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Monday, October 1, 2007

Cocktail from Hell

October 1, 2007 - 3:36 p.m.

You may have read in the newspapers this past week that the U.S. Supreme Court has agreed to hear arguments as to whether the current method of lethal injection is unconstitutional. It is likely that they agreed to hear the issue due to the increased number of botched executions in the past year. I never understood this issue when I was in the free world. I never liked capital punishment, but I thought that if we had to have it, putting someone to sleep with drugs was a pretty humane way to do it. I have since come to understand the truth of the three-drug cocktail, and I present that information here. The following information comes directly from case law. None of it is new, or unknown to State officials. The faint of heart should probably stop reading here.

The current drug cocktail causes death by poisoning the person with a lethal combination of three chemical substances: Sodium Thiopental, or Sodium Penththal (an ultra short-acting barbiturate); Pancuronium Bromide, or Pavulon (a curare-derived agent which paralyzes all skeletal or voluntary muscles, but which has no effect on awareness, cognition, or sensation); and Potassium Chloride (an extraordinarily painful chemical which activates the nerve fibers lining the person's veins and which can interfere with the rhythmic contractions of the heart and cause cardiac arrest). While each of these chemicals individually creates concerns about their use in the execution process, in combination they cannot pass constitutional muster. Far from producing a rapid and sustained loss of consciousness and humane death, this particular combination of chemicals often causes the inmate to consciously suffer an excruciatingly painful and protracted death.

Over the last two decades, however, numerous states, and most recently the State of Texas, have enacted statutes regulating the euthanasia of animals which preclude using the same combination of drugs currently administered to human beings during executions. If evolving standards of decency, as reflected by legislative action and the professional association of veterinarians preclude the use of these particular drugs when killing a dog or a cat, then certainly those same standards of decency would require a more humane, readily available version of the lethal injection for human beings as well. Anyway. Here is what the drugs actually do to the human body.

Sodium Thiopental: This drug, also called sodium pentothal, is a short-acting barbiturate which is ordinarily used to render a surgical patient unconscious for mere minutes, only in the induction phase of anesthesia, specifically so that the patient may reawaken and breathe on their own power if any complications arise in inserting a breathing tube pre-surgery. Because of its brief duration, sodium thiopental may not provide a sedative effect throughout the latter two stages of the execution process. Given the fact that several minutes pass between the administration of the first and second drugs, this is virtually guaranteed. Dr. Dennis Geiser, the chairman of the Department of Large Animal Clinical Sciences at the College of Veterinary Medicine at the University of Tennessee, recently explained:


"Sodium Thiopental is not a proper anesthetic for use in lethal injection. Indeed, the American Veterinary Medical Association standards for euthanasia indicate that the ideal barbituric acid derivative for animal euthanasia would be potent, long-acting, stable in solution, and inexpensive. Sodium pentobarbital (not sodium thiopental) best fits these criteria. Sodium thiopental is a potent barbituric acid derivative but very short acting with one therapeutic dose."

(See his affidavit HERE)

Due to the chemical combination used in the Texas execution process, there is also a probability that the sedative effect of the sodium thiopental is neutralized by the second chemical, pancuronium bromide. As Dr. Mark Heath, Assistant Professor of Clinical Anesthesia at Columbia University states:


"Sodium thiopental is an ultra short-acting barbiturate. It would not be used to maintain a patient in a surgical plane of anesthesia for purposes of performing surgical procedures. It is unnecessary, and risky, to use a short-acting anesthesia in the execution procedure. If the solution of sodium thiopental comes into contact with another chemical, such as pancuronium bromide, the mixture of the two will cause the sodium thiopental immediately to precipitate or crystallize. These factors are significant in the risk of the inmate not being properly anesthetized, especially since no one checks that the inmate is unconscious before the second drug is administered."

(See his affidavit HERE).

Concerns about using sodium thiopental are heightened by the lack of medical personnel, the lack of proper monitoring of the inmate during the process and the lack of inmate-specific dosing of the barbiturate.

According to Dr. Geiser:


"The dosage of thiopental sodium must be measured with some degree of precision, and the administration of the proper amount of dosage will depend on the concentration of the drug and the size and condition of the subject. Additionally, the drug must be administered properly so that the full amount of the dosage will directly enter the subject's blood stream at the proper rate. If the dosage is not correct, or if the drug is not properly administered, then it will not adequately anaesthetize the subject, and the subject may experience the untoward effects of the neuromuscular blocking agent..."

In other words, the patient feels what is going on.

Pancuronium Bromide: The second chemical used in the execution process, called pancuronium bromide, or Pavulon, is a derivative of curare that acts as a neuromuscular blocking agent. If, as is probable in the Texas execution process, the sedative effect of the sodium thiopental is ineffective or neutralized, the pancuronium bromide would serve only to mask the excruciating pain of the condemned inmate. Pancuronium bromide makes the patient look serene because of its paralytic effect on the muscles. The face muscles cannot move or contract to show pain. It therefore provides a "chemical veil" over the proceedings. By completely paralyzing the inmate, pancuronium bromide masks the normal physical parameters that an anesthesiologist or surgeon would rely upon to determine if a patient is completely unconscious and within a proper surgical plane of anesthesia. Because pancuronium bromide is an invisible chemical veil and not a physical veil like a blanket or hood that is easily identifiable, the use of pancuronium bromide in lethal injections creates a double veil. It disguises the fact that there is a disguise over the process. (See affidavit HERE).

In the case of Abdur' Rahman v. Bell, Dr. Geiser asserted that while Pavulon paralyzes skeletal muscles, including the diaphragm, it has no effect on consciousness or the perception of pain or suffering. Administration of Pavulon is like "being tied to a tree, having darts thrown at you, and feeling the pain without the ability to respond." (Affadavit of Dr. Dennis Geiser, in the case of Abu-Ali Abdur' Rahman v. Bell, 226F.3d 696 - 6th Cir. 2000. Cert granted on grounds, 122S.Ct 1463 - USA April 8, 2002, No. 01-9094).

This assertion is corroborated by the experience of eye surgery patient, Carol Weihrer. During Ms. Weihrer's surgery the sedative she received was ineffectual and Ms. Weihrer was conscious the entire surgery. Due to the administration of a neuromuscular blocking agent like pancuronium bromide, however, she was unable to indicate her consciousness to others.


"I experienced what has become to be known as Anesthesia Awareness, in which I was able to think lucidly, hear, perceive, and feel everything that was going on during the surgery, but was unable to move. It burnt like the fires of hell. It was the most terrifying, tortuous experience you can imagine. The experience was worse than death."

(See her affidavit HERE).

In short, the second chemical, pancuronium bromide, or Pavulon, in the lethal injection protocol serves no purpose other than to guarantee that the condemned inmate will be forced into a total chemical straight jacket and gag while he consciously experiences the potassium chloride ravaging his internal organs. Persons viewing the lethal injection procedure and the public will never realize that a cruel fraud is being perpetrated upon them: instead of witnessing an inmate quietly and motionless while being "put to sleep", they are witnessing the cover-up of a deliberate act of torture only the inmate is aware of.

Potassium Chloride: Finally, the use of potassium chloride itself raises important Eighth Amendment concerns. James J. Ramsey, a certified perfusionist and currently the Program Director in the Program in Cardiovascular Perfusion at Vanderbilt Medical Center, Nashville, Tennessee, gave a lengthy statement in Abdur Rahman's case regarding the use of potassium chloride in lethal injections. Perfusion is the study of medicine related to the artificial circulation technologies, including but not limited to the operation of the heart-lung machine, a medical device commonly used during open-heart surgeries of all kinds. The area involving the chemical arrest of the heart lies uniquely within the practice of the clinical perfusionist. Regarding the administration and efficacy of potassium chloride in the lethal injection context, Ramsey stated that:

"It is my understanding that during the performance of lethal injection as carried out during the death penalty, potassium (and other agents) are administered intravenously to the defendant. Such administration is, in my professional opinion based upon my knowledge, training, and experience, and within a reasonable degree of medical certainty, entirely inadequate in order to achieve reasonable cardiac standstill. Since the agents are introduced intravenously, there will occur an immediate dilution of the solution, weakening any potential effect it might have. By illustration an 80 kilogram person would have a blood volume of approximately 5.5 to 6 liters. An administration of 100 milli-equivalents of potassium intravenously to the 80 kilogram person would result in a blood concentration of only16.6 meq/L. Such a dose is according to scientific literature...and evidenced in my practice, inadequate to achieve cardiac standstill. Furthermore, it must be remembered that in contrast to the administration of the potassium chloride in the surgical context, such administration is: 1.) Not directed into the coronary arteries; 2.) directed only in an antegrade fashion; 3.) is at mormothermia (37 degrees Celsius, NOT at 5 degrees Celsius). Without reasonable data regarding any one person's anatomic and pathologic state as to their myocardial function prior to administration of the potassium, there can be no reasonable certainty that the potassium solution intended to arrest the heart would be distributed in a fashion that would arrest the heart. Thus, the very orchestrated and methodical methods used in surgery should not be thought of as optimizing the arrest of the heart, but should be considered to be necessary as the only reasonable mans of ensuring that the heart is arrested. If the heart could be arrested by intravenous objections, cardiac surgery today would be a very different animal-science and research tells us that mere intravenous injection of potassium is not sufficient. Additionally, in my professional opinion and within a reasonable degree of medical certainty, barring an effective cardiac arrest, it is entirely possible that a lethal injection as I understand it will serve ONLY to arrest the function of the pulmonary system, thereby causing a state in ischemia to the entire body (no oxygen delivery), which, in turn, will ultimately arrest the heart as well (with no oxygen delivery to it.) As a result, the defendant is simply suffocated due to lack of oxygen."

So, basically, you get paralyzed, and then get to feel the potassium shut down your internal organs. That's pretty much the long and short of it. If some of the language here seemed like lawyerese, and unlike my normal writing style, that is because I simply stole a lot of that from legal briefs. Personally, I wish they had brought the firing squad back. At least then you could die on your feet, like a man. Give me my last cigarette (I don't smoke, but, hey, why not?) and my casually indifferent sneer. (Insert French accent here) "Well, get on with it, I haven't got all day." At least that is better than being strapped to a gurney, wearing a diaper. Whatever the High Court decides, Texas is going to keep on killing people in the meantime (as evidenced by the execution of Louisiana Red on Tuesday). I'm sure Texas still has "Old Sparky" around somewhere, ready to go, just in case.

© Copyright 2007 by Thomas Bartlett Whitaker.
All rights reserved.

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