After that, deputies entered the cell several times to make sure Durrah was still responsive, but no medical care was provided. They didn’t call for an ambulance until staff discovered the 35-year-old man in their custody was unconscious.

Durrah’s final moments are detailed in a Wyoming Division of Criminal Investigation report obtained by WyoFile and the Gillette News Record through a public records request. The DCI investigation, which took 15 months to complete, cleared jail staff of criminal wrongdoing.

“The deceased’s death likely was caused by a methamphetamine overdose, as evidenced by high levels of such substance indicated in the toxicology report, and the cardiac effects of excited delirium,” Weston County Attorney Michael Stulken wrote in a letter explaining why he declined to press charges.

Multiple medical experts who reviewed the case shared concerns about Stulken’s characterization that Durrah died from “the cardiac effects of excited delirium.” The term, which was commonly used to explain lethal encounters with police, has been abandoned as a diagnosis by most major medical associations.

Dr. Thomas Bennett, who conducted the autopsy, told WyoFile he also no longer uses “excited delirium” as a cause of death. That’s why, Bennett said, he used the phrase “consistent with excited delirium due to methamphetamine overdose” in the autopsy report and not “caused by excited delirium.” Bennett was not contacted by Stulken for more information, the doctor said.

Stulken declined comment Friday.

The term “excited delirium” suggests the death was beyond jail staff’s control, medical experts say, and obscures questions about the dangers of certain restraint techniques or why EMS wasn’t called immediately after deputies watched him ingest what they suspected was meth.

No diagnostic language can, however, address an even more fundamental question: How did Durrah obtain a lethal amount of methamphetamine inside the jail?

The Campbell County Sheriff’s Office says detention deputies responded to the incident appropriately, but admitted there are ongoing challenges keeping drugs out of the jail and did not have an explanation as to why emergency medical personnel weren’t called a second time.

Medical experts and Durrah’s family who reviewed the DCI report were left with questions surrounding the circumstances and explanation of Durrah’s death.

“It still doesn’t make sense to me that you saw somebody ingest drugs and you cut off their clothes and put them in a chair,” said Joshua Durrah, Kenneth’s brother. “That’s negligent.”

Dec. 1, 2022Flickering cell lights inside the Campbell County jail’s Q block marked the first signs of Durrah’s initial medical episode at about 1:20 a.m. on Dec. 1, 2022.

More inmates began flashing lights on and off, signaling to gain the attention of jail staff who arrived a few minutes later outside of Durrah’s cell — No. 15.

DCI agent Zack Miller, who investigated the death, documented the sequence of events in a summary of video footage from inside the jail, and accounts told to him by jail staff involved in the incident.

Durrah, who had complained of chest pains and trouble breathing, was described as thrashing on the ground in his cell when deputies apparently hooked him up to a medical device before helping him to his feet and walking with him from his cell block to the booking area.

Two EMTs, who later refused to cooperate with DCI investigators under the guidance of Campbell County Health legal counsel, evaluated Durrah and cleared him to remain in jail. Deputies recounted to DCI that the EMTs told Durrah his heart rate was elevated because he was holding his breath.

At 1:46 a.m., Durrah, under direction from jail staff, walked himself into cell No. 5, still in the booking area. Several minutes later he was heard asking for water, with the report noting that he did not have labored breathing and spoke clearly.

A back-and-forth ensued while Durrah asked for water repeatedly. Throughout Durrah’s time in the booking area, jail staff and investigators said he displayed what they described as erratic behavior.

“What is that?” a camera recorded one deputy saying at 2:15 a.m., while another said, “Do not swallow it!”

Several jail staff described the object as a small plastic bag with suspected meth that Durrah then put in his mouth. Two deputies entered the cell attempting to grab what Durrah was trying to swallow. Then he apparently burst from the cell with one of the deputies hanging onto his uniform while several other jail officers tried to take hold of him. They brought him to the ground, where they handcuffed him.

While handcuffed, Durrah asked deputies for Narcan and apparently said that he had taken an “8-ball,” slang for an eighth-ounce of drugs, often cocaine or meth.

Between 2:18 and 2:23 a.m., jail staff cut Durrah’s uniform off and strapped him into a restraint chair, which they wheeled into booking cell No. 13. The door was left open, within view of cameras positioned in the booking area.

From the time of the scuffle through his placement in the restraining chair, Durrah was yelling and screaming, and told deputies several times that he was HIV positive, the DCI report states.

At 2:28 a.m., video showed Durrah moving while in the restraint chair and captured him yelling “I can’t breathe. I’m dying. Help!”

Deputies began a rotation of checks on Durrah beginning with one at 2:34 a.m., then 2:44 a.m. and 2:51 a.m.

Ten minutes later, at 3:01 a.m., a deputy found Durrah unresponsive and an ambulance was called. After attempts at CPR, Durrah was taken to the Campbell County Memorial Hospital where he was pronounced dead.

Special prosecutorThe investigating DCI agent and Campbell County Attorney Nathan Henkes met Oct. 12 regarding Durrah’s death, according to DCI’s report, shortly after another death occurred in Campbell County Sheriff’s Office custody. Dennis Green died while in sheriff’s office custody after attempting suicide Sept. 21 inside a holding cell in the Campbell County Courthouse. He’d been brought there for a hearing.

In December, the county attorney’s office brought Durrah’s case along with Green’s — which the Gillette Police Department investigated — to county commissioners, who forwarded each case to special prosecutors outside the county to avoid potential conflicts of interest.

It took less than three months for Green’s investigation to make it to a special prosecutor, while Durrah’s case took more than a year.

Durrah’s brother Joshua said he and his family have been frustrated by the drawn-out investigation that took months to pass through the offices of Campbell and Weston county prosecutors. The DCI report shows a lag in new reports entered, starting last January, with an entry approved by Louey Williams, former team leader of DCI’s northeastern region. No new entries were made until Sept. 22, the day after Green was found inside the courthouse. That entry was approved Sept. 29 by Chad Quarterman, DCI’s current northeastern region team leader, who took over after Williams’s retirement.

Stulken described his decision not to seek charges against anyone involved in the case in a letter to Wyoming DCI dated March 4 of this year.

News of his decision was made public by Sheriff Scott Matheny on March 13, more than 15 months after Durrah died and more than three months after the DCI report was sent to a special prosecutor for review.

Joshua said he reached out to the Weston County Attorney’s Office prior to Stulken’s decision, and that he didn’t hear back until more than two weeks after the decision had been made.

“And I didn’t hear it from him first, I had to hear it from the news,” Joshua said. “I just think this whole thing was handled unprofessionally, it wasn’t handled with any decency. It feels like almost everybody is covering up something for each other and that there’s no true justice being sought for the death of my brother.”

Excited delirium

Stulken declined to bring criminal charges against jail staff because the autopsy “indicates no outside physical injuries were had relating to this case and that the deceased’s death likely was caused by a methamphetamine overdose, as evidenced by high levels of such substance indicated in the toxicology report, and the cardiac effects of excited delirium,” he explained in his letter to DCI.

“There is really no evidence to indicate that this was a restraint related death,” Stulken wrote.

Outside experts who reviewed the autopsy, toxicology and investigatory documents agreed that methamphetamine likely played a role in Durrah’s death, but challenged the use of the term “excited delirium” and the assertion that the absence of physical injuries guaranteed restraints did not contribute to his death.

Excited delirium is no longer recognized as a legitimate diagnosis or cause of death by most major medical societies, including the American Medical Association, the American Psychiatric Association and the National Association of Medical Examiners, as reported by KFF Health News.

The term, while not backed by rigorous scientific study, was used for decades because it offered a simple explanation for the deaths of people on drugs or experiencing psychiatric emergencies who were restrained by police, Eric Jaeger said. Jaeger is a paramedic and lawyer who has devoted the last decade of his career to EMS education.

“I think part of the problem in the past, if you were a coroner or medical examiner, and you were presented with Kenneth Durrah’s body, and you were asked to examine his death and figure out what happened, and you can’t find any bruises and you can’t find, for example, significant heart disease, and you need to put something down on a piece of paper to explain the cause of death, you were lucky because you could find in the literature this concept of excited delirium,” Jaeger said. “It’s this idea that people became so excited, either through methamphetamine or just by struggling [against restraints] that they effectively work themselves to death.

“The layperson’s description of excited delirium is they became so worked up, their heart rate became so high that they essentially work themselves to death,” Jaeger said.

Body camera footage of in-custody deaths attributed to excited delirium started to poke holes in the use of the term, Jaeger said, because physicians could see what was happening to these individuals before they died.

“They were being restrained on the ground in a way that restricted their breathing,” Jaeger said. “It’s really medical science 101 that if [I] can’t breathe effectively, and [I’m] agitated, my heart rate goes up, my blood pressure goes up, my oxygen consumption goes up.”

Because breathing is how we compensate for having low oxygen levels, by breathing faster and more deeply, Jaeger explained it’s hard for humans to recover when restrained the wrong way, as was the case for Elijah McClain in Colorado in 2019 and George Floyd in Minnesota in 2020.

“So the medical community has, as a whole over the last five years, shifted away from the excited delirium to recognizing that most of these deaths are likely due to what’s called positional asphyxia, restraint asphyxia or compressional asphyxia. The concept being that their breathing is restricted by the restraint, or in some cases by straps, and they die due to low oxygen levels or a buildup of acid in their body called acidosis.”

Lethal restraints won’t always leave a mark, Brooks Walsh said. A supervising emergency physician who specializes in cardiology and resuscitation, Walsh helped successfully advocate for the American College of Emergency Physicians to abandon use of excited delirium.

“If someone is choked with a cord or hands, there can be marks around the neck,” Walsh explained. But in cases where “people are held down on their belly or have their breathing impaired — especially when they are highly, highly stressed metabolically — it’s more of a diffuse pressure on the body.”

That diffuse pressure won’t necessarily leave specific bruises or abrasions, Walsh said.

In Durrah’s case, “the written record [investigators] produced, says that he came out of that [prone] position on the floor in handcuffs and was placed in the restraint chair doing fairly well,” Walsh said.

“If you take them at their word, that this guy was in the restraint chair and talking to them . . . and fairly healthy . . . then that doesn’t fit with the description of excited delirium.”

The decision by deputies to get Durrah out of the prone position was a good one, Jaeger said, if the restraint chair straps were properly applied.

“It’s a device specifically designed to keep someone restrained and safe, and the problem with that argument is so too is an ambulance stretcher and yet, in multiple cases, we’ve seen people restrained on the stretcher, where the strap is pulled too tight, and they have drugs or alcohol [in their system] and they’ve died as a consequence of that strap being too tight and their breathing being restricted.”

Public access to the video could help examine Durrah’s status after being restrained on his belly and whether the restraint chair restricted his breathing in some way.

Labeling his death “excited delirium” is an unnecessary distraction, Walsh said, that “only serves to stop any further conversation about the death, which is probably not what should be happening here based on all the questions the [investigation] raised for me.”

Jaeger, the paramedic and attorney, is also concerned that excited delirium provides an out when more questions need to be asked.

“To be clear,” Jaeger said, “whether you’re talking about a jail inmate that is suffering from a mental health emergency or a drug overdose, and needs to be restrained for his own safety, or you’re talking about someone we encounter on the street who’s having a psychiatric emergency or a substance use problem, those are inherently difficult and dangerous situations.”

Jaeger’s big problem with excited delirium is that it misconstrues the danger that resulted in these individuals’ deaths. He says that puts EMS providers and law enforcement in a difficult situation.

“If you don’t understand what’s killing these people, then you don’t know how to avoid those deaths in the future,” Jaeger said. “And when those patients or individuals die, it’s of course tragic for them, but from my perspective, it’s also terrible from the standpoint of the paramedic or the police officer involved, if that death resulted in part from a misunderstanding of what was occurring.”

Drug overdose and chest pains

Toxicologist Ryan Marino sees evidence in the investigatory materials of a meth overdose that warranted immediate medical attention.

“There’s a chance that this could have been treatable,” Marino said. There are ethical issues, however, when it comes to saying someone needed to do more, or placing blame for not providing adequate care, Marino said, because ultimately Durrah ingested the meth.

“But just because someone knowingly overdosed on meth, doesn’t mean they deserve to die,” Marino said.

Could Durrah’s death have been prevented? Likely, yes, Marino said, but he still has lots of questions about Durrah’s medical condition that night.

“They got a report that there were drugs in that area of the jail . . . and then after that, he said he had chest pain, and then [EMTs] said he didn’t need to go to a hospital. Then they saw him take something and then they tied him up in a chair and he died,” Marino said. “It seems like a weird, weird timeline.”

The EMTs who initially responded to Durrah’s complaints of chest pain, “talked about the high heart rate, and that’s concerning,” Walsh said. “I would never want a paramedic who’s working with me to leave someone on the scene who had a high heart rate. It’s just too much of a red flag for a lot of badness.”

“One of the tenets of medicine is if someone is saying ‘I’m having chest pain,’ we might not think it’s a heart attack but we still do all the tests to determine whether it’s a heart attack,” Jaeger said. “And EMS cannot do [all] those tests on scene.”

One of the detention deputies told DCI that when EMTs cleared Durrah, they said he “had a high heart rate and blood pressure, but his EKG was normal.”

He should have gone to the hospital anyway, Walsh said, because “EKGs are not so easy to interpret. There are a lot of things that your standard line paramedic is not going to appreciate, certain patterns that are still very bad.”

Whether Durrah was already in medical distress is worth examining, Jaeger, Walsh and Marino agreed, but the key question is: Why after watching Durrah swallow drugs, and wrestling him into the restraint chair, did they not immediately call for an ambulance again?

Jail protocol

Sheriff’s Capt. Kevin Theis, who oversees the jail, said that he believes jail guards who responded to the incident that night followed policy and protocol. He too was unclear why an ambulance was not called back to the jail after guards saw Durrah consume what they believed to be meth.

“That’s a good question. I can’t provide you an answer for that one,” Theis said. “Other than maybe just the ambulance had already been there, checked him out, and then they just didn’t think about it again.”

Restraint chairs are used on Campbell County jail inmates to prevent them from harming themselves or others, Theis said, and many of those incidents don’t necessarily warrant calling an ambulance.

“So maybe it just didn’t click at that time,” Theis said. “And so they didn’t think to re-call the ambulances to re-check him out again, now that they suspected that he’s ingested [suspected meth], so I can’t really give you a solid answer.”

Sheriff Scott Matheny said he would not release the jail’s policy on medical emergencies and in-custody death protocol due to potential security risks related to information about jail operations contained within the policy.

When placed into restraint chairs, Theis said, inmates are handcuffed behind their back, and sometimes also confined in leg shackles.

A strap is then locked across their shins to prevent kicking, and two seat-belt-like straps cross the inmate’s chest to hold them against the chair. The inmate’s hands may be removed from the handcuffs behind their backs and placed into cuffs locking their arms straight down to either side of the chair.

The cuffs are tested for tightness by fitting a finger between the inmate’s skin and the cuff, to ensure blood circulates.

Three of the jail staffers involved in the incident were still in their first year of working in the jail, Theis said.

“I think all the way the events happened, it might have just thrown them off of their routine game so they just didn’t think about it,” Theis said about not calling an ambulance a second time. “But certainly, hindsight always being 20/20, it should have been done.”

No sheriff’s office workers involved in the incident were placed on administrative leave.

“Our goals are safety and security and when things go outside of that normal, daily routine and result in somebody passing away, it’s traumatizing to them,” he said. “They’re not used to having to deal with those types of situations as frequently as a patrol deputy would be.”

Drugs in jail

The investigation into drugs found in Durrah’s cell block prior to his death did not uncover who had brought them into the jail.

“There were some characters in here who were pointing fingers at each other, so I’m not sure which one got it in or how they had gotten it in,” Theis said.

Officers shook down Durrah’s block on Nov. 28, 2022, three days before his death, but that investigation began with reports of shanks in Q block, Theis said. During that search, drugs were found.

DCI interviews with anonymous inmates produced accounts of drugs found in Q block in the days leading up to Durrah’s death.

Although the investigation was inconclusive, Theis and Matheny said they suspect Durrah had smuggled meth into the jail himself, based on the timeline of his stint in jail corresponding with drugs reported in Q block. There were inmates who also revealed information that pointed to Durrah, Theis said.

Durrah standoff

Durrah was arrested Nov. 22, 2022, following a standoff with Gillette police that lasted more than two hours. He died a little more than a week after his arrest.

Prior to his arrest, he had been released from prison in South Dakota for aggravated assault with a weapon and drug charges. His parole officer contacted Gillette police to revoke his parole.

Police were told at the time that Durrah was suspected of an assault in Spearfish, South Dakota, according to an affidavit of probable cause.

Durrah had ingested a significant amount of cocaine during the standoff leading up to his arrest, police reported at the time, but information released immediately after the incident and available in court records did not indicate whether meth was found.

Not long after Durrah’s death, the sheriff’s office lobbied county commissioners for an X-ray body scanner, which cost $174,000 and was installed late last summer.

The scanner adds an extra layer of protection against drugs entering the jail. But through its first several months in operation, it hasn’t had the high-level impact that officials hoped.

Its presence is now thought of as a deterrence, as much as a means of catching inmates red-handed with contraband during the booking process.

On tape

Medical experts who reviewed the DCI report and Durrah’s family were left with questions that they felt video of the events may help answer. But that video hasn’t been released.

“It wasn’t just an overdose, it was after an altercation that led up to that,” Joshua said. “They told us George Floyd was just an overdose, but we’ve seen the officer’s knee on his neck. So now I feel that video needs to be reviewed by the public, seen by the public so we can see for ourselves.”

Responses to public records requests from WyoFile and the Gillette News Record for investigatory materials did not include video from the Campbell County Detention Center. While DCI has access to the video, the agency instructed reporters to obtain a copy directly from Campbell County. A specific request for the video was filed Thursday.

“I believe in the justice system … I just know what the report says,” Joshua said. “Until that video is shown, then we can see how they handled him. But what you know is that they failed to give him medical aid when he was in distress.”

WyoFile is an independent nonprofit news organization focused on Wyoming people, places and policy.

This story was posted on April 16, 2024.