program Reviews Program Reviews/Audits • Evictions and Calls for • MPD Involvement in Service Pre-Hospital Sedation • Domestic Violence Response Research and Study • Mental Health and Policing – Preliminary Study results 2
Introduction • Audit authority • Purpose • Greater implications 3
Timeline • Internal Audit’s Body Worn Camera Review • OPCR Complaint • Analysis Period [Winter, 2017 – Spring, 2018] • Video analysis • Police report review • Policy research • Draft Report • Draft Report Dissemination • Final Report 4
Report Contents • Ketamine • Method • Data • Case Studies • Recommendations 5
Ketamine • What is ketamine? • Hennepin County conducted multiple studies • Study findings 6
Risk Assessment • No corresponding MPD policy • Officers are assisting in administration of sedatives without formal guidance • Officers participating in decision-making regarding pre- hospital sedation • Importance of controls • Hennepin County ketamine policy • Profound agitation 7
Data Analysis • Analysis Process • Methodology created in advance • Not intended to capture every instance in which a sedative was administered • Big picture of what is creating potential risk, frequency of events, common trends 8
Results MPD Reports Citing Ketamine Administration 70 62 60 50 40 35 30 20 14 8 6 10 3 2 0 0 2010 2011 2012 2013 2014 2015 2016 2017 9
Data Analysis • Date, Time, Location • Computer Aided Dispatch (CAD) Problem, Offense listed in report • Whether body camera recordings captured the incident • Whether the call was coded as emotionally disturbed person (EDP) • Whether MPD discussed ketamine prior to the arrival of EMS • Whether the decision to use ketamine was captured on video • Whether MPD specifically called for ketamine • Whether MPD assisted EMS when the ketamine injection occurred • Whether the individual resisted either passively or actively • Where the injection occurred (street, ambulance, hospital) • Whether the individual was restrained and if so, how • Whether the individual was a minor • Whether the individual was reported to have used intoxicants prior to the injection • Demographic information 10
Results • Observations from BWC recordings or reports from 2016-2018: • 76 instances of officers assisting EMS professionals during ketamine injection • 8 instances in which officers were involved in decision- making • No instances of MPD officers administering ketamine 11
Video Analysis • Work of Video Analyst • Locate and review BWC footage for MPD incidents to assist in the investigation of police complaints and provide data for OPCR audit projects. • BWC video provides important context to police incidents that is not otherwise captured in standard police reports. • Hundreds of hours of review were completed in order to fully assess what was happening so recommendations could be made and what is happening could be understood. 12
Case Studies • Common Use Case • An MPD incident which appeared to be exemplary of the type of incident in which pre-hospital sedation would commonly be found. • Exception Cases • Four cases which appeared to be exceptions to the type of incident in which pre-hospital sedation would commonly be found, and which raised questions about how and when it is being used, particularly from the perspective of MPD involvement in administration. • Information vetted by City Clerk 13
Common Use Case • Individual is being restrained by private security when MPD arrives. • Individual is unable to verbally communicate beyond screaming, “1, 2, 3!” repeatedly. • Individual is physically resisting. • MPD officers not involved in pre-hospital sedation decision-making. • Individual is sedated prior to being loaded onto a stretcher. • Once sedated, individual is placed into an ambulance and transported to HCMC. 14
Exception Case 1 • MPD responds to a call involving an emotionally disturbed person. • Individual is restrained by MPD officers and does not physically resist. • Officer is familiar with ketamine, and specifically requests it to be used throughout the incident, and mentions the use of sedation to the individual several times. • In this instance, EMS professionals do not sedate the individual. 15
Exception Case 2 • Individual appears to be intoxicated, requesting medical attention, specifically an asthma inhaler. • MPD officers restrain the individual, who does not physically resist. • MPD assists EMS professionals load the individual onto a stretcher. • Once inside the ambulance, the individual is given ketamine. • MPD officers are not involved in decision making regarding pre-hospital sedation 16
Exception Case 2 • Per the corresponding police report, the individual stops breathing and is taken to the HCMC STAB Room. • After transport, an MPD officer discusses sedation with an EMS professional who states that they are doing a study on agitation, and had to give the individual ketamine. 17
Exception Case 3 • Individual has had numerous interactions with MPD. • Individual is restrained prior to being injected with ketamine. • MPD officers are not involved in decision-making regarding pre-hospital sedation. • Individual verbally objects to being injected with ketamine, but is ultimately injected. • Body camera video ends before transport to HCMC. It is unclear if the individual receives additional injection(s). 18
Exception Case 4 • MPD and EMS professionals respond to an EDP call. • The individual appears to be confused, possibly intoxicated. • The individual is handcuffed, and restrained in a stairs chair to be taken from the residence. • MPD participates in the decision-making regarding pre-hospital sedation. 19
Exception Case 4 • The individual is given three injections of ketamine. An EMS professional states that the third injection is over the dosage for the individual’s size. However, a second EMS professional authorizes the third injection. • MPD and EMS professionals discuss that they will need to intubate the individual after the injection. • Per the corresponding police report, the individual stops breathing and their heart stops. 20
Case Studies: Conclusion • Analysis showed that Minneapolis Police Officers are involved in pre-hospital sedation in a variety of ways. • Lack of policy for officers leaves no controls or guidance on the proper interaction with EMS professionals who are administering pre-hospital sedation. • Case studies paired with data show the need for recommendations to be made on controls. 21
Recommendations • MPD should create a policy covering appropriate actions with EMS professionals and requirements for writing reports and reporting to a supervisor when assisting EMS professionals. • COMPLETED : See MPD Policy 7-350 EMERGENCY MEDICAL RESPONSE • Officers should be provided guidance for its implementation. 22
Recommendations • MPD should explore additions to the Policy and Procedure Manual regarding interactions with emotionally disturbed persons. • MPD should establish a protocol with Hennepin County surrounding any potential future involvement in medical research. • City leadership should explore options for notification of medical research involving constituents and visitors. 23
Recommendations • City leadership should request answers to any remaining questions about the use of ketamine outside the scope of this report. • OPCR will establish document control processes to prevent unauthorized disseminations. • COMPLETED : See Appendix 6 OPCR Document Controls 24
Closing Statement • Receive and file report • OPCR directed to publish report 25
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