At least 16 people died in California over a decade following a physical encounter with police during which medical personnel also injected them with a powerful sedative, an investigation led by The Associated Press has found.
Several of the deaths happened in the San Francisco Bay Area, including two in recent years involving people restrained by the Richmond Police Department. Other places with cases included Los Angeles, San Diego and cities in Orange and San Bernardino counties.
While the use of the drug ketamine has drawn scrutiny in other states, AP’s investigation found that California paramedics almost always used midazolam, better known by its brand name Versed.
The deaths were among more than 1,000 that AP’s investigation documented across the United States of people who died after officers used not their guns, but physical force or weapons such as Tasers that — like sedatives — are not meant to kill. Medical officials said police force caused or contributed to about half of all deaths.
It was impossible for the AP to determine the exact role injections may have played in many of the 94 deaths involving sedation that reporters found nationally during the investigation’s 2012-2021 timeframe. Few of those deaths were attributed to the sedation and authorities rarely investigated whether injections were appropriate, focusing more often on the use of force by police and the other drugs in people’s systems.
The idea behind the injections is to calm people who are combative, often due to drugs or a psychotic episode, so they can be transported to the hospital. Supporters say sedatives enable rapid treatment while protecting front-line responders from violence. Critics argue that the medications, given without consent, can be too risky to be administered during police encounters.
California was among the states with the most sedation cases, according to the investigation, which the AP did in collaboration with FRONTLINE (PBS) and the Howard Centers for Investigative Journalism.
Midazolam was given in 15 of the 16 California cases, all by paramedics outside of a hospital. The drug can cause respiratory depression, a side effect experts say may be dangerous when mixed with police restraint tactics that restrict breathing — or with alcohol or certain drugs that a person may already have consumed.
The 16th case involved a man injected with a similar class of drug, lorazepam, while police restrained him at a hospital in San Diego.
Two emergency room doctors in San Diego told the AP they have discussed switching to ketamine, which supporters say is safer and works faster than midazolam. But the doctors said negative headlines about ketamine, especially after deaths and misuse in Colorado, stalled that idea.
AP’s investigation shows that the risks of sedation during behavioral emergencies go beyond any specific drug, said Eric Jaeger, an emergency medical services educator in New Hampshire who has studied the issue and advocates for additional safety measures and training.
“Now that we have better information, we know that it can present a significant danger regardless of the sedative agent used,” he said.
Sedatives were often given as treatments for “excited delirium,” an agitated condition linked to drug use or mental illness that medical groups have disavowed in recent years. California in 2023 became the first state to bar excited delirium as a valid medical diagnosis, including as a cause of death in autopsies.
