Thursday, 24 May 2007

Behind the Curtain - How Modern day Executioners Botch Their Job

Submitted by ielwood on Thursday, May 24, 2007 - 23:41 New College News

By Jessica Ablamsky

"It's a strange thing to be present and watch someone who is perfectly healthy die," said Jim Willet, former warden of the Huntsville Unit, the prison where Texas' death row population goes to die. "I probably thought about it every time I did it, that you're walking with someone who's fixing to die in the next room," said Willet.

Willet, now director of the Huntsville Prison Museum, was warden of the Unit for three years, from 1998-2001. As warden, it was his job to direct the executions. During his tenure, he directed 89.

"The very first one I ever dealt with, they tried and tried and couldn't find a vein," said Willet. That was the execution of Joseph Cannon, April 23, 1998. It took two tries. After technicians inserted the needle and opened the curtain, revealing Cannon to the witnesses who watch from the next room, a vein in his arm collapsed and the needle popped out. The curtain was closed so technicians could find another vein and reinsert the needle.

There were 2 or 3 executions where vein access was a real problem, according to Willet. Like the execution of Claude Jones on December 7, 2000. "We probably messed with that guy, the medical team, for 20, 25 minutes," said Willet.

And the guys who do that, they're not doctors. They weren't during Willet's tenure at least. No one was. Not the people who tied the restraints, not people who inserted the IV, not the executioner. "The only place a doctor comes in… he comes in and does all the things a doctor does to pronounce death," said Willet.

Willet got to see something that few of us ever will. Today, all executions are shielded from public view and conducted only in front of a state mandated number of witnesses. So far this year, 15 people were executed in the United States. All but one was killed using the lethal injection. And the lethal injection is supposed to be painless.

The lethal injection is supposed to be painless. That's why it was developed, and is now used in 37 of the 38 death penalty states. It borrows medical skills, equipment, and drugs, in order to kill. What witnesses generally see is an inmate lying sedately on a table, already strapped down, with IVs in place. It's quick, bloodless, sanitized. That's the point of the procedure.

But, before the curtain that veils witnesses from the death chamber opens, technicians sometimes struggle for up to an hour to insert the IVs into an inmate's veins so that the lethal drugs can flow. The serenity of the lethal injection, that just going to sleep, is due to a paralytic drug that is administered as part of the lethal injection process. This drug that saves witnesses from having to view involuntary spasms as the inmate dies, and saves the public from having to hear about them, prevents the inmate from crying out if the painkiller wears off before their heart stops.

Although we no longer conduct executions as a display for the public's amusement, the secrecy that has enveloped the implementation of the lethal injection conceals from public view the problems that the lethal injection was supposed to solve- the inhumanity carrying out the death penalty.

"They butchered me back there."

On June 8, 2000, Bennie Demps was executed by lethal injection by the state of Florida. Technicians struggled for 33 minutes to insert two IVs into Demp's veins. When the curtain opened, Demps was already strapped down, with needles inserted. During his final statement he said, "They butchered me back there. I was in a lot of pain. They cut me in the groin, they cut me in the leg… This is not an execution, this is murder," according to the Miami Herald. Demps said the medical examiner would find a wound on his leg that technicians sutured back up. "I was bleeding profusely," Demps said.

When Demps was killed, the lethal injection was new to Florida. Florida had switched from electrocution to the lethal injection only months before. "This being a fairly new procedure at the time, I did not have any expectations," said George Schafer, Demps' lawyer, who witnessed the execution.

What was it like to watch Demps being executed? "Well, it was a horrible experience and I had nightmares about it," Schafer said, "and it was terrible because afterwards I had to tell his wife what had happened." Demps' wife, who chose not to witness the execution, was distraught by the news. "Oh, she was very upset. It was just awful," Schafer said.

During his final statement, Demps asked his lawyer to investigate what happened during the execution, according to Schafer. Schafer honored his client's last wish. Schafer made a formal request to the state attorney, Rod Smith, for a full investigation into the execution. On behalf of the state of Florida, Smith declined. Schafer said he was, "not surprised, but very disturbed."

There have been at least 35 botched executions in 13 states, according to information compiled by Michael Radelet, a professor at the University of Colorado who studies the death penalty, and Deborah Denno, a lawyer and professor at Fordham University who is an expert in death penalty law. Of those botched executions, 14 were in Texas, which does the most executions each year. Illinois, Missouri, Ohio, and Oklahoma each had 3 botched executions, Arkansas had 2, while Arizona, Florida, Georgia, Indiana, Nevada, South Carolina, and Virginia each had 1 botched execution.

"Everyone assumed that when the method of execution changed from electrocution to lethal injection that it would be more humane, and that assumption needs to be reexamined," Schafer said.

That assumption is being reexamined in many death penalty states around the country. On June 12, 2006, the Supreme Court handed down a ruling in Hill v. McDonough that made it easier for inmates around the country to question the constitutionality of the lethal injection process in civil rights lawsuits. In 2006, inmates in Arkansas, California, Delaware, Florida, Maryland, Missouri, Ohio, Oklahoma, Tennessee, and Texas were granted stays of execution as a result of challenges to the lethal injection process.

Most cases argued that the drugs used in the lethal injection would result in an excessively painful execution, and technicians who implement the lethal injection are inadequately trained. Although many of those inmates were denied a full hearing on the lethal injection, and some have since been executed, full hearings on the lethal injection are being conducted in Maryland, Missouri, and Oklahoma. A full hearing on the lethal injection procedure was conducted in California, leading a judge to order the state to change its lethal injection procedure. Formal moratoriums on the death penalty are in place in Illinois and New Jersey. All executions are currently on hold in Florida, Maryland, South Dakota, and Tennessee, due to issues with the lethal injection procedure.

Lethal injection protocols vary from state to state, but generally the condemned is strapped to a gurney. Two needles are then inserted into usable veins. The needles are connected to long tubes that run through a hole into another room, where one or more executioners release the lethal drugs. After a signal from the warden, the curtain is raised and the inmate is exposed to the witnesses who watch from another room. After the inmate makes his final statement, the lethal drugs are injected.

The first drug is a fast acting barbiturate that ideally renders the inmate unconscious. The second drug paralyzes the inmate and stops the lungs. The third drug, the killing drug, stops the heart. A lot of the current controversy surrounding the lethal injection has come from doctors who have testified in court that if the fast acting barbiturate wears off before the inmate dies, then he will feel the pain of suffocation during the execution but be unable to cry out because of the paralytic drug.

This paralytic drug is central to the controversy that currently surrounds the lethal injection. But why states are bothering to fight for the drug is a good question. The paralytic drug serves no medical purpose. It doesn't kill the inmate and it doesn't speed up the process. If the barbiturate wears off before the inmate dies, then he will feel an intense burning sensation in his veins as the paralytic drugs flows through his system. Veterinarians don't even use it for euthanasia unless involuntary movements on the part of the animal could harm the handler. "It's not used to sanitize the process, it's used when there's a danger," said Michael San Filippo, Media Relations Assistant for the American Veterinary Medical Association.

The drug's only real purpose is to make the lethal injection easier to watch. Without the paralytic drug, the lethal injection wouldn't have the same serenity. Inmates wouldn't appear to just go to sleep; their bodies would spasm as they die. Apparently, death penalty states are willing to fight in court to maintain the serenity of the lethal injection.
The most reliable information on how the lethal injection is carried out in the United States has come out of court cases over the past few years. Some states have been forced to reveal their lethal injection protocol. A lethal injection protocol is a written document that contains the steps that are followed leading up to and during the lethal injection, the qualifications of the team who inserts the IV, as well as drugs used, who prepares them, and in what amounts. Such information is vital. The humanity of the lethal injection depends on the qualifications of those who carry it out.

It is difficult at best to determine what the qualifications of the people who administer and monitor IV lines. Many lethal injection protocols are partially or completely private. According to a report by Deborah Denno, a lawyer at Fordham University, of the 13 states with botched executions, three consider their protocol partially private: Indiana, Missouri, and Ohio. Three states with botched executions consider their entire protocols confidential: Nevada, South Carolina, and Virginia.

The other seven states consider their protocols public information: Arizona, Arkansas, Florida, Georgia, Illinois, Oklahoma, and Texas. However, the various Corrections departments sometimes remain unwilling to reveal the qualifications of those who carry out the lethal injection because the identity of executioners is always confidential.

Oklahoma, for example, has a public protocol. However, the public information officer would not reveal qualifications the lethal injection protocol mandates that the IV team have. "Number one, I don't know, and number two, I'm not allowed to say," said Jerry Massie, Public Information Officer. Massie affirmed that there was a doctor on hand to pronounce death. Has the doctor ever participated in the executions, beyond pronouncing death? "No, not that I'm aware of," said Massie.

Indiana has a partially private protocol. The Chief of Staff for the Indiana Department of Corrections, Randy Koester, said, "We don't talk about anything that involves who does what or when." What qualifications does the protocol require the IV team to possess? "I'm not going to discuss what the protocols require, that's confidential," he said.

South Carolina has a completely private protocol. In an email, the South Carolina Department of Corrections replied, "SCDC does not comment on execution procedures." Virginia also chose not to comment.

Slightly more information is available from Florida and Ohio. According to the lethal injection protocol for Florida, the executioners should be, "fully capable of performing the designated functions to carry out the execution." The execution team consists of people who have "the training and qualifications, and possess the necessary licensure or certification, required to perform the responsibilities or duties specified." In other words, Florida's protocol says that members of the execution team are qualified to do their job because they are able to do their job.

In Ohio, according to a memo from Terry Colins, the director of the Ohio Department of Rehabilitation and Corrections, "the persons who insert the needles are trained medical professionals who are legally qualified to start intravenous lines in patients." However, the medical professionals are not doctors. "No physician participates in the insertion of the needles, the delivery of the medication, or in any way other than the pronouncement of death," Collins said, in the memo. According to the memo, medical professionals are responsible for starting the IV lines. However, we don't know what sort of medical professionals they are, or what training they have.

Is there a Doctor in the Room?

"Clearly this whole lethal injection procedure is borrowed from the medical profession," said Richard Dieter, Director of the Death Penalty Information Center, an anti-death penalty group. "Now you have prison guards and non medical personnel performing medical procedures," he said. To conduct the lethal injection without an unnecessary amount of pain, a doctor would needs to oversee the procedure. "They'd have to be willing to step in if necessary and intervene," said Dieter, "I don't think that doctors are willing to do that."

Some doctors agree that the humanity of the lethal injection depends on doctor participation, and they're speaking out. It isn't possible for people who are not trained medical professionals to implement the lethal injection without risking excessive pain on the part of the inmate, according to Dr. Jonathan Groner, a professor of surgery at Ohio State University who has studied lethal injections. "No, I don't think that's possible," he said. "It is very difficult to train a non-medical person because of the steps that are involved," said Groner.

Carrying out the lethal injection painlessly involves more than just injecting a few chemicals into a person's veins. "Those drugs at those doses are never given without fairly extensive monitoring," said Groner. The monitoring that is conducted in hospitals is not done during the lethal injection process. In most cases, the lethal drugs are injected remotely, from another room, where executioners cannot easily monitor the IV lines.

When the lethal drugs are injected from another room, the IV setup consists of extended tubing that is assembled by hand prior to the execution, according to the testimony of Dr. Mark Heath, assistant professor of Clinical Anesthesiology at Columbia University. "Any of these connections may loosen and leak. In clinical practice, it is important to maintain visual surveillance of the full extent of IV tubing so that such leaks may be immediately detected….hindered opportunity for visual surveillance, interferes with detection of any leak that may occur and is not acceptable," said Dr. Heath, in testimony for an Arkansas lethal injection case.

IV lines leaked throughout the 1998 execution of Tyrone X. Gilliam in Maryland. In an affidavit, Gilliam's lawyer, Jerome H. Nickerson, Jr., said, "…I noted fluid continuously drip from this line onto the floor of the execution chamber. By the time Mr. Gilliam was pronounced dead a puddle of liquid had formed on the floor of (the) lethal injection chamber immediately below where the IV line was located. This puddle had a circumference of five to seven inches across." According to Nickerson's affidavit, after the execution a media witness questioned a Department of Corrections official about the fluid seen dripping onto the floor. The official replied that dripping fluid was normal. Unfortunately for Gilliam, it's not.

Vein access has been the most consistent problem in botched executions. Not everyone has good veins, particularly the death row population. Some are morbidly obese. Others have a history of drug abuse. If an inmate has diabetes, or just has small veins, inserting the IV is much more difficult. "It sort of always gets back to, you always need a trained medical professional sometimes," Dr. Groner said. "We use the imagery of healing to justify killing, and that's really what the lethal injection does. The problem is, you need doctors. That's where the lethal injection is running into trouble right now," said Groner.

When It Don't Work

On May 2, 2006, Joseph L. Clark was executed by the state of Ohio using the lethal injection, the sole method available in that state. After the curtain opened, with the IV already in place, Clark raised his head and body and said, "It don't work. It don't work," five times, according to an article in the Canton Repository by Paul Kostyu. The curtain was closed, and witnesses heard, "moaning, crying out and guttural noises," according to the Columbus Dispatch. The curtain did not reopen for another 30 minutes. It took the state an hour and a half to kill Joseph Clark.

"When it proceeds smoothly, placement of the IV should, in my experience, take on the order of two minutes or less," said Dr. Heath, in a deposition for a California lethal injection challenge. Clark's execution did not proceed smoothly. "It took quite a while for it to be set up to begin with," said Kostyu, who witnessed the execution. Technicians struggled to find two veins to insert the IVs into Clark's arms. After 30 minutes they gave up, settling for one vein. "Then the veins in the arm had collapsed, so they had to start all over again," said Kostyu. That's when the curtain was closed again. Technicians struggled for another 30 minutes to find another vein.

"It was horribly mangled, they tortured the man," said Jeffery Gamso, Legal Director of the American Civil Liberties Union (ACLU) of Ohio.

As a result of the execution, the Ohio Department of Rehabilitation and Corrections reviewed its lethal injection protocol. According to a memo from the Director of Corrections to the Governor of Ohio, the first change Corrections recommended was relieving the staff of any pressure to do their job quickly. The second recommendation is that, "the condemned prisoner should be thoroughly evaluated on the day of arrival at the institution, which should include a hands-on evaluation to the extent possible, and a review of the medical file as has occurred previously," according to the memo.

So, in order to prevent another execution that takes an hour to insert the IVs, Ohio will relieve their staff of any pressure to insert the IVs in a timely manner. They will also review the inmate's medical file prior to the execution, like they've always done, and do a hands-on evaluation of the inmate before the execution, if they can. Big changes for Ohio.

And it was lawyers who suggested those changes, not doctors. The Director of Corrections got their lawyers together, along with the Assistant Director of Corrections, and a warden, to review their lethal injection protocol. "They didn't actually bring in a doctor, they basically had a bunch of lawyers get together…," said Gamso. The changes amount to, "we're going to be more careful," Gamso said.

The review also didn't take into account an autopsy report of Clark's body, because Ohio didn't bother to do one. Clark's family had to order an autopsy. "They did not do an autopsy at the time. Their report did not take into account the autopsy," said Alan Konop, attorney for Clark's family.

Although Clark's execution was one of the longest lethal injections, it is not unique. "In fact, there are lots of botched executions and there always have been," said Gamso, "We're gonna keep botching them, and it's gonna keep happening…"

The response from death penalty states has been mostly disappointing. The Department of Corrections in any given death penalty state has only revealed information about the lethal injection while kicking and screaming. The experience of a Florida lawyer, D. Todd Doss, epitomizes this unwillingness to disclose how the lethal injection is conducted. Doss filed a lethal injection challenge in Florida on behalf of a client. Unfortunately, he wasn't able to obtain a copy of Florida's lethal injection protocol until after his client was put to death.

About the lethal injection process, Doss, said, "Every time it's been exposed to the light, it's been blackening. With these guys here in Florida, they consistently refuse to turn things over. We have very little. Hopefully that will change." The same can be said for any of the lethal injection states. Every time the lethal injection process has been exposed to the light, it's been blackening. We know very little. Hopefully that will change.

But, wait. Why should that change? We're talking about murderers- men and women who have committed despicable acts that are deplored by society. Who cares what pain they suffer? They didn't care about the pain they caused their victims, why should we care about the pain they feel before their own death?

It's a good question. Murderers don't care about the pain they cause their victims. Why should be care if we cause a murderer pain?

Here's a final question from Todd Doss: "Do we want to use the ethical stance of a murderer as a society?"

It's a good question.


capsid294 said...

I'm not really for the dealth penalty. But, as an anesthesiologist, these statements are really misleading. You would not spasm from the cardiac stopping drugs. The heart stopping doesn't cause a seizure. When people die (and I've seen it many times), they rarely spasm. The paralytics don't burn, they just make you stop moving (which would admittedly be very scary if you were awake, but not painful). And, if you are concerned about the sedative wearing off, then you can just run an infusion of it instead of pushing one dose.

As far as IV's are concerned. We sometimes struggle to get them into people at the hospital - and those people aren't criminals - they are just having surgery. And, if it's a big concern, a simple central line could be put in (takes about ten minutes).

You can argue all you want about the death penalty being wrong - I don't really disagree. But, saying it's painful isn't really true.

markvanslam said...

But if you're a doctor then u are arguing that these untrained ppl who aren't medical professionals should somehow be able to do things u went to school for? Clearly they are botching it time after time and many doctors have argued that these meds by them selves are painfil

Anonymous said...

Telling me these evil men suffer at death is suppose to do what exactly? Their victims didn't get final meals and farewells. Electrify, shoot, behead...I don't care!