Hunter Barr was a “very good soul” who had lots of friends, rarely got angry, lost himself in playing the guitar and piano, and liked to toke marijuana now and again, says his father, Mark Barr.
“He was just really easygoing,” Barr says. “He never argued with me.”
So on Sept. 25, 2020, when the 26-year-old swept his arm across the mantel, knocking everything off, Barr worried about his son’s health and safety.
Hunter told his dad that morning he’d taken LSD. He stumbled and fell a couple of times, leading his dad to call 911 for help.
After police officers pinned him to the ground and handcuffed him, paramedics injected Hunter twice within about five minutes with the controversial drug ketamine to calm him.
Less than three hours after Mark Barr called for help, his son was dead of a toxic dose of ketamine, the initial autopsy report said. That report was later amended to list cause of death as toxic effects of ketamine combined with LSD and cough medicine.
Now, Mark Barr and Hunter’s mom, Carma McMichen, have given several government agencies notice they might file a lawsuit alleging Hunter’s “wrongful death.”
Ketamine’s use in non-hospital settings for those who experience excited delirium, itself an unsettled diagnosis in the medical community, has taken center stage in a national debate after the August 2019 death of Elijah McClain, 23, in Aurora.
The normally docile, slightly built McClain was dosed with the drug after police stopped him as he walked home, waving his arms and singing, because someone reported he looked “sketchy.”
Now, state lawmakers have proposed House Bill 21-1251, which would tighten requirements for the use of ketamine. And the Colorado Department of Public Health & Environment is revisiting a program that issues waivers for emergency responders to inject ketamine.
But even if those efforts lead to major changes in ketamine’s use, for Hunter Barr, it’s too late.
Barr’s parents’ attorney, Henry Miniter of Greenwood Village, declined to provide the Indy with a comment about Hunter’s death. His mother, who lives in Alabama, couldn’t be reached.
But his dad questions why his son was given ketamine in the first place, much less two doses. “They already had him face down and had his hands cuffed behind his back already before they administered the sedative,” Barr tells the Indy. “I was wondering what the need was for it at that point.”
He also wonders why the medical professionals weren’t more on top of his son’s condition, given that he disclosed to medics and police right away that Hunter had taken LSD.
“When I got to the hospital, they were asking me what he took,” Barr says. “They should have known. They acted like they didn’t know what all he had in his system.”
What happened to Hunter that day is depicted in CSPD’s case report and body camera videos obtained by the Indy through an open records request and Barr’s parents’ notice of claim submitted Feb. 2.
The police report says Mark Barr called police because his son was acting out and appeared to be under the influence of drugs, though he’d never known him to use drugs other than marijuana and cough syrup.
He later told police, as reported by CSPD Officer Andrew Kessler, that when he spoke to Hunter that day, “he immediately could tell by looking at Hunter’s face that ‘something was not kosher.’”
When he asked Hunter what was wrong, Hunter told his dad, “I think I’m dying,” Kessler’s report says.
They both went to the basement and talked for about 30 minutes, during which Hunter “was making unusual movements with his body and was often incoherent,” Kessler’s report says.
“Mr. Barr said he could clearly tell that something was wrong and that Hunter was under the influence of an unknown substance,” the report says. His dad later asked what Hunter had taken, and Hunter told him LSD.
At one point, Hunter swept off the mantel, knocking things to the floor, including an elephant figurine he’d given his dad for Christmas a few years back. He also fell a couple of times, his father told police.
“Mr. Barr called 911 as he was concerned for Hunter’s medical well-being thinking he was overdosing,” Kessler’s report says.
After officers were called at 10:34 a.m., Cpl. Allison Detwiler ascertained from Hunter’s dad that he didn’t have any weapons and that he had taken LSD.
Hearing “banging and yelling” from inside the house, Detwiler says in her report she saw Hunter fall face first through a storm door.
Though at first he appeared cooperative, she says, “He was very strong and struggling with all of us and even with the weight of my body on his legs he was able to completely lift his legs with me on top of them off the ground numerous times before medical got there to intervene.”
Firefighters from Fire Station 15 arrived and “asked the father several medical questions before giving Hunter [redacted] and attempt[ing] to calm him down,” Detwiler writes in her report. “Even while restrained Hunter continued to fight officers.... After Hunter continued to be very combative... CSFD gave a second dose of [redacted] which calmed him enough that we were able to put him on [a] medical stretcher and have him transported to Memorial [Hospital] North.”
Officer Benjamin Johnson described the scene this way in his report:
“While Officers were attempting to evaluate Hunter he became combative. Hunter was originally in a face up position and then was rolled over by Officers to a face down position and I placed him into handcuffs. Officers did not use any take down or pain compliance techniques on Hunter. Officers advised medical [personnel] who were on scene it was safe for them to contact Hunter. Officers continually spoke with Hunter who was unable to hold a conversation and was incoherent. During my contact with Hunter he continually balled his fists, arched his back, kicked his legs, and attempt[ed] to break the handcuffs he was in then immediately would go limp. This up and down cycle continued the entire time we were on scene.”
Johnson also says in his report that “medical [personnel] administered an unknown drug to Hunter with the intent to calm him down,” and, “Officers were instructed by medical personnel to keep Hunter in the position he was in until the drug took effect and could safely move him.”
Kessler says in his report, “Due to Hunter’s semi-conscious state and his in-and-out lucidity, officers were able to use a minimal amount of force to gain compliance and restrain him.” But he also notes that Hunter continued to resist officers.
“Medical personnel eventually administered a drug, unknown to this officer, in an attempt to calm Hunter so they could transport him to the hospital safely,” Kessler wrote.
The bodycam footage shows officers restraining Barr. Though he initially kicks, moans and writhes, Hunter is subdued by being handcuffed behind his back and then rolled face down in the dirt. Three officers hold him down.
Hunter alternately stiffens and flexes his body and then lies still but doesn’t appear to actively fight against officers.
Officer Johnson rubs Hunter’s back, advising him to “breathe slow in and out, in slow, out slow,” and warning him, “You’re just going to hurt yourself.”
Hunter groans and says, “Motherfucking god.” And, “damn, ah, ah, holy shit. Holy motherfucking shit.”
Detwiler tells paramedics, “Hey, guys, can you come up real quick and get him something?”
When someone asks what drugs he might have taken, Detwiler says, “LSD is what dad is saying. He’s still fighting pretty good.”
A firefighter in personal protective equipment can be seen in the background retrieving something from a bag. An American Medical Response (AMR) medic wearing a patch imprinted with “Colorado Springs Paramedic El Paso County” injects Hunter in the right hip, though the injection site is blurred on bodycam footage. Also, audio is silenced at times, presumably when medical information is discussed, due to privacy laws that protect such information.
After the injection, Hunter lies still but continues to groan and says, “I’m all right now.” Less than five minutes after the first dose, the medic appears to inject him again when Hunter is docile.
“We’re here to help you, man,” one officer tells him.
At one point, an officer asks Hunter, “You got any hobbies? What do you like to do? You a gamer?”
With his face pushed into the dirt, it appears he has difficulty breathing.
When an officer tells Hunter they’re going to roll him onto his back, he says, “Don’t you ever. Damn.”
After being rolled over, he is conscious but shivering and tense. Eventually, someone wipes his mouth, which appears to contain dirt, and he’s loaded onto a gurney and placed in the ambulance. No breathing equipment was used prior to him being placed in the ambulance.
Later, at the hospital, Kessler interviews Mark Barr and explains that officers don’t believe Hunter committed a crime. “The reason we’re doing this is because we want to see what led up to this, so that if anything happens to him negatively we can show what was happening prior to us getting there. We have to do a report. Any time we use any kind of force we make a report,” Kessler says.
Before he parts with the elder Barr, the officer says, “I hope everything turns out OK.”
Hunter died at 1:24 p.m. that day.
Several days later, Barr met with officers at a police station to relinquish his son’s two cell phones to investigators.
During the exchange, Barr breaks down. “They lost his pulse so they worked on him 20 minutes. They couldn’t get the pulse back,” he says, covering his eyes and weeping. “I just told them to go ahead and stop.”
CSPD Public Information Officer Lt. Jim Sokolik says police officers don’t order that drugs be given, “because that’s not in our purview.
“The determination to give any kind of medical treatment would lie with the medical professionals,” he says, adding that CSPD can’t comment on the Barr case due to pending litigation.
In the notice of claim, attorney Miniter lists potential defendants, including the Colorado Springs Fire Department, Police Chief Vince Niski, then-Fire Chief Ted Collas and Mayor John Suthers. He says the lawsuit could seek $10 million in damages.
A city spokesperson declined to comment, citing potential litigation.
The claim letter notes that EMS providers “elected” to inject Barr with ketamine; he arrived at Memorial North unconscious, suffered cardiac arrest and, “Despite concerted efforts from a team of physicians and nurses, Hunter Barr expired in the emergency department.”
The letter also notes that Dr. Travis Danielsen with the El Paso County Coroner’s Office at that time ruled that Hunter’s death resulted from “toxic effects of ketamine,” which is reflected on the death certificate.
The coroner’s report, however, was later amended to state cause of death as “toxic effects of ketamine in the setting of dextromethorphan [a drug found in cough medicine] and lysergic acid diethylamide [LSD] intoxication.”
It was also amended to add that Hunter displayed symptoms that are consistent with “seratonin syndrome,” a condition that the health website 10faq.com describes as having high seratonin levels that disrupt neurotransmitters and can be brought on by taking certain types of drugs, including antidepressants, cough suppressants, some painkillers, illegal drugs and some supplements.
Symptoms include hypothermia, agitation and restlessness, roving eye movements, muscle rigidity, tremor, nausea, vomiting and diarrhea, heavy sweating, shivering and goosebumps, high blood pressure and rapid heart rate, the website says.
The amended autopsy report described Barr as febrile [feverish], agitated, hypertensive and perspiring heavily when EMS personnel treated him.
El Paso County Coroner Dr. Leon Kelly tells the Indy by phone that the autopsy found LSD in urine but didn’t test Barr’s blood for the hallucinogen.
“The challenge, though, is you can’t use urine alone to determine if someone is intoxicated,” Kelly says. “The issue is whether he was intoxicated at the time of his arrest.” And that requires testing the blood, he says. Blood testing performed after the original autopsy report was issued showed the presence of LSD.
Kelly says he became aware of the case from the Indy’s Feb. 19 blog post about Barr’s death and UCHealth’s subsequent request for information in order to conduct a review of the case. That triggered his second look at the autopsy report to further explore “how the drugs interacted.”
While LSD won’t kill someone, Kelly says, when used in combination with other drugs, a person can suffer from hyperactivity, agitation and a racing heart, which can bring death.
The level of LSD is less important than its mere presence in his system, Kelly notes. “It’s the setting in which LSD was used that causes death,” he says. “It’s not how much was there but that it was in the blood.”
He further explains there’s no specific “lethal” dose of ketamine. “Anyone having surgery has a lethal level of drugs in their system,” Kelly says. “Ketamine is no different.” Medical personnel must assure a patient’s airway is supported, assure he or she is breathing, has oxygen and a normal heart rate, he says, adding, “As long as that’s OK, they’re going to be fine.
“When you go to surgery and they use sophisticated sedatives, they have this opportunity to have a conversation with you [beforehand] to identify at-risk scenarios,” Kelly says. But on emergency calls, use of ketamine becomes a contemporaneous decision, sometimes made without consultation with a patient, he says.
If a person under the influence of ketamine, or any sedative, starts having trouble breathing, “you intubate them, breathe for them and support them, just as you would do in surgery, and that’s the responsibility of first responders to do that.”
Kelly didn’t suggest that medics involved in Barr’s treatment failed to take appropriate action, noting, “All drugs interact with other drugs. It depends on what other drugs are on board. That’s when you get into trouble, when you can have adverse outcomes.”
The coroner says whether two doses of ketamine were excessive is a debate that falls within the bigger conversation taking place nationally, as well as whether it’s appropriate to use the drug at all outside a hospital setting.
In his view, ketamine can be used appropriately in certain non-hospital circumstances. “The important thing is the use of that medication is driven by doctors and medical protocols, not as a chemical means of restraint,” he says. “If it’s being used to restrain people, then that’s not an appropriate use.”
Calling the Barr case one of the 10 most difficult toxicology cases of his career, Kelly terms it “a good example of use of this drug in that setting when things can go wrong.”
The Colorado Department of Public Health & Environment has issued waivers to dozens, if not hundreds, of medical providers to direct use of ketamine and other emergency procedures outside a hospital setting with special permission. (That list can be found at tinyurl.com/4yznzxe2.)
EMS providers work under the direction of physicians, who define a scope of practice for that purpose. The use of ketamine is not included in that scope of practice, which means physicians must obtain a waiver to allow EMS workers under their purview to use it.
The application is considered by the state’s Emergency Medical Practice Advisory Council, which makes a recommendation to CDPHE on whether it should be granted. CDPHE then decides.
Medical directors for fire departments and emergency ambulance providers throughout the Pikes Peak region have obtained ketamine waivers.
Dr. Eric Bronsky with Centura Health serves as CSFD’s medical director. (The other CSFD and AMR medical director is Dr. Matthew Angelidis with UCHealth, who says through a spokesperson the ketamine waivers are under Bronsky’s name, but the two share medical direction responsibility and oversight.)
Bronsky’s waivers allow dispensing of ketamine by CSFD and AMR for pain management, “excited delirium” and for Rapid Sequence Intubation (RSI). Medical website emra.org explains that RSI is used “when there is neither the time nor the luxury of adequately prepping a patient whose airway and breathing are compromised.” The process includes using an “induction agent,” one of which is ketamine, which acts as “an anesthetic, amnestic, and analgesic.”
State records show Bronsky’s waiver for ketamine was most recently renewed for three years, effective Sept. 8, 2020. The permission was granted for CSFD and AMR paramedics to administer ketamine “independently” under standing orders, as opposed to only under direct supervision of a higher level health care provider. That means medics on scene can act without contacting Bronsky before they use the drug.
According to data provided by the state, ketamine was administered 264 times by CSFD and AMR in 2018 under Bronsky’s waiver. AMR also provides emergency ambulance service in the county outside the city. It was used most often for pain management, but also was dispensed 16 times as a sedative, 20 times for RSI and 21 times for delirium. All but 21 of those uses resulted in “improved” condition of the patient, records show.
It was given in doses that ranged from 11 milligrams to 500 milligrams, but even at the highest dosage the drug didn’t always achieve the desired result. After a 500-milligram dose, one patient “still was combative” and the patient’s blood pressure barely budged, state data shows.
In 2019, the most recent full year’s data available from the state, 352 doses were given under Bronsky’s waiver — most often for pain, but also eight times as sedation, 22 times for delirium and 28 times for RSI.
Another set of state data shows that of the 1,833 ketamine uses under Bronsky, four, or a fraction of 1 percent, resulted in an overdose but no deaths in a three-year period ending in July 2019.
In his most recent waiver application, Bronsky notes the CSFD made 50,000 calls in the prior year, with nearly 85 percent being for medical and trauma cases. The need for ketamine is due to the “significant population of drug users” and “an increased psychiatric patient demographic due to our homeless and military populations.”
CSFD/AMR must be able to sedate those patients for safety reasons, according to the application, which called ketamine a “fantastic tool” for treating a “diverse range of patients with a high safety profile.” The application stressed that ketamine use is “reviewed extensively” via a quality-control program.
CSFD’s protocols for patients with extreme agitation prohibit use of ketamine on people under the age of 13. “Small adults” may be given 250 milligrams with that amount repeated after three to five minutes. For “larger adults,” — the autopsy report states Barr weighed 172 pounds — 500 milligrams of the drug can be given, but repeat doses require medics to “contact medical control,” the protocols state.
The protocols allow use of ketamine for “patients exhibiting signs of excited delirium.“
CSFD spokesperson Capt. Mike Smaldino says the city’s emergency medical crews, including AMR’s, injected 309 doses in 2020. He says only 27 doses, or 9 percent, were used for patients with extreme agitation; 222 doses were injected for pain, and 60 for “medication assisted airway management” and Rapid Sequence Intubation.
Through April 8, CSFD/AMR used ketamine for extreme agitation/excited delirium 17 times, and for pain management 156 times, Smaldino said.
Bodycam footage of Hunter Barr’s incident shows an AMR paramedic injecting Barr, but it’s worth noting that CSFD retains tight control over protocols of ambulance crews.
For example, CSFD’s contract with AMR specifically requires the company to contract with the city’s medical directors “to act as the Contractor’s supervising physician(s) for purposes of assigning and monitoring the quality of care and providing 911 pre-hospital medical care and education.”
Moreover, the contract assigns “on-scene authority” to the fire chief or company officer, and if questions arise as to medical treatment, CSFD “shall” make the “final decision.”
“[W]henever there is a question as to medical treatment or patient destination, the final decision shall be made by the CSFD chief officer, company officer, firefighter/paramedic, or on-line medical control,” the city’s EMS Operating Guide, a companion document to the contract, states.
The guide also notes the city “has authority over emergency medical services scenes” and “the ambulance Contractor’s employees shall operate under the City’s command & control structure and policies....”
The contract, though, also calls for AMR to be “responsible for the professional quality, technical accuracy, and the coordination of all services....”
Thus, the city presumably would have say-so on what drugs are given under what circumstances at a scene.
Asked about who specified use of ketamine in Barr’s case, AMR’s vice president of operations, Scott Lenn, says via email that federal privacy regulations prevent him from discussing individual patients.
As for who makes decisions in the field about ketamine use in general, Lenn says, “All protocols for clinical care are promulgated by the EMS system’s medical directors.”
But Lenn dodged a question about AMR’s position on using ketamine to restrain people, saying, “In Colorado Springs, the system’s protocols provide for the use of ketamine in certain circumstances.”
Smaldino declined to comment on the Barr case specifically in light of the notice of claim.
Similarities can be drawn to two previous high-profile cases — McClain’s death and that of George Floyd, whom officers described as being in an agitated state when he died in May 2020 under the knee of ex-Minneapolis police officer Derek Chauvin, now on trial for murder.
The Adams County coroner report listed McClain’s cause of death as undetermined, but an independent panel that investigated his death reported in February this year that officers placed McClain in a carotid hold and medics were slow to help him before injecting a ketamine dose adequate to sedate a 190-pound person, The New York Times reported. McClain weighed 50 pounds — more than 25 percent — less than that.
After KUNC reported in July 2020 that medics in Colorado dosed 902 people with ketamine for excited delirium in a 2½-year period, CDPHE said it would investigate its waiver program.
That review, however, was later “paused” in order to “reassess the scope” of the investigation and in deference to other investigations, Fox31News reported in January. CDPHE Executive Director Jill Hunsaker Ryan said at that time the review would look at the program “as a whole” rather than focus on individual incidents.
It’s unclear when CDPHE will report on that review. A CDPHE spokesperson says there’s no report date, and Rep. Leslie Herod, D-Denver, co-sponsor of the bill to restrict ketamine’s use, also says it’s unknown when the report will be released.
As for the Floyd case, Reason magazine Senior Editor Jacob Sullum wrote in an April 1 column that Minneapolis Officer Thomas Lane suggested that Floyd should be rolled off his stomach, because, “I am worried about excited delirium ....”
The U.S. Court of Appeals for the 5th Circuit ruled in a 1998 case that use of force by police can be excessive “when a drug-affected person in a state of excited delirium is hog-tied and placed face down in a prone position,” which “may present a substantial risk of death or serious bodily harm,” Sullum notes.
Floyd was not “hog-tied,” but his restraint in a prone position “plausibly contributed to the ‘adrenaline flowing through his body’ and the ‘cardiac arrhythmia’...,” Sullum writes.
But whether excited delirium — when a person is extremely agitated or delirious and can be aggressive, tolerant of pain, display extreme strength and hypothermia — is a legitimate medical diagnosis has become as controversial as the drug used to counter it.
The American College of Emergency Physicians recognizes excited delirium as a legitimate medical condition.
But the American Psychiatric Association’s board of trustees adopted a position statement in December 2020, saying the term “excited delirium” is nonspecific, lacks clear diagnostic criteria, and should not be used as a diagnosis until such criteria are validated with further study.
“The concept of ‘excited delirium,’” the statement says, “has been invoked in a number of cases to explain or justify injury or death to individuals in police custody, and the term excited delirium is disproportionately applied to Black men in police custody. Although the American College of Emergency Physicians has explicitly recognized excited delirium as a medical condition, the criteria are unclear and to date there have been no rigorous studies validating excited delirium as a medical diagnosis. APA has not recognized excited delirium as a mental disorder, and it is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM5)....”
Noting that data show persons detained by police and exhibiting so-called “excited delirium” have frequently been medicated by EMTs with ketamine, the statement asserts that in some cases it’s “questionable” if the person had any condition warranting the drug’s use.
“Many sedating medications, used in outside of hospital contexts, including ketamine, have significant risks, including respiratory suppression. Supporting respiration may be challenging outside of a hospital setting, where it may require intensive medical oversight or involvement,” the statement notes.
Nor has the American Medical Association or the World Health Organization officially recognized excited delirium as a valid medical diagnosis, according to a Dec. 13, 2020, segment of 60 Minutes, which featured McClain’s death.
That segment quoted Paul Appelbaum, chairman of the DSM Steering Committee for the American Psychiatric Association as calling excited delirium “bad science” based on faulty studies that grew out of the 1980s cocaine epidemic.
Appelbaum labeled it a “wastebasket phrase” that serves as a way for police to explain what happened “without necessarily bearing responsibility for it.” Lastly, Appelbaum noted the diagnosis is disproportionately assigned to young Black men during their encounters with the police.
Dr. Marvin Swartz, professor in the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine and faculty member at the Wilson Center for Science and Justice, calls the diagnosis “bogus.”
“Doctors treat medical disorders, not aid police in subduing subjects — [doctors] are not extensions of the police, should not be directed by police to administer so-called medical care and should not do the bidding of police for the purposes of incapacitating patients,” he said in an article on the Wilson Center’s website.
“It is urgent that we do not use medical practices to restrain or incapacitate people,” he said.
In a joint statement issued in October 2020, several emergency medical organizations outlined their position on excited delirium and its treatment, saying ketamine is “an effective method” to protect against self-injury by patients who are violent or combative or suffer from “excited delirium.”
Signatories include the National Association of EMS Physicians, National Association of State EMS Officials, National EMS Management Association, National Association of Emergency Medical Technicians and the American Paramedic Association.
First, the statement calls for “appropriate de-escalation techniques” over physical restraint or pharmacological management, whenever possible.
Second, “EMS practitioners must not administer sedating medications to an individual to facilitate arrest or to assist law enforcement to take the individual into custody.”
Rather, EMS personnel should use the “least restrictive restraint techniques” necessary to assess, treat and transport the patient to a hospital.
“In all circumstances,” it says, “the decision about using pharmacologic management is a health care decision that must be made by the EMS practitioner with oversight by an EMS medical director.”
Moreover, the statement also notes, “Patients must not be restrained in a position with hands and feet tied together behind their back or restrained with techniques that compromise the airway or constrict the neck or chest.”
The Emergency Medical Services Association of Colorado adopted a position statement on Nov. 5, 2020, saying while EMTs work with law enforcement, “we do not allow law enforcement or other non-medical persons to dictate our medical care.”
But paramedics do support using ketamine when medically necessary.
“Ketamine is one of the safest drugs that we give,” Nick Nudell, president of the American Paramedic Association, tells the Indy in a phone interview.
“There are no recorded instances of anybody dying from ketamine,” he says. “The cases in the literature of somebody who has died with ketamine, the medical experts have found the substances [previously ingested, such as illegal drugs] or the condition the patient was already in led to their death, not the administration of ketamine.”
For Mark Barr, Sept. 25, 2020, was a nightmarish day as he watched the final hours of his son’s life, though he didn’t know they were his last at the time.
Hunter had a typical childhood filled with swimming and playing soccer and roller hockey, his dad says, and he had a good relationship with his older brother, who was three years his senior.
A soft-spoken person who taught himself to play the guitar and piano, Hunter liked all types of music, especially jazz and Beatles tunes.
He also was an artist, had lots of friends and worked in a restaurant doing whatever was necessary, including washing dishes and food preparation.
His dad offers no insight into why his son would ingest LSD, saying he smoked pot at times but “was always pretty normal.”
“He was a very, very good guy,” Barr says. “I could ask him to get up in a snowstorm and check the mail and he wouldn’t give me any trouble about it. He was just really easygoing.”
Editor’s note: The Indy paid $67.50 for bodycamvideos and the police report.