States' use of execution drugs varies widely
The prolonged execution of an Arizona death row inmate with a new, two-drug combo has highlighted the patchwork quilt approach that states now take with lethal drugs, with types, combinations and dosages varying widely. A question and answer look at how the disparity came about and why, following more than three decades in which all death penalty states used the exact same three-drug mixture.
Q: What are states currently using for lethal drugs?
A: Georgia, Texas and Missouri use single doses of compounded pentobarbital, an anesthetic similar to the drug used to put pets to sleep. Arizona and Ohio use a combination of midazolam, a sedative, and hydromorphone, a painkiller. Florida uses midazolam, vecuronium bromide and potassium chloride. Oklahoma has authorized five different lethal injection protocols: a three-drug method beginning with sodium thiopental, pentobarbital, or midazolam, a two-drug procedure using midazolam and hydromorphone, or a single, lethal dose of pentobarbital.
Q: All death penalty states used the same three-drug combo for lethal injection for more than three decades. Why isn't that done now?
A: Two reasons. First, supplies of the drugs started to run short as death penalty opponents in Europe put pressure on their drugmakers — which manufactured key anesthetics — to prohibit their use in executions. Secondly, states eager to avoid ongoing lawsuits alleging the old three-drug method caused inmates to suffer unconstitutional levels of pain looked for alternatives beginning about five years ago.
Q: Why don't all states follow the lead of Georgia, Missouri and Texas and use compounded pentobarbital?
A: The compounded version is difficult to come by, with most compounding pharmacists reluctant to expose themselves to possible harassment by death penalty opponents. Adopting it also raises the specter of lawsuits over its constitutionality, based on arguments that its purity and potency could be questioned as a non-FDA regulated drug. So far, Georgia, Missouri and Texas won't reveal their sources, while Ohio, whose protocol includes the option of compounded pentobarbital, hasn't been able to obtain it.
Q: Why can't states just find another drug as effective as pentobarbital?
A: Basically, options are running out. The leading candidate after pentobarbital was propofol, the painkiller known as the drug that caused pop singer Michael Jackson's 2009 overdose death. Missouri proposed using propofol but withdrew the idea over concerns the move would create a shortage of the popular anesthetic. Meanwhile, manufacturers are also starting to put limits on drugs in the old three-drug combo still in use in states like Florida.
Q: With all this uncertainty, why don't states return to the electric chair or other non-drug methods?
A: Most states retired their electric chairs or used them sparingly with the advent of the three-drug method introduced in the 1970s. Tennessee recently enacted a law allowing its use if lethal drugs can't be found, and other states are debating its reintroduction. But electric chairs come with their own constitutional problems, since they have produced a number of botched executions over the years, as did hanging decades ago. Many death penalty experts, even some opponents, believe the quickest and most humane method is the firing squad. But it's unclear whether there's a public appetite for moving to that method.
— The Associated Press
This undated file photo provided by the Arizona Department of Corrections shows inmate Joseph Rudolph Wood. Wood took nearly two hours to die and gasped for about 90 minutes during his execution in Arizona on Wednesday, July 23, 2014. (AP Photo/Arizona Department of Corrections, File)Photo by Associated Press /Chattanooga Times Free Press.
FLORENCE, Ariz. — U.S. District Judge Neil V. Wake was attending a ceremony for a judicial colleague when he received an urgent — and unusual — request: Lawyers for a condemned inmate wanted him to stop an execution that didn't seem to be working.
"He has been gasping, snorting, and unable to breathe and not dying," lawyer Robin C. Konrad told the judge over the phone Wednesday, according to a transcript. "And we're asking — our motion asks for you to issue an emergency stay and order the Department of Corrections to start lifesaving techniques."
The judge asked his law clerk to quickly locate a phone number for an attorney for the state so he could find out what was happening. They conferenced in Jeffrey A. Zick, who was getting updates from the scene from Arizona's corrections chief.
What followed provided a window in to the nearly two-hour execution of 55-year-old Joseph Rudolph Wood as the defense lawyer pleaded to stop it and the Arizona attorney assured the judge everything was fine. In the middle of the arguments, Zick informed them that Wood had died.
The execution brought new attention to the death penalty debate in the U.S. as opponents said it was proof that lethal injection is cruel and unusual punishment. On Thursday, the state's top prison official said Arizona would temporarily put on hold any future executions as it reviewed what happened to Wood.
Department of Corrections Director Charles Ryan read a statement outside his office in which he dismissed the notion that the execution was botched, calling it an "erroneous conclusion" and "pure conjecture." He did not take questions from reporters.
He said IV lines in the inmate's arms were "perfectly placed" and insisted that Wood felt no pain. He said the Arizona attorney general's office will not seek any new death warrants while his office completes a review of execution practices ordered by Gov. Jan Brewer.
Wood's lawyer Dale Baich called it a "horrifically botched execution" that should have taken 10 minutes.
Wood gasped more than 600 times over an hour and a half. During the gasps, his jaw dropped and his chest expanded and contracted.
An Ohio inmate gasped in similar fashion for nearly 30 minutes in January. An Oklahoma inmate died of a heart attack in April, minutes after prison officials halted his execution because the drugs weren't being administered properly.
States have scrambled in recent years to find alternative drugs because of a shortage rooted in European opposition to capital punishment. Arizona uses a combination of midazolam, a sedative, and hydromorphone, a painkiller.
Anesthesiology experts say they're not surprised that the combination of drugs took so long to kill Wood.
"This doesn't actually sound like a botched execution. This actually sounds like a typical scenario if you used that drug combination," said Karen Sibert, an anesthesiologist and associate professor at Cedars-Sinai Medical Center. Sibert was speaking on behalf of the California Society of Anesthesiologists.
Sibert said midazolam would not completely render Wood incapacitated. If he'd felt pain or been conscious, he would have been able to open his eyes and move, she said.
Sibert says that medical patients who are under general anesthesia are typically connected to a bispectral index, a technology that measures a person's level of consciousness and sends the information through a monitor. But for those who are only sedated, monitoring heart rate and blood pressure can suffice to determine whether there is brain activity.
"It's fair to say that those are drugs that would not expeditiously achieve (death)," said Daniel Nyhan, a professor and interim director of the anesthesiology department at Johns Hopkins University School of Medicine.
The execution prompted a series of phone calls involving Ryan, Brewer's office, lawyers and judges as the inmate gasped for more than 90 minutes.
Nearly two hours after he'd been sedated, Wood finally stopped taking those gasps that almost had a pattern to them. Every five seconds. Then every six seconds. Now seven.
While the gasps were occurring, Judge Wake was trying to determine if Wood was suffering pain.
"I am told that Mr. Wood is effectively brain dead and that this is the type of reaction that one gets if they were taken off of life support. The brain stem is working but there's no brain activity," Zick said, according to the transcript.
The judge then asked, "Do you have the leads connected to determine his brain state?"
The lawyer said he didn't think so.
"Well if there are not monitors connected with him, if it's just a visual observation, that is very concerning as not being adequate," the judge said.
Moments later, Zick said he received a note indicating the snoring had stopped and Wood's heart rate was slowing considerably. The judge asked him to call Ryan and find out the latest, and Zick left the call at 3:43 p.m.
"And again, I do need to make a decision within a few minutes as to whether to suspend the execution," the judge said.
Zick got back on the line about four minutes later.
"The director indicated that in consultation with the IV team leader, who is a medical doctor, Mr. Wood is apparently comatose; that he cannot change course at this point," he said.
The judge then weighed the pain question and whether it was too late to do anything. Then Zick interrupted.
"I just learned that the IV team leader has confirmed Mr. Wood's death," he said.
As they wrapped up, the judge offered a glimpse that the issue isn't going away.
"So there will be time to deal with whatever consequence these events have for other plaintiffs," he said.