60 Minutes - 12/13/2020: Saudi Fugitives, The High Cost of Healing, Excited Delirium

Episode Date: December 14, 2020

California Attorney General Xavier Becerra, President-elect Joe Biden's pick to run HHS, says Sutter Health's practices led to some of the highest health care costs in the state. Lesley Stahl has the story. Saudis accused of serious crimes have fled to the kingdom before trial. The FBI believes they had help from U.S. ally Saudi Arabia. Scott Pelley talks to Oregon Senator, Ron Wyden, who made the claims. And John Dickerson investigates the controversial syndrome not recognized by many leading medical groups, "excited delirium." Those stories on this week's "60 Minutes." To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

There's a lot going on right now, mounting economic inequality, threats to democracy, environmental disaster, the sour stench of chaos in the air. I'm Brooke Gladstone, host of WNYC's On the Media. Want to understand the reasons and the meanings of the narratives that led us here, and maybe how to head them off at the pass? That's On the Media's specialty. Take a listen wherever you get your podcasts. Two weeks before the scheduled trial,

police say Noura was picked up by this black SUV. The SUV turned and stopped at a gravel quarry where the GPS bracelet would later be found. The SUV doubled back and headed in the direction of the airport. You know, the facts as we know them almost sound like an intelligence operation, an exfiltration.

Do you agree with that? I don't think I could comment on that. I mean, he had help. I would assume he had help getting out. Where is he? He's in Saudi Arabia. 60 Minutes has been following a landmark case in California that may explain why American health care costs are going through the roof. The largest driver? It's hospital prices. And they're not providing more services, and the quality isn't increasing.

They are just charging more for the same thing. And they do it because they can. I'm so sorry. I have no good. Elijah McLean's death sparked five federal, state, and city investigations. His stop was captured on tape as he pleaded for his breath. Police and medical workers say he wasn't making sense and showed superhuman strength, symptoms of a syndrome known as excited delirium. Excited delirium is a perplexing term. Perplexing why? It doesn't

correspond to any discrete reality out there in the world. I'm Leslie Stahl. I'm Bill Whitaker. I'm Anderson Cooper. I'm John Dickerson. I'm Scott Pelley. Those stories and more tonight on 60 Minutes. air. I'm Brooke Gladstone, host of WNYC's On the Media. Want to understand the reasons and the meanings of the narratives that led us here and maybe how to head them off at the pass? That's On the Media's specialty. Take a listen wherever you get your podcasts. As President-elect Biden begins to engage the world, one of his most challenging relationships will be with Saudi Arabia. The oil kingdom and ally against Iran has a dismal record on human rights, even in the United States.

Case in point, 15-year-old Fallon Smart of Portland, Oregon. She was killed in a hit-and-run by a Saudi student who vanished before trial. He's among many Saudis accused of serious crimes in the U.S. who mysteriously disappear. Their victims include Fawn Ling Venice, the mother of Fallon Smart. She told us about the day in 2016 that she drove to pick up her daughter at a shop. Fallon only had to cross two-lane Hawthorne Street to reach her mother and two siblings in their car. Fondling Venice waved to her daughter, lost sight of her, and realized something was wrong. So I left my daughter with a complete stranger, my younger daughter with a complete stranger on the corner of Hawthorne and I ran up to Fallon with my young son still in my arms.

And I started shouting Fallon's name. She was splayed out on the, in the middle of the street, clearly very injured. So I threw my body onto the cement next to her and was holding her hand, looking her in the eye, and we fell and I made eye contact. And she was just looking back at me kind of in shock. And at first I remember saying her name softly, you know, like, if Helen is going to be okay, it's going to be okay. But then when her gaze turned from acknowledgement and eye contact and then kind of faded away into

emptiness. I remember shouting her name louder and louder as if perhaps it would wake her up or something. I don't know. Because when the ambulance finally made it there, I still had it in my head that we would get in the ambulance and go to the hospital.

Like that's what we were going to do. So when the ambulance came, the original man who was giving CPR to my daughter came over to me and told me that she was dead. And I remember trying to negotiate with him. Like, no, you don't understand. She's not dead because she is about to graduate. She's going to graduate high school with a year of extra credits. And then I remember, like, wailing. I was going to graduate high school with a year of extra credits. And then I remember, like, wailing for a while. This was the moment before the crash. A gold Lexus was barreling toward the intersection where traffic had stopped to let Fallon cross.

This is the same scene in real time. Police say the driver was 20-year-old Abdul Rahman Noora, a Saudi who'd been enrolled two years in a Portland community college. Sean Overstreet is prosecuting the case. It appeared that Mr. Noora was driving westbound on Hawthorne at about 70 miles an hour. That portion of Hawthorne is one lane in each direction. There's also a center turn lane, and Mr. Noora was driving in that center turn lane. What is the speed limit on Hawthorne Street? It was 25 miles an hour. Noora returned to the scene after a few

minutes. He was arrested on charges of manslaughter in the first degree. What is manslaughter in the first degree? It's when you recklessly take somebody's life, but it has to be under conditions manifesting extreme indifference to the value of human life. Three days after her daughter's death, Fondling Venice saw Noora in court. He kind of just had this nonchalant attitude, and that was very disturbing to me, just the lack of remorse. Prosecutors argued Noora was a flight risk. The judge ordered bail of $1 million, a GPS tracking bracelet, and confiscation of Noura's passport. By law, Noura needed only 10 percent of the bail, but that was $100,000, and prosecutors described his family in Saudi Arabia as middle class.

Did he have any trouble coming up with that? Well, I don't believe that Mr. Noura had any access to that kind of money. Who bailed him out? Saudi consulate provided the $100,000 to Mr. Noura so that he could bail himself out. Two weeks before the scheduled trial, police say Noura was picked up by this black SUV. The SUV turned and stopped at a gravel quarry, where the GPS bracelet would later be found. The SUV doubled back and headed in the direction of the airport. Who was driving the black SUV?

It's a question we don't have an answer to right now. You obviously checked all of the airline manifests. Sure. Didn't find his name on any outbound flight? No, and we didn't really expect to, because one of the conditions of his release was he had to forfeit his passport. How did he travel without his passport?

That's a good question. Where is he? He's in Saudi Arabia. Have you asked for his return? Oh, of course. There's an active warrant for his arrest. We're waiting to prosecute, but the United States does not have an extradition treaty with Saudi Arabia.

There were many people who outwardly said, he's gonna run. I didn't listen to them. I just discounted it as, I don't know, conspiracy or something. You had faith in the... I had complete faith. ...the system of American justice. Absolutely. How could he get away? That was the question Portland's Oregonian newspaper asked.

And in partnership with the non-profit investigative reporting group ProPublica, reporters discovered nearly two dozen similar cases involving serious crimes, including rape. Being raped feels like someone comes into the deepest part of you and takes a knife and slashes you open. Teresa, who we met in 2019, asked us to use only her first name. She says four years ago, during a party at her home, she drank too much, went to bed, and awoke to find a stranger on top of her. I felt like it was a dream still, but it wasn't until I felt pain that I came to and realized it wasn't a dream. And I had the vague recollection of pushing him out of my room and closing the door. Did you know who it was? I knew who it was from that night.

And, like, seeing his face, you know, he had kind of a distinctive afro. Prosecutors charged Faisal Al-Taleb, a Saudi national who was a student. Al-Taleb told police he was drunk that night. I drank a lot, but I don't remember anything. What's the problem? Police say Al-Taleb fled before he was charged. He had his passport.

Whether he had help escaping, we do not know. But he's back in Saudi Arabia, enjoying the protection of the kingdom. You feel when you're raped, there's no safe place. Like, my body was not a safe place, and my home was not a safe place, and my town was not a safe place. And then, you know, now there's no law enforcement that's protecting me either. You have come to learn since then that a number of Saudi citizens have escaped justice in the United States. What do you think of that? This happened to me. This destroyed my life. But what's even

more disturbing than that to me is that our government isn't doing anything about it. I mean, there was someone else in my town just months apart who was raped by her Saudi Arabian roommate. And that suspected rapist, Sami Almanzani, also fled quickly before he was charged. Prosecutors say he escaped to Mexico and then Saudi Arabia, where he is free. The American people deserve to know the truth here. Oregon Senator Ron Wyden is a member of the Senate Intelligence Committee with a top security clearance. I take it you have seen what U.S. intelligence says about Saudi fugitives. I'm constrained in terms of what I can say, but I can tell your viewers the Saudis pursue

these cases with extraordinary sophistication, and they are certainly looking at every possible tool for being above the law. assessment, which concludes, Kingdom of Saudi Arabia officials almost certainly assist U.S.-based Saudi citizens in fleeing the United States. The assessment specifies cases of rape, child pornography, and manslaughter. Senator Wyden is also working to declassify what the U.S. knows about the murder of journalist Jamal Khashoggi, dismembered in 2018 by Saudi intelligence agents. I wonder what you thought when you heard about the murder of Jamal Khashoggi, the Washington Post columnist who was killed in the Saudi consulate in Turkey. That was the first time that I really understood the enormity of what had touched my life. You know what I mean? Because before this it was a hit and run, it was a dumb kid.

And then it grew into me realizing that I was dealing with something much larger and much darker and much more violent and something powerful, something that had influence in our government, and that terrified me. look, these are tragic cases, but it's far more important for the United States to work with Saudi Arabia on terrorism than worry about a few dozen fugitives. I just don't buy the idea that fighting terrorism and securing justice are mutually exclusive. Our government ought to be doing both. It's its own form of terrorism because it's terrorizing the American people who are in their own country and can't feel safe. I feel like protecting the American people on American soil should be a pretty high priority. Saudi officials declined an interview, but in an email they said, The notion that the Saudi government actively helps citizens evade justice is not true.

This is evidenced by the fact that a number of Saudi citizens are currently serving prison sentences in the U.S. But the man who was wanted in the death of Fallon Smart can be found these days on social media, enjoying the protection of the Saudi kingdom. I think we do need to re-examine our relationship with Saudi Arabia so that we can guarantee the safety of American citizens. I don't want this to happen to another family. My daughter's gone. And I'll miss her. But she's gone. To keep the memory of Fallon Smart alive,

her mother has a tattoo recalling Fallon's favorite children's book, The Giving Tree. Fallon's ashes are mixed in the ink. biscuit or English muffin sandwiches, small hot coffee, and more. Limited time only at participating Wendy's Taxes Extra. When does fast grocery delivery through Instacart matter most? When your famous grainy mustard potato salad isn't so famous without the grainy mustard. When the barbecue's lit, but there's nothing to grill. When the in-laws decide that, actually, they will stay for dinner. Instacart has all your groceries covered this summer. So download the app and get delivery in as fast as 60 minutes. Plus, enjoy $0 delivery fees on your first three

orders. Service fees, exclusions, and terms apply. Instacart, groceries that over-deliver. The coronavirus pandemic has unleashed more than a flood of disease in this country. It's also expected to accelerate a wave of hospital mergers and acquisitions, with big hospitals buying up smaller ones. This consolidation, economists say, is one of the main reasons the cost of health care in this country is going through the roof. There's a lawsuit over this in COVID-ravaged California, with the state attorney general claiming that Sutter Health, a hospital chain based in Sacramento, got so big it had essentially become a monopoly. On the eve of the trial, Sutter tentatively agreed to a settlement that's awaiting a judge's approval. But this is, even at this stage, a landmark case because it pulled back the curtain on what has rarely been seen

or so thoroughly documented before, how and why hospital prices have been skyrocketing. Sutter is a sprawling health care system that's the largest and most dominant provider in Northern California. They're like the bully on the block. They were able to bully everyone else to conform. It was my way or the highway. The state's attorney general, Javier Becerra, filed a civil lawsuit against Sutter in 2018.

We interviewed him before the pandemic and before he was nominated for Secretary of Health and Human Services. They were gobbling up hospitals. They were gobbling up physicians through these physician practices. They were just munching away, getting bigger and bigger. Till they amassed a conglomerate of 24 hospitals, 12,000 physicians, and a string of cancer, cardiac, and other health care centers. Sutter got big enough that it could use its market power to dominate, to dictate. It was abusing of its power. The suit accuses Sutter of embarking on an intentional and successful strategy of cornering much of the market in Northern California and then jacking up prices, for example, on the price of delivering a baby. You live in Sacramento. You can expect to

pay twice as much to deliver that baby here than in your hometown of New York City. I actually heard that it costs more to deliver a baby here in Sacramento than anywhere else in the entire country. Why Sacramento should be the most expensive place to have a baby, there's no way to explain it. Caring for a premature baby in Northern California, for example, costs about $605,000. In Southern California, $343,000. In all, he says, the average cost of inpatient care in Northern California

is 70% higher than in Southern California. When you did the investigation, did you look at other variables that might have been the reason for the higher prices? Quality might have been better, maybe equipment higher prices. Quality might have been better. Maybe equipment was better. Did you take all that into consideration? That's why this investigation took years, because you have to eliminate all the other reasons

that might be out there. And you can't explain it away by the cost of living, cost of labor. Or quality of care. Or quality of care. It's just Sutter, Hiking prices. It's domination of the market. Sutter's quest to dominate the market, Attorney General Becerra says, began in the 1990s with a campaign of mergers and acquisitions that enabled it to grow

from two hospitals into the behemoth it is today. They really pioneered this model of reducing competition to raise prices. They were the first one to do it, and the prices continually grew faster and faster than other comparable hospitals. Glenn Melnick is a healthcare economist at the University of Southern California who consulted on the lawsuit and was one of the first researchers to document Sutter's strategy of making itself indispensable. He found, for instance, that in 11 counties of Northern California... They're either the only one hospital or one of two hospitals. And some of these counties are

1,000 square miles. And there's one or two hospitals and there's 1,000 square miles? That's right. So they have monopoly power in a number of these counties, right? And their prices went up. The next year, they went up even faster. And they figured out, wow, this really works.

You might look at that and say, that's monopolistic. Someone else might look at it and say, wow, that's smart business. That's really clever. Good for them. If Sutter is able to raise their prices by improving quality, value, and service, that's fine. What they came up with is a model that allowed them to acquire market power and get higher prices without doing any of those good things for consumers. In the lawsuit, evidence showed that Sutter's quality of care, while well regarded, was generally comparable to other hospitals in California, and that its higher prices have been contagious.

So we called it the Sutter effect, where if you have a large, dominant system like this, they raise their prices high, all their competitors can raise their prices higher. So there's kind of this second-order effect that this type of behavior leads to much higher prices across the board. It's outrageous. Hillary Ronan is a member of San Francisco's

City and County Board of Supervisors and sits on its budget committee. We have so many difficult problems in San Francisco that we're trying to fix. I understand that the city and county of San Francisco spends roughly $800 million a year in health costs. That's right. That money comes from the same pot of money

that we use to build new homeless shelters, to hire firefighters, to pave our streets, to repair our parks. And the more we're paying on employee health care, the less we're paying on the toughest entrenched problems we're trying to fix in San Francisco. A reason their health costs were so high, she says, is because Sutter was able to block the city and its insurer, Blue Shield of California, from steering employees to hospitals with lower prices. And it was able to prevent Blue Shield from telling the city what Sutter's hospitals would charge for individual procedures. Sutter won't allow us to see

how much they charge for their services. It's unbelievable. And so we can't comparison shop. And they keep naming their price, and I feel like I'm handcuffed to do anything about it. The insurance company, Blue Shield. Yes. They can't fight either?

They are also blocked? They are. Blue Shield is as at the whim of Sutter naming its price as we are. For once in their life, the insurance company is not the worst actor in the room. It's Sutter. The state accused Sutter of using its windfall from its excessive pricing to finance the acquisition of new hospitals and physicians groups, and to pay its outgoing CEO $13 million in 2016, and a year later, paid its new CEO $6 million.

It galls Hillary Ronan that Sutter is a not-for-profit company, meaning legally it pays no taxes, even though it earned $13 billion in revenue last year. Sutter avoids tens of millions of dollars a year in local property taxes. And at one hospital alone, they're avoiding $20 million a year. Wow. And business taxes that they don't pay are added on top of that. Are added on top of that. Sutter's a not-for-profit hospital.

Exactly. Which suggests that they're not out for financial gain. Right. So how does that square? Any way you look at it, any path you look, we are getting screwed. That sentiment is shared by one of the state's largest labor unions, the United Food and Commercial Workers, as well as many of the state's large employers

that belong to the Pacific Business Group on Health. And we started seeing these price increases, and they didn't make sense. Headed by CEO Elizabeth Mitchell. Collectively, our members spend $100 billion a year purchasing health care on behalf of 15 million Americans. So who are some of these big companies? Walmart, Boeing, Cisco, Intel, really the biggest companies in the world, very sophisticated.

So here you have these giant companies. You think of them as being all-powerful, and they could not control Sutter. They could not. The more hospitals they acquired, the more physicians they employed, the more leverage they had in the market. And they did this very strategically. So if there was a specialty, say maternity, that they knew every employer would need, they created a monopoly around maternity. So if an employer would try to exclude the system, they said,

well, you can't do that because you have to have our maternity services. Now they control the maternity care in Northern California? As an example, they control the maternity care. According to the lawsuit, Sutter used its leverage to force the big companies and their insurers into what are called all-or-nothing contracts, meaning that they had to include all 24 of Sutter's hospitals in their health plans. And sometimes they would have to include hospitals that were in regions that the employers didn't even have employees in. Sutter was forcing big companies to cover hospitals in places where nobody who worked for the company lived? That's right. It was all or nothing. And no employer could do without all of the Sutter system.

We asked Sutter for an interview, but the hospital declined and instead sent us a statement saying, in part, that it's committed to high-quality, affordable care and that its coordinated health care network delivers healthier patient outcomes at a lower total cost of care, something that has proven even more critical during the COVID-19 pandemic. Sutter says that when you have a system as big as theirs, what they can offer is coordinated care, they can reduce duplication, and they can cut costs. Now, that sounds reasonable.

Well, that is true in every other industry, that they use their size to reduce their prices. And yet, the opposite has been true in health care. They merge, and then they use their market leverage to increase prices. But what about this idea of coordinated care? I think that was one of the reasons that these mergers were allowed to happen. Coordinated care is what everybody wants.

The problem is it has not been achieved in these mergers. We're not getting bettergers. We're not getting better outcomes. We're not getting, you know, healthier people. Most alarming, she says, hospitals across the country have been following Sutter's lead. This is happening in Maine. It's happening in Texas. It's happening across the country. The largest health systems are buying up everything. Do you think that this is the main reason that health costs are going up? We have seen the data. It is the largest driver of health care cost increases. It's hospital prices. And they're not providing more services, and the quality isn't increasing. They are just

charging more for the same thing. It is just the prices, and they do it because they can. It's a far-reaching deal. Attorney General Becerra and Sutter are waiting to see if the tentative, out-of-court settlement they reached is approved. If so, Sutter will admit no wrongdoing, but will pay $575 million and agree to stop blocking patients' access to less expensive hospitals and requiring all-or-nothing contracts. You called this case a big effing deal. Yes. Why? This settlement is going to change the life for hundreds of thousands of Californians. And I'd say millions of Americans,

because I think you're going to see other states take what we did and say, aha, we've got some facilities that are behaving the same way. Let's push. So you think what you did will become a model? I think it's a game changer. There are very few things that you can be certain of in life. I think it's a game-changer. 5G subscription phone plans, you'll pay the same thing every month. With all of the mysteries that life has to offer, a few certainties can really go a long way. Subscribe today for the peace of mind you've been searching for. Public Mobile, different is calling. Buried in the charging documents in the George Floyd murder case is something called excited delirium. One of the

junior officers mentioned it during Floyd's arrest. We had never heard of excited delirium. One of the junior officers mentioned it during Floyd's arrest. We had never heard of excited delirium, but discovered it is widely used by police and paramedics to describe a life-threatening syndrome among suspects exhibiting wild behavior and extreme strength, and that it is being used to justify injecting them with a powerful chemical restraint, ketamine. But in the medical world, we found deep skepticism over whether excited delirium is even a real condition and concern about an over-reliance on ketamine and the use of excited delirium as a shield to protect police from charges of misconduct.

These issues are at the heart of five federal, state, and city investigations sparked by the death of another Black man named Elijah McClain. When you hear him in that audio, what do you hear your son going through? He's being erased. He's being literally erased from existence. They forced his breath out of him. They forced his life out of him. Shanine McLean describes her 23-year-old son Elijah as a peaceful person, a musician who played violin for rescued animals. On August 24th last year, he bought an iced tea at a convenience store in Aurora, Colorado. Surveillance video showed him wearing a mask and bowing to customers. He had committed

no crime. Yet someone called 911 saying McClain was behaving oddly. Hey, stop right there. Stop. Stop. Stop. Stop. I have a right to stop you because you're being suspicious. Turn around. Turn around. Stop tensing up. No, let go of me. Stop tensing up. No, I am an introvert. Please respect the boundaries that I am speaking. They could have asked questions before they hopped out the car. They could have treated him like a person instead of an animal. I'm so sorry. I have no good.

That's where I tried to rot. I don't do that stuff. I don't do any fighting. The three officers, who were joined by at least nine more, put McLean in a neck hold, forced him to the ground. I can't breathe correctly. Handcuffed and struggling for air, he vomited. If you keep messing around, I'm going to burn my dog out. He's going to dog bite you. You understand me? Keep messing around. Within'm going to bring my dog out. He's going to dog bite you. You understand me? Keep messing around. Within minutes, he lost consciousness.

Could they have done things differently? Absolutely. I wish they would have. Elijah McClain did nothing wrong. The officers don't know that, though. The officers know nothing about Elijah McClain. Adams County District Attorney Dave Young, whose jurisdiction covers Aurora, reviewed all the recordings in the case. You can see that the officers are at least trying to have a conversation with Elijah McClain. But it's a one-way conversation.

Absolutely. They're not listening to Elijah McClain. Well, they're not listening to Elijah McClain. That's correct, because they're trying to control the situation. It goes from zero to 60 pretty quickly. He's pretty articulately saying, I'm an introvert. Please don't hurt me. I can't breathe. And yet the escalation of force continues. Well, the escalation started when Elijah McClain didn't stop walking.

They took it to the next level and say, all right, this person's not complying with our lawful commands. Now we're going to stop him and go hands on. The escalation continued. McClan's pleading did too. According to their statements and the district attorney, the police and medical workers said they thought the 140-pound McLean wasn't making sense and showed super strength, signs they took not as a struggle to survive, but as symptoms of excited delirium. So when the ambulance gets here, we're going to go ahead and give him all the drops.

Yep, sounds good. Perfect, dude. And so adhering to their protocol, paramedics injected him with a drug called ketamine, a powerful anesthetic used in hospitals. Paramedics gave McClain a ketamine dose for someone closer to twice his weight, according to the family's civil rights lawsuit. He suffered respiratory and cardiac arrest and died three days later. His death triggered protests and calls for accountability, but District Attorney

Dave Young chose not to file criminal charges against the officers. Now, if the officers came right out and shot Mr. McClain, it would be an easy decision for me, okay? If that's the bar, that seems like an extremely high bar. It was the car carotid hold and the pathologist came in and said he died from strangulation, then I would have to look and say, what the heck is going on here? Why did they have to use that amount of force under these circumstances? Let me borrow that sentence from you. What the heck is going on here that they had to use that amount of ketamine? Why isn't that the same thing? They have a policy in the city of the Aurora that says paramedics do this when you have these circumstances, and they follow that policy. That policy is now on

hold and under review in the wake of McLean's death. The county coroner, who consulted with police in conducting the autopsy, concluded the cause of McLean's death was undetermined because he may have died from a host of possible causes, including excited delirium. And that possibility, District Attorney Dave Young said, convinced him he could not win a homicide case against the officers. Did the excited delirium being included in the autopsy make your job easier or harder in terms of making your final determination? That's a good question. And the answer to that question is it made it easier because you're missing a key element to a homicide investigation. You can't file a homicide charge without cause of death. The term excited delirium, not all doctors agree that it even exists as a condition. Do you see problems in that, or do you think it's an airtight term?

Well, I think it's science. I think there's always, you know, in pathology, there's a best guess, for lack of a better term. When you listen to the audio of the arrest, do you hear him being delirious? When I hear him on that tape, I hear him completely sane, completely in his right mind. I truly believe it was in his right mind up until the time he passed out. Elijah McClain's case is not an isolated one. A 2018 review of 66 studies and articles referencing excited delirium found it was cited in more than 10 percent of deaths in police custody. Though it is supported by some in law enforcement and emergency medicine, it is not

recognized by the American Medical Association, the World Health Organization, or the American Psychiatric Association. Paul Applebaum, who oversees changes to psychiatry's main diagnostic manual, says excited delirium is bad science based on faulty studies that grew out of the 1980s cocaine epidemic. Excited delirium is a perplexing term from my perspective. Perplexing lie. It doesn't correspond to any discrete reality out there in the world. So it's a catch-all phrase? It's a wastebasket phrase.

It also had utility for the police since so many of the early cases and some of the continuing cases occur in police custody and result in death. It's a way of explaining what happened without necessarily bearing responsibility for it. If there's a bad outcome, you have a ready excuse at hand. And as Applebaum discovered, it is disproportionately associated with one sector of the population. They tend to be young, they tend to be male, and they tend to be African American. So what are people implying excited delirium to? Large numbers of people who are agitated and hard to control,

often hard for the police to control. Should it be sufficient to just say they're hard to control? You might want to go beyond that and ask why they're agitated. Is this somebody who's intoxicated? Is this somebody who is experiencing a psychotic episode? Or is this somebody who's just afraid, who's been confronted by the police on a dark street at night, minding his own business, and is suddenly fearful for his life? While the debate over the validity of excited delirium continues, even some of its proponents

say it has been applied too often, creating a demand for a quick-acting solution and triggering a rise in the use of the drug ketamine, which can be deadly during arrests. Over the last several years, there's been almost an exponential growth in the use of ketamine in exactly these kinds of encounters on the street with the police, with the EMTs then called to help subdue the person. In Colorado, for example, in the last two and a half years, 900 doses of ketamine. Does that seem excessive? That seems astounding. Resulting, Colorado data shows, in nearly a 17% rate of complications. Using ketamine for excited delirium became more widespread after a 2009 paper by the American College of Emergency Physicians and a 2013 study co-authored by Jeffrey Ho,

former medical director of EMS at Hennepin Healthcare in Minneapolis. In a blurring of roles, Ho is also a sheriff's deputy in rural Minnesota. In Minneapolis, a city review found a 3,000 percent increase in the use of ketamine during police encounters from 2010 through 2017, and the jump has led to mistakes. I was trying to figure out how, when you have a diabetic seizure, do you end up getting ketamine? Last July, Barb Johnson's son, Max, had a diabetic seizure, and his girlfriend, Abby, called 911. Johnson, who spoke on her son's behalf, says the police didn't think it was diabetes, but that Max had been using drugs. The officers had Abby cornered continually asking her about drugs,

telling her that if you, you know, we don't want to rip your apartment apart, where are they? Were drugs involved in any way? This was a seizure related to hypoglycemia. As Max emerged from the seizure, confused, agitated, and combative, records show paramedics gave him ketamine, a bad choice after seizures, according to his mother, a nurse. It's unacceptable to me. You know, EMS doesn't always have a reliable, accurate witness to tell them what's going on. These folks did. His girlfriend, Abby, watched as after two doses, Max lost consciousness and was rushed to Hennepin Healthcare, the same facility where Dr. Jeffrey Ho launched ketamine studies.

Max had to be put on a ventilator for two days, but ultimately recovered. Hennepin Healthcare declined our request for an interview. I'm literally telling you if this happens to my family, it can happen to anybody. Ketamine is supposed to be a medical choice by paramedics in Minnesota, not a law enforcement tool wielded by the police. If they're fighting with police and they don't want to be placed under arrest, that's not a medical emergency. Paramedic Joe Baker says he believes it is a tempting way to end rocky police encounters. Baker, who brought a whistleblower's lawsuit after resigning from

his job in Woodbury, Minnesota, was called last year to the home of a man suffering a mental health crisis. He says the police requested that he arrive needle-ready, prepared to administer ketamine. Each police officer asked me if I had my ketamine drawn up, but I let the police officers know I have it with me. I'm not going to draw it up. I want to make sure that the patient's being evaluated. And they were not happy with that. Joe Baker said he settled the patient without medication. We moved him inside the ambulance. And the interesting part of that was the next thing that that individual said was,

well, what's the score of the Vikings? And at that point, I realized how much regret I would have if I decided to follow those directives and administer ketamine. So you deliver the patient to the hospital. After you do that, what happens? I found out from my partner that the police officer was asking why I wasn't willing to play ball and cooperate with them when they're asking me to drop ketamine. And so I found the police officer waiting for me

at the fire station after we finished the call. Was he trying to make you feel like you had made them less safe by not coming in and administering it? Yes. In a statement, the city of Woodbury said Baker's claims are without merit and its officers followed policy. Policing by needle for a highly debated condition of excited delirium is hard to track because emergency medical services are decentralized. But Baker says the practice overrides the paramedic's duty to care for patients, a point that he said he made to his superiors. Did they say you did the right thing? No.

They told me that I was being insubordinate to that police officer for refusing to administer ketamine. How can you be insubordinate in doing something you're, that they're not supposed to ask you to do? That's a very good question. Tonight, the fourth night of Hanukkah, the Festival of Lights, Jewish families gather to light another candle on the menorah. Western Christians celebrate the third Sunday of Advent lighting candles on Advent wreaths

in anticipation of Christmas. As we approach the winter solstice, when daylight is short and nights seem nearly eternal. Lights twinkle on main streets and in neighborhoods as if chasing the darkness away. And now, right on time, another ray of light in this season of darkness, approval of a COVID vaccine. Brighter times are still months away, but like bright spring days, now we see them coming. I'm Leslie Stahl. We'll be back next week with another edition of 60 Minutes. There's a lot going on right now. Mounting economic inequality, threats to democracy, environmental disaster, the sour stench of chaos in the air. I'm Brooke Gladstone, host of WNYC's On the Media. Want to understand the reasons and the meanings of the narratives

that led us here, and maybe how to head them off at the pass? That's On the Media's specialty. Take a listen wherever you get your podcasts.