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Originally published May 1, 2014 at 8:39 PM | Page modified May 2, 2014 at 7:42 AM

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States cling to 3-drug protocol when single drug will do

Several factors have conspired to produce painful scenes in the death chamber, experts say, including an ill-conceived drug formulation and the lack of medical expertise among people planning and carrying out executions.


The New York Times

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Terminally ill people who want to die can take drugs to end their lives peacefully. Ailing pets are put down humanely every day. Clearly, the technology exists to bring about a quick and painless death.

Why, then, do executions by lethal injection sometimes become troubling spectacles? The death in Oklahoma on Tuesday of Clayton Lockett, amid struggling and apparent pain, was not the country’s first bungled execution.

Several factors have conspired to produce painful scenes in the death chamber, experts say: an ill-conceived drug formulation clung to by many states; the lack of medical expertise among people planning and carrying out executions; and, more recently, drug shortages that have pushed prison officials to improvise lethal cocktails and buy drugs from loosely regulated compounding pharmacies.

According to prison officials in Oklahoma, an intravenous line inserted into Lockett’s groin did not work properly and interfered with the flow of drugs. But doctors say the drugs themselves, three used in a certain sequence, are a deeper part of the problem, because two cause suffering if they are administered improperly. And those two drugs are not necessary.

Physicians have long known that massive doses of single drugs — certain sedatives or anesthetics — can take a life painlessly and with far less distress than the three-drug cocktail causes if the injection is botched.

Since 2010, more death-penalty states — Oklahoma not among them — have moved to use single drugs for lethal injection. Even critics of the death penalty say most of those executions have gone more smoothly than ones involving multiple drugs.

Barbiturates — including sodium thiopental and pentobarbital — infused into the bloodstream can quickly make a person go deeply unconscious, stop breathing and die. Dr. Mark Heath, an anesthesiologist at Columbia University and an expert on lethal injection, said high doses of pentobarbital were routinely used to euthanize animals, from pet rabbits to beached whales.

Barbiturates alone have been used in 71 executions, in Arizona, Georgia, Idaho, Missouri, Ohio, South Dakota, Texas and Washington, said Jennifer Moreno, a lawyer with the Berkeley Law School’s Death Penalty Clinic.

Heath, who opposes lethal injection, said that switching to a single drug would not fix all the problems with lethal injection because intravenous lines would still be needed. Starting them requires medical skill.

The three-drug combination used on Lockett was modeled on a plan developed in Oklahoma in 1977 by Dr. Jay Chapman, then the state’s chief medical examiner. State lawmakers had asked him if there was a more humane way to execute people than electrocution and the firing squad.

Chapman proposed a large dose of a barbiturate, sodium thiopental, followed by two other drugs: one to cause paralysis and halt breathing, and the other, potassium chloride, to stop the heart. His recipe was adopted by nearly every death-penalty state.

The potential pitfall in the original formula is this: If the barbiturate is not fully effective, perhaps because the dose is too low or the needle misplaced, the inmate may still feel pain. If the paralyzing agent is then injected, the person will feel suffocated — but will be unable to move or cry out and may even look peaceful. The potassium chloride then will cause an intense burning sensation, muscle cramping and chest pain.

“The second two drugs are completely unnecessary and only have a prospect of causing pain,” Heath said.

The odds of the drugs being administered incorrectly may have been higher than Chapman anticipated because many lethal injections have been performed by people with little or no medical expertise. Although some doctors participate, many have distanced themselves, seeing execution as a betrayal of their oath to do no harm.

In recent years, supplies of sodium thiopental and pentobarbital have dried up because their European makers refuse to sell them for lethal injections. Prison systems have responded by concocting new formulas, sometimes, as in Oklahoma, sticking to three-drug combinations.



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