Thursday, 30 November 2006

More on Kentucky LI Ruling

Wednesday, November 29, 2006

More on Kentucky LI Ruling

Since today's earlier post is down the page and off the screen, I'll add this update on today's ruling with this AP article, via the Louisville Courier-Journal.

Kentucky must hold public hearings on its execution protocol after changing how a lethal injection is administered, a state judge ruled Wednesday.

Franklin County Circuit Judge Sam McNamara's ruling could prevent the state from executing any inmates until the issue is resolved. The ruling came a week after the Kentucky Supreme Court upheld the state's lethal injection law, saying it did not amount to cruel and unusual punishment.

Kentucky Death Row inmates Thomas Clyde Bowling, 52, and Ralph Baze, 49, challenged the lethal injection method in Franklin County Circuit Court in April, saying the Kentucky Department of Corrections did not follow state-mandated administrative procedures before instituting it.

The two inmates also challenged the method of executing condemned prisoners in 2004, saying the drug formula used amounts to cruel and unusual punishment.

After that suit was filed, the state changed the mixture of drugs used in giving a lethal injection as well as procedures for how it is administered.
Rebecca DiLoreto, post-trial division director for the Kentucky Department of Public Advocacy, said McNamara's ruling simply requires the state to follow its own rules before making administrative changes.

More on the lethal injection issue is here.

California Execution Team Said to Lack Training

Tuesday, November 28, 2006

California Execution Team Said to Lack Training

The San Jose Mercury News reports on additional material filed in the challenge to California's lethal injection procedure. Federal District Judge Jeremy Fogel is expected to rule soon. LINK

By their own account, current and former members of San Quentin's execution team have little training or understanding of the rules or mixture of drugs used to put condemned murderers to death, documents released Monday show.

The documents, filed by lawyers for death-row inmate Michael Morales in a federal court challenge to California's lethal-injection procedure, reveal testimony given by execution team members who were questioned privately earlier this year in the legal battle over the state's execution method. Morales has challenged California's lethal-injection protocol, arguing that it risks causing inmates undue pain during an execution and amounts to cruel and unusual punishment.

Morales' lawyers maintain the testimony from execution team members demonstrates a lack of training and safeguards in the state's lethal-injection method.

Asked what kind of training they get before an execution, one former execution team member who has participated in seven executions, replied: ``Training? We don't have training really.''

More on lethal injection is here, including reports of the four-day hearing Judge Fogel held earlier this year.

Tuesday, November 28, 2006 at 09:39 AM in Lethal Injection

More coverage of California LI Challenge

Wednesday, November 29, 2006

More coverage of California LI Challenge

Yesterday, we linked you to San Jose Mercury News coverage (here.) Today, Henry Weinstein of the Los Angeles Times reports on the additional briefing filed with Judge Jeremy Fogel in the challenge to California's procedure. LINK

California's procedures for executing prisoners by lethal injection fall short of standards set by the veterinary profession for animal euthanasia and were formulated with less care than methods in China, the world leader in capital punishment, according to a brief filed Tuesday in San Jose federal court by attorneys for a death row inmate.

In addition, the brief asserts that the execution team at San Quentin State Prison is "unlicensed, untrained, unprofessional and incompetent" to carry out its duties.

The brief was lodged as U.S. District Judge Jeremy Fogel prepares to rule on perhaps the most fiercely fought of a number of legal challenges in several states to lethal injection, the dominant method of execution in the nation.

Fogel is expected to rule by the end of the year in the case of Michael Morales, who argues that California's injection methods create an unnecessary risk of excessive pain and as a consequence violate the 8th Amendment prohibition against cruel and unusual punishment.

The California Department of Corrections and Rehabilitation "conducts its executions in an outdated, cramped gas chamber with an undersized and dark anteroom," from which prison staff are supposed to assure proper administration of a three-drug protocol, the brief says.

The brief also says the state uses chemicals "mixed by untrained and unsupervised prison staff, while ensuring that there is no meaningful oversight or review."

Judge Fogel is expected to issue his ruling soon.

Wednesday, November 29, 2006 at 04:31 PM in Lethal Injection

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San Quentin's execution team is called incompetent

San Quentin's execution team is called incompetent

A brief filed on behalf of killer Michael Morales finds broad problems with death penalty cases.

By Henry Weinstein, Times Staff Writer

November 29, 2006

California's procedures for executing prisoners by lethal injection fall short of standards set by the veterinary profession for animal euthanasia and were formulated with less care than methods in China, the world leader in capital punishment, according to a brief filed Tuesday in San Jose federal court by attorneys for a death row inmate.

In addition, the brief asserts that the execution team at San Quentin State Prison is "unlicensed, untrained, unprofessional and incompetent" to carry out its duties.

The brief was lodged as U.S. District Judge Jeremy Fogel prepares to rule on perhaps the most fiercely fought of a number of legal challenges in several states to lethal injection, the dominant method of execution in the nation.

Fogel is expected to rule by the end of the year in the case of Michael Morales, who argues that California's injection methods create an unnecessary risk of excessive pain and as a consequence violate the 8th Amendment prohibition against cruel and unusual punishment.

The California Department of Corrections and Rehabilitation "conducts its executions in an outdated, cramped gas chamber with an undersized and dark anteroom," from which prison staff are supposed to assure proper administration of a three-drug protocol, the brief says.

The brief also says the state uses chemicals "mixed by untrained and unsupervised prison staff, while ensuring that there is no meaningful oversight or review."

Earlier this month, the California attorney general's office issued a ringing defense of the state's procedures, maintaining in its brief that "there is no evidence that any prior execution resulted in the unnecessary and wanton infliction of pain."

But the 274-page brief filed by Morales' attorneys finds fault with virtually every aspect of California's administration of capital punishment, frequently citing statements by state personnel during the proceedings.

For example, the execution team leader, identified only as Witness No. 5, said that for the last eight executions, he did not require team members to practice mixing sodium thiopental, which is supposed to anesthetize the inmate before the two other drugs — pancuronium bromide, which paralyzes the inmate, and potassium chloride, which causes cardiac arrest — are administered.

One of the key arguments in the Morales case, and in several other lethal injection challenges around the country, is that the anesthetic has not been properly administered, with the result that the inmate experiences excruciating pain but cannot express it because he is paralyzed.

Witness No. 4, a licensed vocational nurse, said in a deposition that she was not trained to mix thiopental. The first time she prepared it was the night of an execution, she said.

The Department of Corrections "has failed to comprehend both the importance of properly preparing [the drug] and the difficulty of doing so," according to the brief filed by defense lawyers David A. Senior, Kathleen T. Saenz and Benjamin D. Weston of Century City. Attorneys Ginger Anders of Washington, John Grele of San Francisco and Richard Steinken of Chicago helped prepare the brief.

In response to a question from the judge, the defense brief indicated that it might be less risky to use a single drug. Still, Morales' lawyers cautioned that there would still be risks. Significant problems with the execution chamber and drug delivery apparatus, including cramped quarters, poor lighting and bad sight lines, still exist.

Fogel asked the lawyers how the procedure could be improved. But Morales' lawyers said that they were ethically constrained in their answers, saying they could not "be put in the position of designing for the state its execution procedure."

In response to another question from Fogel, defense lawyers said many of the dangers in monitoring the inmate, inserting the IVs and injecting the drugs "flow from the fact" that the state continues to execute prisoners in San Quentin's old gas chamber, instead of in a facility designed for lethal injection.

"It is common sense that a facility should be designed to accommodate the specific elements of the procedure that will be performed in that facility. The veterinary profession has recognized this and advocates using dedicated rooms for euthanasia," the defense brief stated.

Defense lawyers noted that a witness for the state, Dr. Robert Singler, observed that "the cramped quarters and positioning of the gurney rendered placing the IVs more difficult than in a clinical setting." Execution staffers have repeatedly experienced difficulty inserting IVs to deliver the lethal drugs, the brief pointed out. It noted that several other states have built a facilities for lethal injections.

Defense lawyers said there may be a better execution anesthetic than thiopental. But as long as the protocol includes pancuronium bromide and potassium chloride, "it is imperative" that the state provide for a clinical bedside evaluation of anesthetic levels by a trained professional, the brief said.

The defense said it "should not be that difficult" for the state to retain such a doctor, although a brief filed by the California attorney general's office earlier this month asserted that such a requirement would effectively shut down capital punishment in California because leading physicians' organizations have urged their members not to participate in executions.

Morales' lawyers criticized state officials for failing to adequately research either their original lethal injection protocol or a modified procedure adopted in the face of his legal challenge. In contrast, they said, Chinese government officials conducted detailed experiments on animals before executing humans by lethal injection

Morales' lawyers argued that the state needed to bring its execution procedures into the open.

"For the past 14 years," they said, the Corrections Department has undertaken the recruiting, screening and training of execution team members "in total secrecy. That secrecy has permitted the execution system at San Quentin to operate in an unbelievably dysfunctional manner.",0,4845037.story?coll=la-home-headlines

Tuesday, 28 November 2006

SQ execution team members say they get little lethal injection training

San Quentin execution team members say they get little lethal injection training

By Howard Mintz
Mercury News
By their own account, current and former members of San Quentin's execution team have little training or understanding of the rules or mixture of drugs used to put condemned murderers to death, documents released Monday show.

The documents, filed by lawyers for death row inmate Michael Morales in a federal court challenge to California's lethal injection procedure, reveal testimony given by execution team members who were questioned privately earlier this year in the legal battle over the state's execution method. Morales has challenged California's lethal injection protocol, arguing that it risks causing inmates undue pain during an execution and amounts to cruel and unusual punishment.

Morales' lawyers maintain the testimony from execution team members demonstrates a lack of training and safeguards in the state's lethal injection method.

Asked what kind of training they get before an execution, one former execution team member who has participated in seven executions replied: ``Training? We don't have training really.''

The execution team members' identities have been kept secret.

In another set of deposition testimony, former San Quentin warden Steven Ornoski, asked the definition of a ``successful execution,'' told Morales' lawyers it would be when ``the inmate ends up dead at the end of the process.''

California prison officials maintain that the state's lethal injection process does not expose inmates to pain and suffering, and that Morales failed to prove that the problems justify halting executions. In court papers filed earlier this month, the state said prison officials can improve the procedures, but that ``all reasonable measures are taken to ensure a constitutional execution.''

The execution team administers a fatal dose of three drugs to an inmate. The state has had trouble finding doctors willing to be present for executions because of ethical constraints on the medical profession, but the judge hearing the case has explored the possibility.

California's lethal injection process, the state argued, ``is a rational and humane procedure that poses no arbitary or wanton risk that plaintiff, or any other condemned inmate, will suffer unnecessary pain.''

Morales, on death row for the 1981 rape and murder of 17-year-old Terri Winchell of Lodi, was on the verge of execution in February when he got a reprieve to pursue his lethal injection challenge.

San Jose U.S. District Judge Jeremy Fogel, who held an unprecedented hearing in September in the case, is expected to rule on Morales' claims in the coming weeks. Fogel now has thousands of pages of documents and hours of testimony to consider as he weighs the constitutionality of lethal injection.

California is one of a mounting number of states where death row inmates have challenged the progression of three drugs used in executions as cruel and unusual punishment. Earlier this month, the Kentucky Supreme Court rejected a similar legal challenge.

Fogel's ruling is ultimately expected to be appealed to the 9th U.S. Circuit Court of Appeals.

Monday, 27 November 2006

Hill v. McDonough

Home: Cases: 2000-2009: 2005: Hill v. McDonough

Hill v. McDonough
547 U.S. ___ (2006)
Clarence E. Hill
James R. McDonough, Interim Secretary, Florida Department of Corrections, et al.
Case Media -->
Oral Argument

Opinion Announcement

Written Opinion (Justia)
April 24, 2006
Oral Argument:
April 26, 2006
June 12, 2006
Liability, Civil Rights Acts
D. Todd Doss
(Attorneys for Petitioner)
Carolyn M. Snurkowski
(Attorneys for Respondent)
Facts of the Case
Clarence Hill was sentenced to death in Florida, which ordinarily uses a three-drug combination for executions. Hill claimed that this particular form of lethal injection was unnecessarily and gratuitously painful, and that it therefore violated the Eighth Amendment's prohibition on cruel and unusual punishment. However, Hill had previously filed for a federal writ of habeas corpus challenging his conviction, and the federal district court ruled that his new challenge was the practical equivalent of a second habeas corpus appeal. Successive habeas corpus appeals are not allowed under 28 U.S.C. 2244, and so the district court rejected Hill's petition. The Eleventh Circuit Court of Appeals affirmed the decision.
Is a prisoner's challenge to a particular form of execution - but not to the execution sentence itself - the practical equivalent of a federal habeas corpus petition and therefore barred if the prisoner has already sought habeas review?
No. In a unanimous decision authored by Justice Anthony Kennedy, the Supreme Court held that challenging the form of execution was fundamentally different from challenging the lawfulness of a conviction or sentence, the traditional purposes of a habeas corpus appeal. This finding was supported by the fact that Hill conceded other forms of execution would be constitutional, and that Florida state law does not require the particular form of execution at issue in this case. "Under these circumstances," Justice Kennedy wrote, "a grant of injunctive relief could not be seen as barring the execution of Hill's sentence."
Supreme Court Justice Opinions and Votes
Cite this page
The OYEZ Project, Hill v. McDonough, 547 U.S. ___ (2006), available at: <> (last visited November 27, 2006).

Saturday, 25 November 2006

Lethal injection

Lethal injection

From Wikipedia, the free encyclopedia

This article is about the execution method.

Lethal injection involves injecting a person with fatal doses of drugs to cause death. The main applications are euthanasia and capital punishment. This article focuses on the latter.

As a method for capital punishment, it gained popularity in the twentieth century as a "more humane" form of execution meant to supplant methods such as electrocution, hanging, firing squad, gas chamber, or decapitation; the actual humaneness of the technique has been debated. It is now the most common form of execution in the United States: every American execution in 2005 was induced by lethal injection.[1]
Lethal injection has also been used in euthanasia to facilitate death in patients with terminal or chronically painful conditions. Both applications have used similar drug combinations.[2]


1 History
2 Procedure
3 Lethal injection drugs
3.1 Sodium thiopental
3.2 Pancuronium bromide
3.3 Potassium chloride
4 Euthanasia protocol
5 Constitutionality in the United States
6 Ethics of lethal injection
7 Controversy: Arguments against
7.1 Awareness
7.2 Research
7.3 Single drug
7.4 Cruel and unusual
8 Controversy: Arguments in support
8.1 Commonality
8.2 Anesthesia awareness
8.3 Dilution effect
8.4 Blood levels
8.5 Single drug
9 See also
10 References

The concept of lethal injection was first proposed in 1888 by Julius Mount Bleyer,[3] a New York doctor who praised it as being cheaper and more humane than hanging.[4] Bleyer's idea, however, was never used. The British Royal Commission on Capital Punishment (194953) also considered lethal injection, but eventually rejected it after pressure from the British Medical Association (BMA).[4]

In 1977, Jay Chapman, Oklahoma's state medical examiner, proposed a new, 'more humane' method of execution: "An intravenous saline drip shall be started in the prisoner's arm, into which shall be introduced a lethal injection consisting of an ultra-short-acting barbiturate in combination with a chemical paralytic."[5] After being approved by anesthesiologist Stanley Deutsch, the method was adopted by Oklahoma (Title 22, Section 1014(A)). Since then, thirty-seven of the thirty-eight states using capital punishment have introduced lethal injection statutes.[5] (The sole exception is Nebraska, which continues to electrocute the condemned.)

On 7 December 1982, Texas became the first state to use lethal injection as a capital punishment for the execution of Charles Brooks, Jr..[6] Nazi Germany's T-4 Euthanasia Program also used lethal injection as one of several methods to destroy 'life unworthy of life.'[7]

The People's Republic of China began using this method in 1997, Guatemala in 1998, and the Philippines in 1999; multiple other countries have also legally, but not practically adopted the method.

After the condemned is fastened on the execution table, two intravenous catheters are inserted, one in each arm. Only one is used for the execution, the other is reserved as a backup in case the primary IV fails.

The arm of the condemned is swabbed with alcohol before the needle is inserted. Along with its antiseptic use, the alcohol also causes the blood vessels to rise to the skin's surface, making it easier to insert the needle. [1] The needles and equipment used are also sterilized. One reason for this is because the needles are standard medical products that are sterilized during manufacturing. Also, there is a chance that the prisoner could receive a stay of execution after the needles have been inserted as happened in the case of James Autry in October 1983 (he was executed eventually on 14 March 1984). Finally, it would also be a hazard for those handling unsterile equipment.

The intravenous injection is usually a mixture of compounds, designed to induce rapid unconsciousness followed by death through paralysis of respiratory muscles and/or by inducing cardiac hyperpolarization. The execution of the condemned in most states involves three separate injections:

Sodium thiopental: to induce a state of unconsciousness intended to last while the other two injections take effect.

Pancuronium/Tubocurarine: to stop all muscle movement except the heart. This causes muscle paralysis, collapse of the diaphragm, and would eventually cause death by asphyxiation.

Potassium chloride: to stop the heart from beating, and thus cause death: see cardiac arrest.

The drugs are not mixed externally as that can cause them to precipitate.
The intravenous tubing leads to a room next to the execution chamber, usually separated from the inmate by a curtain or wall. Usually some type of IV technician with certification to insert the IV performs that role, while the chemical technician, who is usually a member of the prison staff, orders, prepares, and loads the chemicals into the machine. After the curtain is opened to allow the witnesses to see inside the chamber, the condemned person will then be permitted to make a final statement.

Following this, the warden will signal for the execution to commence, and the executioner(s), either prison staff or private citizens depending on the jurisdiction, will then activate the machine which mechanically delivers the three drugs in sequence. During the execution, the inmate's cardiac rhythm is monitored and death is pronounced after cardiac activity stops. Death usually occurs within seven minutes, although the whole procedure can take up to 45 minutes. According to state law, if participation in the execution is prohibited for physicians, the death ruling is made by the state's Medical Examiner's Office. After confirmation that death has occurred, a coroner signs the executed individual’s death certificate.

Lethal injection drugs
The below three drugs are a representation of a typical lethal injection cocktail as practiced in the United States for capital punishment.

Sodium thiopental
Lethal Injection dosage: 5 grams
Sodium thiopental (US trade name: Pentothal) is an ultra-short acting barbiturate, often used for anesthesia induction and for medical induced comas. The typical anesthesia induction dose is 3-5 mg/kg (a person who weighs 200 pounds, or 91 kilograms, would get a dose of about 300 mg). Loss of consciousness is induced within 30-45 seconds at the typical dose, while a 5 gram dose - 14 times the normal dose - is likely to induce unconsciousness in 10 seconds.

Thiopental reaches the brain within seconds and attains a peak brain concentration of about 60% of the total dose in about 30 seconds. At this level, the patient is unconscious. Within 5 to 20 minutes the percentage in the brain falls to about 15% of the total dose, since the drug redistributes to the rest of the body. At this concentration in the brain, the anesthetic effects wear off and consciousness returns. This is the typical pharmacokinetics for the induction dose.

The half-life of this drug is about 11.5 hours[2], and the concentration in the brain remains at around 5-10% of the total dose during that time. When a 'mega-dose' is administered, as in lethal injection, the concentration in the brain during the tail phase of the distribution stays higher than the peak concentration found in the induction dose for anesthesia.

This is the reason why an ultra-short acting barbiturate, such as thiopental, can be used for long-term induction of medical comas.
After a 5 gram dose consciousness will be regained in about 5 to 6 half-lives, which occurs in about 57-69 hours. The effects of such a high dose, however, includes profound respiratory depression (depression of the brainstem respiratory center) and vascular collapse (vasodilatation and myocardial depression), which is in itself lethal.

Thiopental historically has been one of the most commonly used and studied drugs for the induction of comas. Protocols vary with how the medication is given, but the typical doses are anywhere from 500 mg up to 1.5 grams. It is likely that these data were used to develop the initial protocols for lethal injection of giving 1 gram of thiopental to induce the coma. Now, most states use 5 grams to be absolutely certain about its effectiveness.

Barbiturates are the same class of drugs used in medically assisted suicide. In euthanasia protocols, the typical dose of thiopental is 20 mg/kg[3] and a 91 kilogram man would receive 1.82 grams. The lethal injection dose used in capital punishment is therefore about 3 times more than the dose used in euthanasia.

Pancuronium bromide
Lethal Injection dosage: 100 milligrams
Pancuronium bromide (Trade name: Pavulon) is a non-depolarizing muscle relaxant (a paralytic agent) that blocks the action of acetylcholine at the motor end-plate of the neuromuscular junction. Binding of acetylcholine to receptors on the end-plate causes depolarization and contraction of the muscle fibre; non-depolarizing neuromuscular blocking agents like pancuronium stop this binding from taking place.
The typical dose for pancuronium bromide is 0.1 mg/kg (a person who weighs 200 pounds, or 91 kilograms, would get a dose of around 9mg). With a 100 milligram dose, the onset to paralysis occurs in around 15 to 30 seconds, and the duration of paralysis is around 4 to 8 hours.

Paralysis of respiratory muscles will lead to death in a considerably shorter time.

Pancuronium bromide is a derivative of the alkaloid malouetine from the plant Malouetia bequaertiana. [4]

Potassium chloride
Lethal Injection dosage: 100 mEq (milliequivalents)

Potassium is an electrolyte that is 98% within the cells. The 2% remaining outside of the cell has great implications for cells that generate action potentials. Typically, doctors give patients potassium when there is insufficient potassium, called hypokalemia, in the blood. The potassium can be given orally which is the safest route, or it can be given intravenously in which case there are strict rules and hospital protocols on the rate at which it is given.

The usual intravenous dose is 10-20 MEQ per hour and it is given slowly since it takes time for the electrolyte to equilibrate into the cells. When used in lethal injection, bolus potassium injection affects the electrical conduction of heart muscle. Elevated potassium, or hyperkalemia, causes the resting electrical activity of the heart muscle to be higher than normal.

Depolarizing the muscle cell inhibits its ability to fire by reducing the available number of Na channels (they are placed in an inactivated state). EKG changes include faster repolarization (peaked T-waves), PR interval prolongation, widening of the QRS, and eventual sine-wave formation and asystole. The heart eventually stops in diastole. Cases of patients dying from hyperkalemia (usually secondary to renal failure) are well known in the medical community, where patients have been known to go from a normal state to death within seconds.

Euthanasia protocol
Euthanasia can be accomplished either through an oral, intravenous, or intramuscular administration of drugs. In individuals who are incapable of swallowing lethal doses of medication, an intravenous route is preferred. The following is a Dutch protocol for parenteral (intravenous) administration to obtain euthanasia with the old protocol listed first and the new protocol listed second:

First a coma is induced by intravenous administration of 1 g thiopental sodium (Nesdonal), if necessary, 1.5-2 g of the product in case of strong tolerance to barbiturates. Then 45 mg alcuronium dichloride (Alloferin) or 18 mg pancuronium dibromide (Pavulon) is injected. In order to ensure optimal availability, these agents are preferably given intravenously. However, there are substantial indications that they can also be injected intramuscularly. In severe hepatitis or cirrhosis of the liver, alcuronium is the agent of first choice.[5]

Intravenous administration is the most reliable and rapid way to accomplish euthanasia and therefore can be safely recommended. A coma is first induced by intravenous administration of 20 mg/kg thiopental sodium (Nesdonal) in a small volume (10 ml physiological saline). Then a triple intravenous dose of a non-depolarizing neuromuscular muscle relaxant is given, such as 20 mg pancuronium dibromide (Pavulon) or 20 mg vecuronium bromide (Norcuron). The muscle relaxant should preferably be given intravenously, in order to ensure optimal availability. Only for pancuronium dibromide (Pavulon) are there substantial indications that the agent may also be given intramuscularly in a dosage of 40 mg.[6]

Constitutionality in the United States
The Supreme Court has never ruled that any specific form of execution has violated the Eighth Amendment clause prohibiting cruel and unusual punishment. In Hill v. Crosby, decided June 12, 2006, the Supreme Court ruled that death-row inmates in the United States may challenge protocols used in the lethal injection process as potentially violating the Eighth Amendment's "cruel and unusual" punishment clause outside of a petition for a writ of habeas corpus. Clarence Hill had already exhausted all of his legal appeals through habeas corpus and filed a lawsuit claiming that lethal injection was a civil rights issue. The Supreme Court, in this ruling, did not decide whether lethal injection as currently practiced in the United States constitutes cruel and unusual punishment. [7] [8] [9]

Ethics of lethal injection
The American Medical Association believes that a physician's opinion on capital punishment is a personal decision. Since the AMA is founded on preserving life, they argue that doctors "should not be a participant" in executions in any form with the exception of "certifying death, provided that the condemned has been declared dead by another person."[10] Amnesty International argues that the AMA's position effectively "prohibits doctors from participating in executions." [11] The AMA, though, does not have the authority to prohibit doctors from participation in lethal injection, nor does it have the authority to revoke medical licenses, since this is the responsibility of the individual states.

Typically, most states do not require that physicians administer the drugs for lethal injection, but many states do require that physicians be present to pronounce or certify death.

Controversy: Arguments against

Opponents of lethal injection believe that it is not actually humane as practiced in the United States. Opponents argue that the thiopental is an ultra-short acting barbiturate that may wear off (anesthesia awareness) and lead to consciousness and an excruciatingly painful death wherein the inmate is unable to express their pain because they have been rendered paralyzed by the paralytic agent.

Opponents point to the fact that sodium thiopental is typically used as an induction agent and not used in the maintenance phase of surgery because of its short acting nature. Following the administration of thiopental, pancuronium bromide, is given, to which opponents argue that it not only dilutes the thiopental, but masks any pain when the thiopental wears off since the patient is paralyzed.

Additionally, opponents argue that the method of administration is also flawed. They state that since the personnel administering the lethal injection lack expertise in anesthesia the risk of failing to induce unconsciousness is greatly increased. Also, they argue that the dose of sodium thiopental must be customized to each individual patient, not restricted to a set protocol. Finally, the remote administration results in an increased risk that insufficient amounts of the lethal injection drugs enter the bloodstream.

In total, opponents argue that the effect of dilution or improper administration of thiopental is that the inmate dies an agonizing death through suffocation due to the paralytic effects of pacuronium bromide and the intense burning sensation caused by potassium chloride.
Opponents of lethal injection as currently practiced argue that the procedure employed is entirely unnecessary and is aimed more towards creating the appearance of serenity and a humane death than an actually humane death. More specifically, opponents object to the use of Pancuronium bromide. They argue that its use in lethal injection serves no purpose, since there is no need to keep the inmate completely immobilized and the inmate is physically restrained.

In 2005, University of Miami researchers, in cooperation with an attorney representing death row inmates, published a research letter in the medical journal The Lancet.

The letter stated that in 43 of the 49 executions they investigated (88%), the level of thiopental in the blood was lower than that required for surgery.[12] This has led them to believe that the prisoners were fully aware of what was happening to them. The authors attributed the rate of likely consciousness among inmates to the lack of training and monitoring in the process, and recommended that states take a look at the American Veterinary Medical Association's recommendations on animal euthanasia[13], which prohibits the use of paralytic agents in combination with barbiturates and adopts as the only "acceptable method" for euthanizing nonhuman primates a single injection of a short-acting barbiturate such as sodium pentobarbital.

Single drug
The opponents say that because death can be painlessly accomplished, without risk of consciousness, by the injection of a single large dosage of barbiturate, the use of any other chemicals is entirely superfluous and only serves to unnecessarily increase the risk of torture during the execution.

Cruel and unusual
On occasion, there have also been difficulties inserting the intravenous needles, sometimes taking over half an hour to find a suitable vein. Typically, the difficulty is found in patients with a history of intravenous drug abuse. Opponents argue that the insertion of intravenous lines that take excessive amounts of time are tantamount to cruel and unusual punishment. In addition, opponents point to instances where the intravenous line has failed, or that have been adverse violent reactions to drugs[14] and that "heavier doses" should have been given.

Controversy: Arguments in support

The combination of a barbiturate induction agent and a nondepolarizing paralytic agent is used in tens of thousands of surgeries every day. Supporters of the death penalty argue that unless anesthesiologists have been wrong for the last 40 years, the use of pentothal and pancuronium is safe and effective. In fact, potassium is given in heart bypass surgery to induce cardioplegia. Therefore, the combination of these three drugs is still in use today.

Supporters of the death penalty speculate that the designers of the lethal injection protocols intentionally used the same drugs as used in every day surgery to avoid controversy. The only modification is that a massive coma-inducing dose of barbiturates is given. In addition, similar protocols have been used in countries that support euthanasia or physician assisted suicide.[15]

Anesthesia awareness
Thiopental and methohexital are ideal drugs for inducing unconsciousness. Both of these drugs cause loss of consciousness upon one circulation through the brain because of their high lipophilicity. Only a few drugs, such as etomidate, have the capability to induce anesthesia so rapidly. Also supporters argue that since the pentothal is given at such a high dose, a dose that is higher than medical-induced coma protocols, it is impossible for a patient to wake up. Regardless, opponents of the death penalty claim that anesthesia awareness still is a concern.

Anesthesia awareness occurs when there is inadequate inhaled anesthetics given by the anesthesiologist. Barbiturates are only given during the induction phase of anesthesia and these medications rapidly and reliably induce anesthesia. A depolarizing paralytic or a nondepolarizing paralytic, like pancuronium, may then be given to cause paralysis which facilitates intubation. Once intubation has been attained, the anesthesia is converted to the inhaled anesthetics since the barbiturates at the dose given induce unconsciousness for only 5-20 minutes. The anesthesiologist has the responsibility to ensure that the inhaled anesthetics are started soon after intubation to prevent the patient from waking up.

Anesthesia is not maintained with the barbiturate class of drugs since these drugs have extremely long half-lives. The "ultra-short" acting pentothal has a half-life of approximately 11.5 hours and the long acting phenobarbital has a half-life of approximately 4-5 days. In contrast, the inhaled anesthetics have extremely short half-lives and allow the patient to wake up from surgery. If the barbiturate class of drugs was used for anesthesia, patients would not wake up for days. Patients only regain consciousness if the anesthesiologist fails to give sufficient inhaled anesthetics. Therefore, anesthesia awareness is not a problem when dealing with the barbiturate class of drugs; it only occurs if there is inadequate inhaled anesthetics.

The average time to death once a lethal injection protocol has been started is about 7-11 minutes.[16] Since it only takes about 30 seconds for the pentothal to induce anesthesia, 30-45 seconds for the pancuronium to cause paralysis, and about 30 seconds for the potassium to stop the heart, death can theoretically be attained in as little as 90 seconds. Given that it takes time to administer the drugs through an IV, time for the line to be flushed, time to change the drug being administered, and time to ensure that death has occurred, the whole procedure takes about 7-11 minutes. Procedural aspects in pronouncing death also adds time and, therefore, the condemned is usually pronounced within 10 to 20 minutes of starting the drugs. Supporters of the death penalty say that a megadose of pentothal, which is anywhere from 14-20 times the normal dose and which induces a medical coma for about 60 hours, could never wear off in only 10 to 20 minutes.

Dilution effect
Death penalty supporters state that the claim that pancuronium dilutes the pentothal dose is erroneous as well. Supporters argue that pancuronium and pentothal are commonly used together in surgery every day and if there were a dilution effect, it would be a known drug interaction.

Drug interactions are a complex topic, but most drug interactions can be simplistically classified as either synergistic or inhibitory interactions. In addition, drug interactions can occur directly at the site of action, through common pathways or indirectly through metabolism of the drug in the liver or through elimination in the kidney. Pancuronium and pentothal have completely different sites of action, one in the brain and one at the neuromuscular junction. Since the half-life of pentothal is on the order of hours, the metabolism of the drugs it is a nonissue when dealing with the short time frame in lethal injection. The only other plausible interpretation would be a direct one, or one in which the two compounds interact with each other. Supporters of the death penalty argue that this theory does not hold true. They state that even if the 100 mg of pancuronium directly prevented 500 mg of pentothal from working, there would be enough pentothal to induce coma for 50 hours. In addition, if this interaction did occur, then the pancuronium would be incapable of causing paralysis.

Supporters of the death penalty state that the claim that the pancuronium prevents the pentothal from working yet still is capable of causing paralysis is not based on any scientific evidence and is a drug interaction that has never before been documented for any other drugs. Supporters of the death penalty question if this is an invented false claim.

Blood levels
Researchers at the University of Miami have published an article in The Lancet claiming that the concentration of pentothal in the blood following execution was not of a sufficient concentration to reach anesthesia. Supporters of the death penalty dispute this claim.
The barbiturate class of drugs is highly lipophilic, meaning that the drugs are absorbed and reach high concentration in fatty tissues. Measurement of the drug by blood testing after administration is difficult to assess since most of the drug will not be in the blood. Blood levels soon after administration are the highest for the barbiturate class since the drug has not completely cleared from the blood. This is known as the initial volume of distribution. After a short period of time, the drug then reaches its apparent volume of distribution. Pentothal's initial volume of distribution is 13.8 liters and its apparent volume of distribution is 233 liters.[17] Essentially, any blood level drawn after an execution could be compared to the drug level that one would expect in the initial distribution. Since the apparent volume of distribution is much larger than the initial distribution, and hence its blood concentration much lower, any researcher can incorrectly claim that the level of pentothal was insufficient.

Given that the half-life of pentothal is 11.5 hours, the amount of pentothal required in the brain to induce anesthesia is about 50-75 milligrams, and that the dose of pentothal given is 5 grams, supporters of the death penalty state that common sense and medical experience indicate that the condemned is in a coma with certainty. Supporters of the death penalty therefore argue that the conclusions derived from the research must be politically motivated.

In fact, the researchers state that “participation of doctors in protocol design and execution is ethically prohibited.”[18] Therefore, the authors conclude that "a more effective, humane protocol cannot be developed."[19] Supporters of the death penalty state that the bias of the authors and faulty study design invalidates the study's conclusions.

Single drug
Amnesty International, Human Rights Watch, the Death Penalty Information Center, and other anti-death penalty groups, have not proposed a lethal injection protocol which they believe is more humane. Supporters of the death penalty argue that the lack of an alternative proposed protocol is testament to the fact that the humaneness of the lethal injection protocol is not the issue. Instead supporters argue that the issue is the continued existence of the death penalty since if the only issue was the humaneness of the procedure, then Amnesty International, HRW, or the DPIC should have already proposed a more humane method.

Regardless of an alternative protocol, some death penalty opponents have claimed that execution can be more humane by the administration of a single lethal dose of barbiturate. Supporters of the death penalty, however, state that the single drug theory is flawed concept. Terminally ill patients in Oregon who have requested physician-assisted suicide have received lethal doses of barbiturates. The protocol has been highly effective in attaining a humane death, but the onset to actual death can be a drawn out process. Some patients have taken days to die whereas a few patients have actually survived the process and have regained consciousness up to three days after taking the lethal dose.[20] In a Californian legal proceeding addressing the issue if the lethal injection cocktail was "cruel and unusual," State authorities said that the time of death following a single injection of barbiturate is approximately 45 minutes.[21]

Scientifically this is readily explained. Barbiturate overdoses typically cause death by depression of the respiratory center, but the effect is variable. Some patients may have complete cessation of respiratory drive, whereas others may only have depression of respiratory function. In addition, cardiac activity can last for a long time, potentially hours, after cessation of respiration. Since death is pronounced after asystole and given that the expectation is for a rapid death in lethal injection, multiple drugs are required; specifically potassium chloride to stop the heart. In fact, in the case of Clarence Ray Allen a second dose of potassium chloride was required to attain asystole. The position of death penalty supporters is that death should be attained in a reasonable amount of time.

Supporters of the death penalty agree that the use of pancuronium bromide is not absolutely necessary in the lethal injection protocol. Some supporters believe that the drug may decrease muscular fasiculations when the potassium is given, but this has yet to be proven. Irrespective, supporters argue that the dose of thiopental is so high that the condemned will be in stage 4 anesthesia theoretically for over 2 days and that there is zero risk of consciouness being regained.

See also
Capital punishment in the United States

"So Long as They Die: Lethal Injections in the United States," Human Rights Watch, 2006, 18(1).
I. Development of Lethal Injection Protocols. Cites DPIC, “Methods of Execution.”.
"Administration and Compounding of Euthanisic Agents," Royal Dutch Society for the Advancement of Pharmacy, 1994.
"Tödliche Injektion." (German)
Capital Punishment U.K.: Lethal injection."
"So Long as They Die: Lethal Injections in the United States," Human Rights Watch, 2006, 18(1).
I. Development of Lethal Injection Protocols.
Groner, Jonathan I. (2002)
"Lethal injection: a stain on the face of medicine," BMJ, 325:1026–8.
Sereny, Gitta Into That Darkness: from Mercy Killing to Mass Murder, a study of Franz Stangl, the commandant of Treblinka (1974)
Bean, Matt. "Lethal injection—the humane alternative?", Court TV, June 8, 2001.
Liptak, Adam. "Critics Say Execution Drug May Hide Suffering", New York Times, October 7, 2003.
"Prisoners 'aware' in executions", BBC News, 14 April 2005.
Kevin Bonsor. How Lethal Injection Works. Retrieved on September 3, 2005.
Koniaris, Leonidas G. et al (2005). "Inadequate anaesthesia in lethal injection for execution". The Lancet 365 (9468): 1412–1414.
"When someone is executed by lethal injection, do they swab off the arm first?" from The Straight Dope
Retrieved from ""
Categories: Execution methods People executed by lethal injection

Friday, 24 November 2006

It looks like medicine

It looks like medicine

by Daniel Sturm
October 12, 2006

In this Walruss interview, Jonathan Groner, an associate professor of surgery at the Ohio State University College of Medicine and Public Health, describes parallels between lethal injection in America and the Nazi Germany "euthanasia" program.

As in Nazi Germany, Groner says that in America doctors are today being asked to hold the lethal syringe.

Daniel Sturm: You say that you see similarities between Nazi doctors and U.S. execution teams?

Jonathan Groner: At Northwestern University I read many Holocaust books, being Jewish and having gone to Hebrew High School. It was interesting to see how intimately doctors were involved in the Nazi euthanasia program, and eventually in the genocide.

When I was a surgery resident, I heard a lecture about Robert Jay Lifton, who studied the corruption of Nazi Germany physicians. Lifton described how the government recruited physicians to kill physically and mentally disabled patients, including the "criminally insane."

What struck me was the idea of using healing imagery to justify killing. That stayed with me.

Daniel Sturm: When did you first become critical of the death penalty?

Jonathan Groner: In 1997 Arkansas executed three people in one night.

Reading about how they came into the room, put the IVs in, laid the prisoners down on the table, and executed them one by one – this sounded a lot like the concentration camps.

The euthanasia program’s chief administrator was often quoted saying, "The syringe belongs in the hand of a physician." The analogy really stuck with me.

Compare the kind of language they use to describe these executions and you will find similarities. It’s a similar kind of healing imagery: "Family hope killer’s death ends their years of pain, lets their healing begin."

The Time magazine article about the first lethal injection in 1982 read, "It looks like a hospital room."

After the Oklahoma City bombing in 1995 President Clinton said, "It’s time to let the healing begin." And his next sentence was, "We’ve got to find the people who did this to kill them!"**

It’s always this pattern of killing/healing/killing/healing.

Daniel Sturm: You argue that after the introduction of lethal injection the number of executions increased. How so?

Jonathan Groner: My thesis is that if we never went with lethal injection, we’d never have begun executing more than five or seven prisoners per year. I think lethal injection puts that veneer of medical respectability on murder.

I think they did a good job in "Dead Man Walking" to demonstrate this kind of medicalization: They swab the prisoner’s arm with alcohol and all that.

It looks like medicine, and again, it’s just like the Nazi regime’s medicalized killing.

Daniel Sturm: In 1977, when Dr. Stanley Deutsch, an Oklahoma anesthesiologist, helped to draft the first state lethal injection law, it was considered progress. A more humane method of killing when compared with the electric chair.

Jonathan Groner: Is there such a thing as humane killing? Could there be less physical torture? I don’t think so either. I have patients who pass out from taking out suture, and others I can cause significant pain to and they seem fine.

You just can’t quantify physical or psychic pain. Would it be more humane to use anesthesia drugs? Perhaps.

But in order for his method to succeed, and not torture people, it requires medically trained individuals.

A prison guard administering pancuronium is almost like me flying a 747. I can actually fly an airplane. But I couldn’t fly a 747.

Daniel Sturm: Why doesn’t Ohio employ physicians to ensure that executions are done properly?

Jonathan Groner: The state fears litigation.

The American Medical Association (AMA) distinguishes between pronouncing death and certifying death. To pronounce death you are trying to ascertain that the moment of death has arrived. In order to do that you have to examine a person’s presence or absence of vital signs.

The AMA considers monitoring the vital signs in an execution to be unethical.

If you monitor vital signs and there is still a presence you would have to give more drugs, so you would instantly become an actor of execution. **

The exact quote of Bill Clinton’s April 23 speech reads, "We pledge to do all we can to help you heal the injured, to rebuild this city, and to bring to justice those who did this evil."

Worse Than We Thought

October 14, 2006

Worse Than We Thought
Sarah Tofte, Human Rights Watch

As a student of lethal injections in the United States, I assumed nothing any state official might say about such executions could shock me. But I underestimated California's officials.

Evidence uncovered during Michael Morales' constitutional challenge to the state's executions-hearings in Morales' case were held in late September in San Jose-reveals an astonishing history of negligence, incompetence, and irresponsibility.

Lethal injections look peaceful and painless-which is why California and all but one of the other death penalty states adopted them to replace the more gruesome spectacles of execution by hanging, firing squad, lethal gas, or electrocution.

The condemned prisoner is strapped to a gurney and injected with a massive dose of the anesthetic sodium pentothal, which should render him unconscious and stop his breathing.

Next he is injected with pancuronium bromide, a drug that paralyzes voluntary muscles, including the lungs and diaphragm.

Finally, he is injected with potassium chloride, which should bring swift cardiac arrest.

California copied this bizarre and dangerous drug protocol from the national leader in executions, Texas, which itself had simply taken the idea from an Oklahoma medical examiner with no pharmacology experience who concocted the protocol in 1977.

When the Morales court earlier this year ordered California to review the protocol because of evidence that it may put prisoners at risk of unnecessary pain, California officials chose not to undertake a careful inquiry.

Instead, they held a short meeting during which the state's lawyers rejected the suggestion by one doctor in the group of an alternative single drug protocol that would carry much less risk of suffering by the prisoner.

When the drugs in the three-drug lethal injection protocol are administered properly, the prisoner should be motionless- as well as unable to feel pain-within a minute or two.

But a California doctor has testified that during four executions he observed prisoners' chests moving up and down long after the drugs were administered. Execution logs from six recent executions also reveal body movements inconsistent with the proper administration of the lethal injection drugs, particularly the anesthetic.

If the prisoners were not sufficiently anesthetized, they may have felt themselves suffocating from the pancuronium bromide, or they may have felt their veins burning up as the potassium chloride coursed its way to their heart.

Indeed, potassium chloride is so painful that U.S. veterinarian guidelines prohibit its use on domestic animals unless a veterinarian first ensures that they are deeply unconscious.

But California does not require anyone to stay at the prisoner's side to make sure he is in fact deeply anesthetized and unconscious before the second and third drugs are administered. Has California taken care to ensure the drugs are properly administered? Hardly.

Members of execution teams have revealed they never practiced mixing the sodium pentothal before executions.

The testimony of four members of one team reveals each had a different understanding of the quantity of the anesthetic that should be used and the number of syringes needed to administer it.

Worse, guidelines for how to mix the drug for intravenous administration are not even included in the written protocol-they are posted on the wall of the room where the executioners work-a darkened room lit only by one dim red bulb.

During the hearings we learned that a nurse in charge of preparing the anesthetic for lethal injections decided that she had no need to study how to do it since she would not be doing it every day.

Execution teams conduct rehearsals of the lethal injection procedure, but they do not rehearse responses to problems that might arise.

The team member responsible for training said that since it was not possible to anticipate all the potential problems, they didn't practice what to do for any.

When a member of Stanley Williams' execution team noticed that the intravenous tube was not connected properly and the drug was not being administered as it should, he never bothered to tell the execution team leader or the warden about this problem.

Indeed, although the warden is responsible for stopping an execution if he notices anything going wrong, the observation room has been so crowded during some executions that the warden could not even see clearly into the execution chamber.

As more court documents in the Morales case are made public, this sorry litany of negligence, botches and bungling will no doubt grow longer. Executions are inherently cruel and inconsistent with fundamental human rights.

But if California is going to have the death penalty, it must ensure that executions are conducted in as pain free a manner as possible.

The Morales hearings reveal that those put in charge of executing California's prisoners have either never understood what they were supposed to do or never tried.

--- Source :
Human Rights Watch
(Sarah Tofte is a researcher at Human Rights Watch and is co-author of the 2006 Human Rights Watch report, "So Long as They Die: Lethal Injections in the United States")

Health workers cross line on death

Health workers cross line on death

October 22, 2006
Jennifer McMenamin sun staff
In North Carolina, a physician monitored a condemned inmate's brain waves as the drugs that would bring death were about to be added to the IV.

The doctor was prepared to direct executioners to inject more anesthesia if the prisoner remained conscious.

Doctors in Georgia have gradually taken on larger roles in state executions, starting intravenous lines when nurses could not and, on one occasion, even ordering a second dose of potassium chloride after a prisoner's heart did not stop.

In Maryland, a team of correctional officers, prison officials and hired nursing assistants and paramedics carries out executions. Although a doctor is present, her only role has been to pronounce death.

Across the nation, doctors are crossing a line that has existed for more than 2,000 years in the view of most medical professionals, violating an oath to do no harm to patients by participating in executions.

Even the limited role of declaring that a prisoner has died is prohibited by the American Medical Association and other professional organizations that have taken firm positions against any involvement by doctors and nurses in the administration of capital punishment.

Now, in a case challenging Maryland's lethal injection procedures, lawyers representing state prison officials and ÀôÀ attorneys for death row inmate Vernon L. Evans Jr. are facing off in federal court over whether physicians and highly trained nurses are needed for Maryland's executions.

Even the judge hearing the case has asked whether medical professionals who live by the Hippocratic Oath can be persuaded to help put a man to death.

Indeed, the question of whether physicians could or should participate in executions has become an issue in the long-running national death penalty debate, with opponents arguing that lethal injection procedures as currently carried out in many states by individuals with little or no medical training represent unconstitutionally cruel and unusual punishment.

The presumption has been that doctors don't participate.

But, in death chambers across the country, some have. "I had no qualms," one nurse, who started an IV in an inmate who was about to be put to death in a prison out West, told a surgeon and medical school professor who wrote an article about physician participation in executions for The New England Journal of Medicine.

"If this is to be done correctly, if it is to be done at all, then I am the person to do it." The nurse - like nearly everyone who has taken part in executions, whether in Maryland or elsewhere - remained anonymous.

Of the 15 medical professionals Dr. Atul Gawande located for his article, only five agreed to speak to him, and only one allowed his name to be used.

That physician, Dr. Carlo Musso, compared his role in executions in Georgia to any other "end-of-life issue" that he faces in his practice of medicine, and said a condemned man is "no different from a patient dying of cancer - except his cancer is a court order." "When we have a patient who can no longer survive his illness, we as physicians must ensure he has comfort," Musso, a death penalty opponent, was quoted as saying.

He told Gawande that he had done nothing during the six executions in which he had participated but watch inmates' heart rhythms on a cardiac monitor to determine when the prisoners had died. Attempts to reach him for this article were unsuccessful.

But physicians who participate in executions - even just to pronounce death - do so in violation of many professional medical associations' codes of ethics.

Dr. Arthur Zitrin, a New York psychiatrist and clinical professor who has lodged complaints with medical licensing boards against the few doctors who have been publicly identified as execution participants, explained: "In the event that the condemned inmate is not dead, the obligation of the physician would be to say, 'Get more drugs' or recommend that the execution process continue. ...

The obligation of the physician would be to make a recommendation to kill a person. He's becoming an executioner, really."

Gawande, a Boston surgeon and Harvard Medical School professor who spent more than a year trying to find doctors and nurses who participate in executions for his New England Journal article, said in an interview that some agree to take part out of the belief that their involvement will help ensure that the lethal injection procedures are carried out as painlessly and humanely as possible.

According to Gawande's article, two doctors had become involved at the request of their patients, who happened to work at prisons where executions were performed.

Another of the doctors told his wife about the job right away but could not bring himself to tell his children until they were adults.

And one, after having to give a deposition in a court challenge to a lethal injection, came to work one day to find a sign on his clinic door that read, "The Killer Doctor."

"The four physicians and one nurse all were people like colleagues I have, and had thought through the problem in their own ways," Gawande said.

"What I found was that I respected them and, by and large, they were thoughtful people who were really trying to grapple with a fundamental moral question." I

n Evans' federal case in Baltimore, the testimony of 11 past and current execution team members has offered an unprecedented glimpse into who does what behind the curtains and mirrored glass of Maryland's death chamber when the state carries out the ultimate sanction.

A doctor who participated in the lethal injections of Steven H. Oken in 2003 and Wesley Eugene Baker in December testified that her role was limited to watching the tracings on an EKG machine and notifying prison officials when the condemned men's hearts had stopped.

Other than that doctor - an internist - the execution team member with the most medical training is a certified nursing assistant who earned an associate's degree at a local community college and was taught at the regional medical center where she has worked for nearly a decade how to draw blood, insert catheters and start intravenous lines.

Expert medical witnesses testifying for Evans have characterized the nursing assistant and her execution team colleagues as unqualified and poorly trained for the jobs they carry out on execution nights.

The pair of physicians criticized execution team members' understanding of intravenous systems and of signs that an inmate being put to death might be conscious, and one doctor concluded that some don't even comprehend their individual responsibilities.

Sentenced to death for the 1983 contract killings of two Pikesville motel employees in an attempt to silence witnesses in a federal drug case, Evans, 57, has sued Maryland correctional officials, alleging that the state's lethal injection procedures, as written and carried out, violate the constitutional ban on cruel and unusual punishment.

Lawyers representing the state have argued that an execution is not a medical procedure and should not be held to the same standards. Their expert medical witness testified this month that the troubling scenario raised in Evans' lawsuit - that the convicted killer could be inadequately sedated but unable to signal his distress as painful paralyzing and heart-stopping drugs enter his system - was "medically implausible."

Legal and medical experts who follow the debate over the involvement of medical professionals in state executions say it's difficult to tell how many doctors and nurses are participating and just what their roles are in the death chambers.

Few medical personnel are willing to publicly discuss their roles, and the corrections departments that hire them zealously protect their identities.

What is known has largely emerged from lawsuits filed by death row inmates who, like Evans, have challenged their state's lethal injection protocol.

In Missouri, a federal judge ordered the participation of trained anesthesiologists after the surgeon who oversaw the state's executions for years and who prepared the drugs used in each lethal injection testified in June that dyslexia sometimes caused him to transpose numbers, confuse dosages and refer to drugs by the wrong name.

In California, execution team members testified last month in a federal lawsuit that the execution anteroom, where lethal doses of three drugs are prepared and injected, is packed with people and so dimly lit that one nurse said she passes syringes to an outstretched hand whose owner she cannot see.

"The room is darkened so that people can't identify who's doing what," said Deborah W. Denno, a Fordham University law school professor and a national expert on lethal injections. "There's such an effort to protect confidentiality and diffuse responsibility that people don't even know what everybody else is doing," she added.

Several studies, surveys and research papers document the willingness of doctors and other medical personnel to participate in state executions.

A 2002 study by Denno found that "in general, states allow for substantial physician participation, although the roles are limited, at least officially."

Her research revealed that doctors declare or "pronounce" the death of a condemned inmate in 13 states while that task is left to coroners or a prison warden in six states.

In Connecticut, a doctor must certify that the "executioners are properly trained, including having the ability to properly insert [an] IV."

And in Indiana, a physician must insert the IV for the administration of the lethal chemicals, according to the study.

A survey of randomly selected practicing physicians published in the Annals of Internal Medicine in 2001 found that 41 percent of respondents indicated that they would be willing to participate in an execution and do more than merely certifying another person's pronouncement that the inmate was dead. (Certifying death and giving a condemned inmate a sedative to calm his nerves before an execution are the only roles that the American Medical Association says do not violate the profession's Hippocratic Oath to "do no harm.")

Nineteen percent of the doctors surveyed indicated that they would agree to administer the lethal drugs.

To Dr. Jonathan I. Groner, a surgeon and medical school professor in Ohio who has written about doctors' participation in state executions, nothing could be more troubling.

Drawing a parallel to German doctors who participated in the Nazis' program of euthanizing intellectually and physically disabled people, known as Aktion T4, Groner said, "Most times in history when doctors have forsaken their ethics to help a government program, it has usually worked out badly, not only for the doctors but also for society as well."

U.S. District Judge Benson E. Legg, who is hearing Evans' federal lawsuit, has told the lawyers handling the case that he wonders whether it would even be possible to find a doctor willing to participate in an execution, should he order the state to do so.

And although Evans' lawyers have highlighted execution team members' lack of knowledge or understanding of the overall lethal injection procedure, the judge has wondered aloud whether that isn't intentional "to lessen the burden for the responsibility of killing someone."

Judges in California and Missouri have ordered prison officials there to involve anesthesiologists or similarly qualified medical professionals in administering the anesthesia and making sure the condemned inmate is unconscious when the second and third drugs are injected into an IV, paralyzing the prisoner and stopping his heart.

Both states, however, have struggled to find medical personnel to play those specific roles and are still tied up in litigation to work out the details.

Lawyers for Evans presented four days of testimony in September, and attorneys representing Maryland prison officials wrapped up their case Oct. 12.

No date had been set for Evans' lawyers to present rebuttal testimony and for both sides to offer closing arguments.,0,324491.story?track=rss

Doctor Continues Critique of Md. Lethal Injection Procedure

Doctor Continues Critique of Md. Lethal Injection Procedure Thursday

November 02, 2006 8:00 pm

An anesthesiologist testified Thursday that during an execution, replacing a nursing assistant who starts the intravenous line used in lethal injections with a nurse anesthetist would put a more highly trained person in position to tell if something went wrong.

Doctor Mark Heath, an anesthesiologist at Columbia University who was called to testify by lawyers for death row inmate Vernon Evans, contends that Maryland's execution team members don't have the medical background to understand the process adequately.

Attorneys for Evans claim Maryland's lethal injection procedure violates the Constitutional protection against cruel and unusual punishment.

Laura Mullally, an assistant attorney general who is defending the state's procedure, has argued that the current team is well qualified to do a job that is, after all, not a medical procedure.

The hearing continues Friday and closing arguments in the case are scheduled for November 15th.

Kentucky upholds lethal injection

Wednesday, November 22, 2006

Kentucky upholds lethal injection

The Kentucky Supreme Court this afternoon upheld that state's lethal injection scheme (opinion here). Kentucky was the second state to have its death chamber shut down over lethal injection concerns and the first do so after a full evidentiary hearing

.The Associate Press notes:
Kentucky death row inmates Thomas Clyde Bowling, 52, and Ralph Baze, 49, challenged the state's method of execution in 2004, saying the drug formula causes inmates to feel pain and is therefore cruel and unusual punishment.

The state has not declared a moratorium on executions but had not scheduled any since the lawsuit was filed. Bowling and Baze have received several stays of execution because of the court challenge.
"We have moved the process forward and, at the appropriate time, will seek a warrant for execution from the Governor," Kentucky Attorney General Greg Stumbo said in a news release Wednesday.

Affirming a lower court ruling issued after a lengthy trial last year, the Supreme Court said the judge in that case made no errors.

"It is not the role of this Court to investigate the political, moral, ethical, religious or personal views of those on each side of this issue. ... We are limited in deciding only whether the method defined by the Legislature and signed into law by the Executive, survives constitutional review," Justice Donald C. Wintersheimer wrote in the unanimous opinion, issued from Frankfort.

David Barron, the public defender for both Bowling and Baze, called the ruling disappointing, but said other inmates' challenges to lethal injection are pending. Barron said he will ask the high court for a rehearing and appeal to the U.S. Supreme Court, if necessary.Both men are likely to have execution dates set for 2007. Interestingly the Court also upheld the viability of the electric chair as well in what appears to be dicta.

The first is the Kentucky Lethal Injection litigation:

The first is the Kentucky Lethal Injection litigation:

While conceding that the chemicals used to execute death row inmates in Kentucky might cause needless pain, the state’s Supreme Court ruled yesterday that using them did not violate the Constitution’s prohibition on cruel and unusual punishment.

“Conflicting medical testimony prevents us from stating categorically that a prisoner feels no pain,” Justice Donald C. Wintersheimer wrote for the unanimous court. “The prohibition is against cruel and unusual punishment and does not require a complete absence of pain.”

Thursday, 23 November 2006

Lethal injection is constitutional

Thursday, November 23, 2006


Lethal injection is constitutional

Cruel-and-unusual claim is rejected

By Andrew Wolfson

The Courier-Journal

Executing prisoners by lethal injection is not cruel and unusual punishment, the Kentucky Supreme Court ruled yesterday.
Unanimously rejecting challenges of two double murderers, the court dismissed claims that the method Kentucky uses to anesthetize, paralyze and stop the heart of condemned killers is unconstitutional.

The decision affirms a July 2005 ruling by Franklin Circuit Judge Roger Crittenden, who heard evidence from 20 witnesses over seven days before rejecting challenges to the lethal injections of Ralph Baze and Thomas C. Bowling.

"Conflicting medical testimony prevents us from stating categorically that a prisoner feels no pain," the justices said. "But the prohibition is against cruel punishment and does not require a complete absence of pain."

The court also noted that evidence presented by the state Corrections Cabinet showed that Eddie Lee Harper, the first and so far only convicted killer to be executed in Kentucky by lethal injection, "went to sleep" in 15 seconds to one minute and never moved or exhibited any signs of pain before losing consciousness.

The 7-0 decision was the first in the nation by a state high court after a full trial on the merits of lethal injection, according to lawyers involved in the case.

Baze was sentenced to death in 1994 for killing Powell County Sheriff Steve Bennett and Deputy Arthur Briscoe, who had gone to his home to serve warrants from Ohio. He shot both officers in the back with an assault rifle.

Bowling was sentencing to death in 1991 for fatally shooting Eddie Earley and his wife, Tina, in Lexington while they sat in their car before opening their family's dry cleaning business. Their 2-year-old child was wounded.
Baze and Bowling, who are on death row at Kentucky State Penitentiary in Eddyville, declined to comment on the ruling. But one of their lawyers, David Barron, an assistant public advocate, said they were disappointed.
The Rev. Pat Delahanty, chairman of the Kentucky Coalition to Abolish the Death Penalty, also said he was disappointed because "there is no humane way to execute one of our own."

David Elliott, a spokesman for the National Coalition to Abolish the Death Penalty, said the ruling was "not a huge surprise" because courts have generally been reluctant to declare specific methods of execution unconstitutional. He said the U.S. Supreme Court has never done so.

In a statement, the state Justice and Public Safety Cabinet said it had expected the ruling and that Gov. Ernie Fletcher has instructed his general counsel, Jim Deckard, to review the cases immediately "and, if appropriate, present the documentation to him so the wishes of the juries may be carried out in accordance with the law."

Attorney General Greg Stumbo, who will have to request warrants for the executions, said: "I am pleased that the Supreme Court has upheld our defense of Kentucky's execution protocol. … We have moved the process forward and, at the appropriate time, will seek a warrant for execution from the Governor."

Lawyers for Baze and Bowling, citing in part problems during lethal injections carried out since Crittenden's ruling, have filed another motion challenging the procedure; a hearing is set for Wednesday in Franklin Circuit Court. Both inmates also are pursuing other potential appeals, though their automatic appeals are exhausted.

The public defenders representing them had argued that the state's execution procedure potentially could leave an inmate conscious but paralyzed and unable to react as the final drug -- a caustic chemical -- is injected to stop the heart.

In a decision written by Justice Donald Wintersheimer, the Kentucky Supreme Court said a method of execution would violate state and federal bans on cruel and unusual punishment if it creates "a substantial risk of wanton and unnecessary infliction of pain, torture or lingering death" and is "contrary to evolving standards of decency that mark the progress of a maturing society."

The court said Baze and Bowling had failed to prove that, given that 34 of the 38 states that allow capital punishment have adopted lethal injection because it is "universally recognized as the most humane method of execution and the least apt to cause unnecessary pain."

The justices also said that, while the inmates presented evidence that other drugs could be administered to reduce the potential for pain during lethal injection, the state and federal constitutions don't provide protection against all pain, only cruel and unusual punishment.

"It is not the role of this Court to investigate the political, moral, ethical, religious, or personal views of those on each side of this issue," the court said. "The legislature has given due consideration to these matters."

Wintersheimer was joined in the opinion by Chief Justice Joseph Lambert, Justices Bill Graves, Will T. Scott and John Minton and Special Justices John R. Adams and Richard Revell. Justices William E. McAnulty Jr. and John Roach did not sit for the case.

The General Assembly in 1998 adopted lethal injection for executions in Kentucky, although condemned killers convicted before that may select between lethal injection and electrocution. Baze and Bowling had refused to choose.

Reporter Andrew Wolfson can be reached at (502) 582-7189.