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The Minneapolis Police Department instructed officers to ignore the findings from a watchdog investigation conducted by the city's Civil Rights Department that documented cases of police inappropriately asking paramedics to sedate uncooperative people during emergency calls, according to court testimony from the Police Department's former training commander.

At the federal trial of three former Minneapolis officers Monday, a defense attorney asked Minneapolis Police Inspector Katie Blackwell about a PowerPoint presentation on training for "excited delirium," a controversial diagnosis that usually refers to a person who is experiencing a potentially fatal state of agitation.

The training slideshow cited a draft of a 2018 report by the Minneapolis Office of Police Conduct Review that found a sharp rise in ketamine injections given to police detainees, along with examples of police asking emergency medical services for the sedative by name and joking about its powerful effects. A footnote on the police training slideshow dismissed the report as a "reckless use of anecdotes" that will "prevent the saving of lives."

"What you train these officers is this draft report is wrong and uninformed?" asked Robert Paule, attorney for former officer Tou Thao.

"Yes," Blackwell replied.

Blackwell said "one of our medical professionals" leads the training on excited delirium, but that she and former Police Chief Medaria Arradondo had reviewed and approved the slideshow. Mayor Jacob Frey, who is in charge of the Police Department and expressed deep concern over the sedation report's findings in 2018, did not respond to a request for comment Monday.

Six days into the trial, the Police Department's past training on excited delirium has become a central point for the defense. Blackwell testified for her third straight day on training, followed by testimony from the Hennepin County medical examiner in the afternoon.

Last week, Blackwell told jurors that former officers Thao, Thomas Lane and J. Alexander Kueng defied department training when they helped restrain George Floyd on May 25, 2020, and Thao and Kueng failed in their duty to intervene when Floyd fell unresponsive. On cross-examination, Paule showed slides on the department's excited delirium training that included videos and photos of other officers pinning down suspects with their knees, similar to how officer Derek Chauvin detained Floyd.

Last week, Paule pointed out many of the symptoms Floyd exhibited that day matched police training on excited delirium symptoms.

Excited delirium has become an increasingly controversial diagnosis in recent years, and some medical and human rights officials have questioned whether it's overused to justify deaths in police custody, sometimes involving the use of a Taser. The American Medical Association has publicly opposed the diagnosis.

Asked why police train for a diagnosis that is disputed among medical professionals, Blackwell said, "If you're dealing with somebody who is displaying signs of excited delirium, it can be very dangerous."

In a statement Monday, police spokesman Garrett Parten said the department's training "no longer uses the term excited delirium," in accordance with the American Medical Association's statement last year.

"The most recent fall 2021 training delivered to all department members by the physician did not include the term excited delirium," Parten said. "MPD training emphasizes identifying altered mental status as a potentially serious medical emergency and obtaining EMS assistance as soon as possible. The planning to provide updated training to all MPD officers without the use of the term began shortly after the AMA's adoption of the policy."

In 2019, Elijah McClain, a 23-year-old Black man, died after being injected with ketamine while handcuffed by police in Aurora, Colo. The police officers who detained him said McClain was erratic and exhibiting superhuman strength, signs associated with excited delirium. Critics say the paramedics appeared to be acting on behalf of police and not their patient. The city of Aurora subsequently paused the use of ketamine.

The quote attached to the training, undermining the sedative report, is not attributed. But it's identical to a statement previously issued by Dr. Jeffrey Ho, medical director of EMS at HCMC, and a colleague. Ho moonlights as a law enforcement officer and has written extensive articles about the dangers of excited delirium, some with funding from Axon Enterprise, Inc., the Arizona-based Taser manufacturer. In 2019, Ho left his position as Axon's medical director, which he held in addition to his job at HCMC, after public officials called the relationship a conflict of interest.

Sedative report

In 2018, Minneapolis elected officials hailed the Minneapolis Civil Rights Department's sedative report as an exceptional example of the city's police oversight commission identifying problematic behavior and recommending policy changes.

"[Use of ketamine] feels like a violation of the spirit of our community," said then Council Member Steve Fletcher. "What most of us feel is recoil."

The Star Tribune obtained a draft copy of the report and published excerpts weeks before the final version was published. The final report, like the draft, showed a surge in popularity of ketamine as an emergency sedative mentioned in police reports, with its use soaring from two incidents in 2010 to 62 in 2017. It recommended the police create clearer protocols for officers dealing with emotionally disturbed people.

The report found police officers asking for ketamine by name when they called paramedics to a scene, though city officials say it's inappropriate for law enforcement to diagnose what medical intervention is needed. Police leadership issued a departmental order saying that officers "shall never suggest or demand EMS personnel 'sedate' a subject."

"This is a decision that needs to be clearly made by EMS personnel, not MPD officers," the memo said.

In one instance in the report, police responded to a possible suicidal individual. They found the person asleep at home and put handcuffs on, then an officer made an injection motion and laughed before paramedics injected the person with ketamine, the report said.

In another, police restrained a suspected jaywalker, who called the officers profane names. "The individual actively resists arrest and scratches one of the officers before being handcuffed, hobbled, fitted with a spit hood, strapped down to a stretcher and loaded into an ambulance," the report stated. One officer then punched the person in the face, and paramedics injected ketamine, despite the person's objections. Afterward, one officer referred to ketamine as "the good stuff."

In a different case, a man who had been sedated with two shots of ketamine became nonverbal, and an officer said "he just hit the K-hole," referring to the powerful sedative effect.

In response to community calls for an outside investigation, Frey hired former Acting U.S. Attorney General Sally Yates to conduct a separate review of police and sedatives. But the Minneapolis City Council cut the contract short, calling it too expensive to finish and repetitive of the civil rights division's report.

Yates' preliminary report found 10 instances in which officers showed "a high degree of familiarity" with the powerful sedative ketamine. Officers then took a "concerning level of participation in conversations with EMS regarding" injecting people with ketamine during emergency calls. In 2019, Yates lamented that the city was leaving "important questions … unanswered" in regard to the police department and sedatives.

Medical examiner testifies

Also on the stand was medical examiner Andrew Baker, who testified that Floyd's heart and lungs stopped due to restraint by law enforcement.

"I view his death as being multifactorial," Baker said, attributing the death to the duration of his "interaction with law enforcement" for 9½ minutes along with his already enlarged heart and hardened arteries.

Baker ruled out a series of other possible contributing factors, including fentanyl and methamphetamine found in Floyd's body, and carbon monoxide poisoning. Baker is expected to return to the stand Tuesday.