Doctors' role in executions debated Death penalty foes go after licenses.
By CARLOS CAMPOS The Atlanta Journal-Constitution Published on: 02/01/05
After a lethal dose of chemicals flowed through the veins of convicted killer Timothy Don Carr last Tuesday night, two physicians with stethoscopes around their necks quietly entered the execution chamber.
One at a time, the doctors confirmed with a somber nod to the warden of the Georgia Diagnostic and Classification Prison in Jackson that the state had succeeded in carrying out the court-ordered death penalty. A third physician, unseen behind a two-way mirror, monitored an electrocardiogram that displayed the prisoner's last heartbeats.
The doctors' identities are carefully protected — as are all involved in lethal injections, including prison officials who activate the plungers that deliver the deadly dose. The contract providing for the doctors' services at an execution forbids the Department of Corrections from disclosing their names.
The doctors have a reason for wanting anonymity: Their medical licenses are under attack from death penalty opponents.
Activists say doctors who participate in executions violate the Hippocratic oath and the American Medical Association's Code of Medical Ethics. Dr. Arthur Zitrin of New York, who calls himself a death penalty "abolitionist," has begun challenging physicians who participate in executions.
In October, Zitrin, two other doctors and a sociology professor lodged a complaint with the Georgia medical board against Dr. Hothur V. Sanjeeva Rao, a physician who testified in a Gwinnett County trial that he had assisted with executions.
"I think it's a totally improper role for a physician to be complicit with the state in killing people, because it's not the role of a doctor to do that," said Zitrin, a professor emeritus of psychiatry at the New York University School of Medicine. "The role of a doctor is to heal and to preserve life, whenever there is a possibility of doing so."
Rao quit working executions in June after he learned that Zitrin planned to lodge a complaint against him. The challenge was dismissed in December by the state medical board.
The Georgia Department of Corrections is lobbying for legislation that would prohibit the challenge of physicians' licenses for participating in executions.
Cost to state rises
Corrections officials say they don't want to get involved in the debate over the death penalty. But it is the agency's responsibility to carry out orders of the court, and state law requires two physicians in attendance at executions "to determine when death supervenes."
Prison officials say the challenge to Rao's medical license dramatically drove up the cost of hiring doctors to attend executions. The prison system now pays Rainbow Medical Associates $18,000 per execution. Before Rao's license was challenged, the department paid $850 per execution, said Bill Amideo, a lawyer for the state agency.
The cost jumped because the doctors had to purchase liability insurance to protect themselves from possible license challenges, Amideo said.
While he expected the prison system would have to pay more for the doctor's services, perhaps as much as $6,000 per execution, "we ended up having to pay three times as much to get this contract," Amideo said.
State officials were in a hurry to sign Rainbow on June 29, just two days before the scheduled execution of convicted murderer Robert Karl Hicks on July 1. Since Rainbow Medical Associates has had the contract, its doctors have presided over three executions.
Georgia has executed 14 people by lethal injection since the electric chair was ruled unconstitutional in 2001.
"What they try to do is get publicity and embarrass physicians," Amideo said, making it difficult for the prison system to find doctors who will work executions.
Lawyers who represent prisoners facing the death penalty have been supportive of the effort, including some in Georgia who have argued in court that lethal injection is cruel and unusual punishment.
Dr. Carlo Musso, who signed the contract with the state on behalf of Rainbow Medical Associates, said the group of seven to 10 doctors provides medical services to county jails throughout Georgia and is available to monitor executions.
Musso said he and other doctors in the group are "a little bit worried" about license challenges, but he feels strongly they are providing an important service.
Musso said in an interview that he was one of the doctors who oversaw Carr's execution Jan. 25.
"If an execution is going to be carried out, it's going to be carried out," Musso said. "Our role is to make sure it is to be performed with the least amount of pain and suffering as possible. That's my duty."
The physician said he personally does not approve of the death penalty except "in the most egregious circumstances." But if doctors do not participate in lethal injections, he said, courts could return to more "archaic" methods of execution.
"If health care professionals were not involved in the process, then there very well may be undue suffering to inmates that occurs during execution, and I think that's a greater concern," Musso said.
Musso, who is also medical director of the Rainbow House, an emergency shelter for abused children in Clayton County, said the doctors have donated some of the money they earn from executions.
Musso is a member of the American Medical Association, a 250,000-member organization that represents the interests of doctors nationwide. The AMA has issued an ethical opinion that a physician "should not be a participant in a legally authorized execution."
The opinion goes on to define physician participation in executions as including monitoring vital signs and electrocardiograms and attending or observing an execution as a physician.
The Medical Association of Georgia, with 7,000 members, has adopted the AMA guidelines. But neither group has the power to sanction physicians beyond revoking their membership in the association.
In November, Zitrin and other doctors questioned whether Gov. Ernie Fletcher of Kentucky — also a physician — had jeopardized his medical license by signing a death warrant for a convicted killer. In January, the Kentucky Board of Medical Licensure ruled Fletcher was acting as governor, not as a physician.
'An obvious tension'
Dr. Michael Goldrich, chairman of the AMA's Council on Ethical and Judicial Affairs, said physicians should play no role in executions.
"There's an obvious tension between the state's requirements and the profession's roles," Goldrich said. "Just because the state says that physicians have to be present for there to be an execution, physicians are under ethical obligation that may be in conflict with the state's desires or needs."
David Cook, executive director of the Medical Association of Georgia, said the group has not taken a formal position on a bill filed last month by State Rep. Alan Powell (D-Hartwell) to block challenges to doctors' licenses for participation in an execution. But Cook said the association believes the state medical board should be able to determine on its own whether license challenges have merit.
Rao's testimony at a Gwinnett County trial that drew the attention of Zitrin and death penalty lawyers involved the execution of convicted murderer Jose Martinez High in 2001.
Medical technicians spent 39 minutes trying to find a suitable vein through which the lethal injection could be delivered.
Rao testified he eventually stepped in and inserted a catheter into a vein between High's neck and shoulder, allowing the execution to proceed.
Zitrin's complaint said Rao's conduct "violates established national medical ethics" and asked the state board to "impose appropriate sanctions should the board confirm these serious ethical violations."
LaSharn Hughes, executive director of the Composite State Board of Medical Examiners, declined to comment specifically on the case or on physician participation in executions, except to say that "it's not a burning issue with the board at this time."
A Dec. 15 letter sent to Zitrin from Hughes said that "after careful consideration, the board has determined that there was no violation of the Georgia Medical Practice Act and has consequently determined to close this matter." The letter went on to note that physician attendance at executions is required by Georgia law.
Rao did not return a telephone call seeking comment, but said in an October interview with American Medical News that he merely monitored lethal injections.
"There was just too much harassment, and I didn't want to be involved in these things," Rao told the medical newspaper. "I don't have any problems with prisoners who have killed people and don't have any regrets receiving the death sentence, but I don't want to be involved."
Powell said doctors should not be punished for helping the Department of Corrections carry out sentences "set forth by a judge and jury."
"Nobody wants to be involved in a public execution, but that's the law," he said. "But he's not injecting the drugs. The Department of Corrections actually does the injection."