April 24 USA: Bad Drugs: Lethal Injection Does Not Work as Designed A new study shows that failure to inject proper dosages potentially leads to slow, painful deaths from chemical asphyxiation Lethal injection was invented in 1977 by Oklahoma state medical examiner Jay Chapman, who, based on his own experiences under anesthesia, concocted the drug cocktail from an ultrashort-acting barbiturate and a chemical paralytic. He added a heart-stopping drug to the mix to provide a painless, quick death with built-in redundancy. If one drug didn't kill the death row inmate, one of the other 2 would. But dosage is critical to the efficacy of lethal injection according to a new study, which found that if any of the doses are off the recipient not only feels pain, but he or she also must suffer a slow death by the asphyxiation following total paralysis. Molecular biologist Teresa Zimmers of the University of Miami Miller School of Medicine and colleagues, including a surgeon, an anesthesiologist and a lawyer, analyzed the sparse public records of executions. Only 2 states provide such records: North Carolina and California, the latter of which was forced to do so by court order. In each of these states, varying dosages of sodium thiopental (a barbiturate to induce anesthesia), pancuronium bromide (a muscle relaxant that paralyzes all the muscles of the body) and potassium chloride (a salt that speeds the heart until it stops) are injected in doses designed to kill condemned inmates. Though the dosages vary by state, they do not vary by inmateeach is given the same amount of the drug whether short or tall, fat or thin. As a result, death by lethal injection is not necessarily quick or painless, according to the study published in PLoS Medicine. In North Carolina inmates took an average of nine minutes to die (and much longer before flawed drug protocols were changed), and in California cessation of the heartbeat took from 2 to 8 minutes after the last injection of the heart-stopping potassium chloride. "When potassium chloride was added, it didn't seem to change the time of death," Zimmers notes. "This suggests that potassium chloride may not be the agent of death." In addition, researchers found that the amounts of thiopental used may not be sufficient to render the procedure painless, based on comparisons with veterinary data. In the veterinary realm, government and professional oversight has led to the development of strict dosage guidelines for the appropriate painless killing of animals. The dosages used in human executions are, in some cases, lower by body weight than the dosages that would kill only 50 % of mice and from which monkeys have been able to successfully recover. "The way that thiopental is administered, it would be an unacceptably low dose if the inmate was a pig scheduled for euthanasia," Zimmers says. And, although the dosages of potassium chloride would be considered adequate to kill animals, they do not appear to have the intended effect in humans, failing to hasten the time of death. "We are doing it successfully in animals and we're doing it successfully because they've taken a hard look at it," notes Jon Sheldon, a study co-author and criminal defense attorney in Virginia. "When you do it with animals, there is no pain. It's likely there is with people." That pain takes the form of slow asphyxiation due to an inability to use the diaphragm muscle to breathe as a result of the pancuronium bromide. "In such case death by suffocation would occur in a paralyzed inmate fully aware of the progressive suffocation and potassium-induced sensation of burning," the researchers write. The scientists analyzed only 41 of the 891 lethal injections that have taken place in the U.S. to date (and considerably more worldwide). But many of the remaining states' drug protocols and details of their executions remain secret. Nevertheless, researchers say the small sample indicates that the cocktail is not working as intended. "This idea that this is a painless procedure is completely wrong," Zimmers says. "It's just invisible because the person is paralyzed." "The legal standard is you can't have unnecessary or gratuitous pain," under the Eighth Amendment of the U.S. Constitution, Sheldon adds. "It seems quite likely that a number of people are suffering pain. If a change to the protocol would be fairly simple to do, then the pain you are inflicting is clearly unnecessary." (source: Scientific American) ********************** Does Execution By Lethal Injection Involve Conscious Asphyxiation? Execution by lethal injection may cause death by asphyxiation, and prisoners being executed may be conscious and may experience pain, claim the authors of a new study published this week in PLoS Medicine. Leonidas Koniaris and colleagues from the University of Miami assessed data from 2 US states that release information on executions together with previously published work on the drugs used in the protocols for lethal injections. They conclude that these protocols may not reliably effect death through the mechanisms intended. Lethal injection is used for execution in a number of countries, most notably the US and China. The current regimens for lethal injection in the US are based on one drawn up by legislators in Oklahoma, which in turn to appear to have been based on personal opinion rather than independent research. The drugs used are a barbiturate, thiopental (which acts as an anesthetic, but does not have any analgesic effect), a neuromuscular blocker, pancuronium bromide (which causes muscle paralysis); and an electrolyte, potassium chloride (which stops the heart from beating). Each of these drugs on its own was apparently intended by those who derived the protocols to be sufficient to cause death; the combination was intended to produce anesthesia then death due to respiratory and cardiac arrest. Following a number of executions in the US, however, it has recently become apparent that the regimen as currently administered does not work as intended. Some prisoners take many minutes to die, and others become very distressed. The authors concluded that in the current regimen thiopental might not be fatal and might even be insufficient to induce surgical anesthesia for the duration of the execution, and that the doses of potassium chloride used did not reliably induce cardiac arrest. Hence, potentially aware inmates are likely to die through asphyxiation induced by the muscle paralysis caused by pancuronium. The authors conclude that even if lethal injection is administered without technical error, those executed may suffocate, and therefore ''the conventional view of lethal injection as an invariably peaceful and painless death is questionable.'' Citation: Zimmers TA, Sheldon JP, Lubarsky DA, Lpez-Muoz F, Waterman L, et al. (2007) Lethal injection for execution: Chemical asphyxiation? PLoS Med 4(4): e156. (http://dx.doi.org/10.1371/journal.pmed.0040156) (Note: This story has been adapted from a news release issued by Public Library of Science) ************************** Lethal injection protocols may violate US constitution: medical study The 3-drug "cocktail" used to execute death row inmates by lethal injection can fail, causing inmates to suffer a painful death, according to a study published Monday by PLoS Medicine. The study's authors said in a summary of their work: We were able to analyze only a limited number of executions. However, our findings suggest that current lethal injection protocols may not reliably effect death through the mechanisms intended, indicating a failure of design and implementation. If thiopental and potassium chloride fail to cause anesthesia and cardiac arrest, potentially aware inmates could die through pancuronium-induced asphyxiation. Thus the conventional view of lethal injection leading to an invariably peaceful and painless death is questionable. According to the editors' summary: The authors conclude that even if lethal injection is administered without technical error, those executed may experience suffocation, and therefore that "the conventional view of lethal injection as an invariably peaceful and painless death is questionable." The Eighth Amendment of the US Constitution prohibits cruel and unusual punishment. The results of this paper suggest that current protocols used for lethal injection in the US probably violate this amendment. The constitutionality of lethal injection has been a hot issue in recent months, with several states - including Florida, Maryland and California - ordering reviews of lethal injection protocols or suspending executions until the status of the death penalty can be resolved. Meanwhile, the American Bar Association has called on Tennessee Gov. Phil Bredesden to extend a temporary moratorium on Tennessee executions. Bredesden imposed the moratorium in February to allow a 3-month "comprehensive review of the manner in which death sentences are administered," but the ABA said Monday that the review should be broadened "to permit a thorough review of every aspect of capital punishment administration in the state," including "excessive caseloads and inadequate standards for defense counsel" and "racial disparities and inadequate review of death row inmates' claims of actual innocence." (source: The Jurist) ******************** Lethal Injection----Reliability of execution drugs is in question; The faulty administration of 2 of the 3 chemicals leaves some inmates suffocating and conscious, a report says. 2 of the 3 drugs used in lethal injection are not administered in a way that reliably produces painless death for inmates, leaving at least some to die of suffocation and be conscious enough to realize it, according to a new analysis of executions in California and North Carolina. Reviewing the cases of 41 inmates dating back to 1984, the researchers found that the dose of anesthesia given at the start of an execution varied widely and was often insufficient to keep an inmate unconscious. They also concluded that the chemical intended to induce cardiac arrest did not always stop prisoners' hearts. "The argument that's always been given about lethal injection is that in theory, a well-trained person could give it humanely," said Fordham University law professor Deborah Denno, who has studied lethal injection for 15 years and is a death penalty opponent. "This casts doubt on even that." The study, published today in the Public Library of Science journal PLoS Medicine, provides scientific data for a debate that has largely lacked hard evidence regarding the medical underpinnings of lethal injection. California and 11 other states have put executions on hold, mostly because of concerns over the constitutionality of lethal injection. Gov. Arnold Schwarzenegger and state Atty. Gen. Jerry Brown intend to recommend reforms by May 15. The study is "shedding light on a process that should have been examined a long time ago," said Michael Rushford, president of the Criminal Justice Legal Foundation, a Sacramento advocacy group that favors the death penalty. Though he doubted many of the study's conclusions, he thought lethal injection might be too problematic to preserve. "The real issue should be 'Is this the best way to do this?' Let's get some doctors together and say, 'If you were going to put your mother down, how would you do it?' " Execution by lethal injection was devised in 1977, after an Oklahoma state legislator who opposed capital punishment worked with the state medical examiner to seek a more humane alternative to electric chairs and firing squads. They developed a regimen of three powerful drugs: the sedative sodium thiopental, to make the inmate unconscious; the muscle relaxant pancuronium bromide, to induce paralysis; and potassium chloride, to stop the heart. Each was supposed to induce death on its own; the combination intentionally redundant. The regimen was never scientifically tested, but it was widely adopted by other states and was used first in 1982 in Texas. More than 30 states allow the death penalty; of them, all but one offer lethal injection, and most use the three-drug regimen. But acceptance of lethal injection as a humane method of execution has been waning. Inmates filed suit, arguing that it violated the constitution's prohibition against cruel and unusual punishment. U.S. District Judge Jeremy Fogel in San Jose put all California executions on hold last year after a challenge from San Quentin death-row inmate Michael Morales. As of Monday, 901 inmates had been executed by lethal injection in the United States, according to the Death Penalty Information Center, a Washington group that opposes capital punishment. Ohio is scheduled to execute James Filiaggi this morning. The new study focused on executions in California and North Carolina because those states had the most complete information available. The authors included an anesthesiologist, a pharmacologist, a molecular biologist, a veterinarian, an attorney and a historian. Many have described themselves as death penalty opponents. Several of the researchers worked on a 2005 study that found prisons routinely failed to administer enough anesthesia to keep inmates unconscious throughout their executions. They based their conclusions on the concentration of anesthesia measured in the bloodstream at post-execution autopsies. In the new study, the researchers focused on what they believed was a key problem: that inmates were given uniform amounts of anesthesia regardless of their body weight or other factors, such as their tolerance for barbiturates. North Carolina uses 3 grams of thiopental; California requires 5 grams. Because North Carolina records included the weight of each inmate, the researchers were able to calculate the dosages in that state, which ranged from 10 to 45 milligrams per kilogram. They calculated that states such as Virginia that use 2 grams of thiopental were administering doses between 6.6 and 30 milligrams per kilogram. Those dosages are below what is necessary to have a 50-50 chance of euthanizing many laboratory animals such as rabbits, dogs and rats, according to the study. In some cases, the dosage overlapped with the 3-to-6.6-mg-per-kg dose of thiopental used to anesthetize patients at the outset of a surgical procedure. But in an operation, more anesthesia would be administered throughout the procedure to keep the patient under. In an execution, "there may or may not be enough anesthetic onboard for the whole process to do its thing," said Dr. Leonidas Koniaris, a surgical oncologist at the University of Miami Miller School of Medicine and lead author of the study. "There's a window for at least part of the process where they may be quite uncomfortable." Without sufficient anesthesia, inmates would feel as if they were being strangled while the pancuronium bromide asphyxiated them by bringing on paralysis. Then they would feel a burning sensation from the third drug, potassium chloride, the researchers said. The study also found evidence that the potassium chloride wasn't inducing cardiac arrest as expected. For 14 years, North Carolina's lethal injection protocol involved only thiopental and pancuronium bromide. It was modified to include potassium chloride. Under the original procedure, the average length of time for an execution was 9.88 minutes. After adding potassium chloride, the average time grew to 13.47 minutes, and a revision in 2004 shortened it to 9 minutes, according to the study. The average times showed that adding potassium chloride to the regimen didn't make a difference in causing an inmate's death, Koniaris said. "If 5 people took a medication and you got some event, and then the other five people didn't take the medication and they got the same event, it's hard to argue that the medication caused the event," he said. The study also included eight executions at San Quentin from 1996 to 2006. In three of those cases, inmates required a 2nd dose of potassium chloride before the execution was complete, calling into question the effectiveness of the chemical. That left pancuronium bromide as the only reliable cause of death. In support of that view, the researchers found that the time frame of executions was more consistent with asphyxiation than cardiac arrest, Koniaris said. Unlike the other 2 chemicals, it does not have to be injected directly into a vein to work. An injection just under the skin or into the muscle will spread the poison effectively. Because the chemical is effective at paralyzing inmates, observers can't tell if the condemned is feeling pain during the execution. Richard Dieter, executive director of the Death Penalty Information Center, said the study "seems to question whether anything is working the way it was promised. I don't think it's too surprising that a protocol introduced 30 years ago is out of date and that the drugs used are not as reliable as once thought in producing the effects they were intended to." -------------------------------------------------------------------------------- Lethal injections California and North Carolina use the same 3 drugs to execute inmates, a process that usually takes about 20 minutes. The procedure 1. Saline solution is administered intravenously to the inmate. 2. Sodium thiopental, a strong tranquilizer, is administered to induce unconsciousness. 3. Then pancuronium bromide, a muscle relaxant, is given to paralyze all muscles and stop breathing. 4. Finally, a dose of potassium chloride is given to stop the heart. (source: Los Angeles Times) **************** Study: Lethal injection flawed Inmates executed by this method may die in agony, says a research team who examined the drug cocktail. Inmates put to death by lethal injection are supposed to die quickly and painlessly, but they actually might suffocate aware and in agony, a team of researchers concluded in a study released Monday. In the report in the online publication "PloS Medicine," the eight-member team said the lethal drug cocktail used by dozens of states, including Florida, is flawed because the mixture doesn't necessarily work as intended. "The reason that polls show most people support lethal injection is because they believe it is a humane medical procedure," said Teresa Zimmers, lead author of the study and a molecular biologist at the University of Miami's Leonard Miller School of Medicine. "We provide more evidence that it might be anything but. There's no question it's not a medical procedure. That is a sham." Under the lethal-injection protocol, which Florida and most states copied from Oklahoma, three drugs are meant to work in combination to render inmates unconscious and then cause death by respiratory and cardiac arrest. Each drug is also supposed to be lethal on its own. But the researchers, who analyzed drug dosages and the time between injection and death in 42 executions in North Carolina and 8 in California, found that the first drug, an ultra-fast-acting barbiturate, might not be fatal or sufficient to keep inmates unconscious for the duration of their executions. They also found that the third and final drug, potassium chloride, did not always induce cardiac arrest as intended. As a result, the researchers said, potentially aware inmates might die through painful asphyxiation induced by the 2nd drug, pancuronium, which paralyzes the muscles. "Thus the conventional view of lethal injection leading to an invariably peaceful and painless death is questionable," the report concluded. A spokeswoman for Florida Corrections Secretary James McDonough said he had not reviewed the report and could not comment. But it is sure to add fodder to the continuing debate about Florida's death penalty, which former Gov. Jeb Bush suspended after the botched execution of Angel Nieves Diaz. A convicted killer, Diaz died after 34 minutes and 2 doses of lethal drugs in December. A medical examiner concluded that his executioners had failed to properly insert Diaz's intravenous needles, forcing the lethal cocktail into the condemned man's tissue rather than his veins. In the study, available on the public-access Public Library of Science at plos.org, the researchers argue that, while proper training might have avoided the "technical" mistakes made in Diaz's execution, the lethal-injection protocol is itself deeply flawed because it was adopted by most states on the opinion of 2 people in Oklahoma, without any experimental data or research. "We take issue with the idea lethal injection is a humane medical means of execution," Zimmers said. "The protocol was not properly evaluated. There was no research, oversight and testing." Researchers also found that most states, including Florida, specify the same dosage of the 1st drug, thiopental, for every condemned inmate, rather than calculate the proper dosage based on the inmate's weight. In Virginia, for example, the execution protocol calls for 2 grams of thiopental to be administered regardless of weight, which researchers said could be inadequate for a very large prisoner. "For a large inmate, that would be less than the equivalent dosage you would use in trying to induce five to 15 minutes of anesthesia in a pig in a veterinary setting," Zimmers said. Florida's protocol calls for 5 grams of thiopental, the same amount used in California, where one inmate continued breathing 9 minutes after the 1st drug was injected, the report said. The researchers cited those 9 minutes "as compelling evidence that even 5 grams of thiopental alone may not be lethal.'" The researchers also identified what they said was a problem with the final drug, potassium chloride, which is supposed to cause cardiac arrest, but, they said, does not do so reliably. As evidence, they noted that North Carolina initially used only the first two drugs, but when the state added the 3rd, it did not significantly speed up the time of death as expected. Researchers also cited a number of executions in which multiple doses of the 3rd drug had to be administered. The researchers, who in addition to Zimmers include five other UM faculty members, a pharmacologist in Spain and a Virginia lawyer who defends death-row clients, received no specific funding for their study. In addition to the lawyer, only one other researcher disclosed a potential conflict of interest: David Lubarksy, the chairman of UM's department of anesthesiology, has been a paid expert in death-penalty litigation. For now, the moratorium Bush imposed on Florida executions continues. The office of Gov. Charlie Crist is reviewing the Corrections Department's response to 38 recommendations issued last month by a commission Bush appointed to review lethal-injection procedures in the wake of the Diaz execution, said department spokeswoman Gretl Plessinger. (source: Orlando Sentinel) PENNSYLVANIA: Jury Deadlocks In Death Penalty Decision A York County man will face life in prison without parole for shooting to death a man who authorities said he sought to prevent from testifying against him. Thomas Lee Brown Jr. was convicted Friday of 1st-degree murder in the April 7, 2006 shooting of Lamont Nelson, 32, of North York. Nelson was gunned down as he stepped through his back gate to go to his car. Police said Nelson was a coworker who was to testify against Brown in a pending drug and firearms case. Jurors deliberated about two hours Monday on whether Nelson should face the death penalty but told Judge Michael Brillhart they were unable to reach a unanimous decision. The judge did not immediately set a sentencing date. (source: WGAL News) ******************** Brown will face life after jury deadlocks on death penalty A man will face life in prison without parole after a jury deadlocked on whether he should face the death penalty in the shooting of a man authorities said he sought to prevent from testifying against him. A judge did not immediately set a sentencing date for Thomas Lee Brown Jr., who had been convicted Friday of 1st-degree murder in the April 7, 2006 shooting of Lamont Nelson, 32, of North York, as he stepped through his back gate to go to his car. Police said Nelson was a co-worker who was to testify against Brown in a pending drug and firearm case. Jurors deliberated about 2 hours Monday on whether Nelson should face the death penalty before telling Judge Michael J. Brillhart they were unable to reach a unanimous decision. Defense attorney Jeffrey Marshall had presented testimony from family members who said Brown was a good father and hard worker. "The death penalty is intended for those in our society who are the worst of the worst," Marshall told the jury. "Thomas Brown is not one of those individuals." (source: Associated Press)
[Deathpenalty] death penalty news----USA, PENN.
Rick Halperin Tue, 24 Apr 2007 15:30:49 -0500 (Central Daylight Time)
