Methodological Rigor and Lethal Injection
As the St. Louis Post-Dispatch and other media sources are reporting, U.S. District Judge Fernando J. Gaitan, Jr., ordered a halt to Missouri executions yesterday, pending the state's development of some semblance of a formal protocol to ensure that the condemned don't suffer unconstitutionally gratuitous pain. We were curious about the expert testimony Judge Gaitan may have considered, and so we dug up a copy of yesterday's opinion in Taylor v. Crawford, No. 05-4173-CV-C-FJG (W.D. Mo. June 26, 2006), which we herewith post for our readers' edification.
It is not for the squeamish. The state follows the usual three-drug regimen. A physician first administers a dose of sodium pentothal, a.k.a. thiopental, as an anesthetic. Pancuronium bromide is them administered as a paralytic agent. A third and final drug, potassium chloride, stops the heart. Only the anesthesia prevents the condemned from suffering excruciating pain when the third drug is administered.
There is no written protocol governing lethal injections in Missouri. Doses are left to the discretion of the physician who mixes the drugs. Judge Gaitan permitted the deposition of that physician to be taken. He is a board-certified surgeon, but not an anesthesiologist. He is dyslexic, so he frequently transposes numbers even while staring at them, but he says this does not affect his usual work as a surgeon. His practice had been to use a 5 gram dose of sodium pentothal, the anesthetic. Recently, however, the state has been obtaining sodium pentothal from a different supplier, and the physician has been using a dosage of 2.5 gram, because of difficulty dissolving much more than that amount in the volume of liquid that the syringes will hold. Pending some solution to that problem, the physician is, as he put it, "improvising."
The physician does not administer the drugs himself. That is done by nonmedical personnel, "and they're in the dark so they have a small flashlight that they're able to quickly identify the syringes, make the appropriate connections and injections, disconnect, and clamp the tube."
The physician is responsible, however, for monitoring anesthetic depth. He does this by viewing the condemned's facial expression. "[I]t’s difficult to describe, but I can tell instantly when the pentothal has taken effect. And in medical practice the instant the pentothal has taken effect they gave absolutely no more because then they move on to the actual anesthesia which has to be started before the pentothal wears off." From a videotape of the execution facility, Judge Gaitan found it would be nearly impossible for the physician to observe the inmate's facial expression. The inmate, at that point in the process, is strapped to a gurney in the execution chamber, across the room and facing away from the operations center, from which the physician is viewing the proceedings through a window obscured by partially closed blinds.
It is not for the squeamish. The state follows the usual three-drug regimen. A physician first administers a dose of sodium pentothal, a.k.a. thiopental, as an anesthetic. Pancuronium bromide is them administered as a paralytic agent. A third and final drug, potassium chloride, stops the heart. Only the anesthesia prevents the condemned from suffering excruciating pain when the third drug is administered.
There is no written protocol governing lethal injections in Missouri. Doses are left to the discretion of the physician who mixes the drugs. Judge Gaitan permitted the deposition of that physician to be taken. He is a board-certified surgeon, but not an anesthesiologist. He is dyslexic, so he frequently transposes numbers even while staring at them, but he says this does not affect his usual work as a surgeon. His practice had been to use a 5 gram dose of sodium pentothal, the anesthetic. Recently, however, the state has been obtaining sodium pentothal from a different supplier, and the physician has been using a dosage of 2.5 gram, because of difficulty dissolving much more than that amount in the volume of liquid that the syringes will hold. Pending some solution to that problem, the physician is, as he put it, "improvising."
The physician does not administer the drugs himself. That is done by nonmedical personnel, "and they're in the dark so they have a small flashlight that they're able to quickly identify the syringes, make the appropriate connections and injections, disconnect, and clamp the tube."
The physician is responsible, however, for monitoring anesthetic depth. He does this by viewing the condemned's facial expression. "[I]t’s difficult to describe, but I can tell instantly when the pentothal has taken effect. And in medical practice the instant the pentothal has taken effect they gave absolutely no more because then they move on to the actual anesthesia which has to be started before the pentothal wears off." From a videotape of the execution facility, Judge Gaitan found it would be nearly impossible for the physician to observe the inmate's facial expression. The inmate, at that point in the process, is strapped to a gurney in the execution chamber, across the room and facing away from the operations center, from which the physician is viewing the proceedings through a window obscured by partially closed blinds.
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