As a physician who is board-certified in anesthesiology, I have closely followed the use of lethal injection in carrying out executions. This is especially interesting to me since the medications used in these executions represent the “tools of my trade.” Because of my knowledge of how these drugs work I am truly concerned that we may never be able to know whether there is pain and suffering in Florida’s executions. This risk is created by the combination of medications Florida uses and is further enhanced by the use of paralytics in the process.
Today, the U.S. Supreme Court will hear the case of Glossip v. Gross from Oklahoma, which challenges the use of the anti-anxiety medication midazolam as a sole anesthetic in lethal injection executions.
Although the safety and efficacy of midazolam is the subject of the U.S. Supreme Court case, it’s the next drug in Florida’s protocol that concerns me most: the paralytic which prevents the prisoner from showing distress.
Between the midazolam and the painful heart-stopping drugs, Florida chooses to administer a muscle relaxant. This drug does not offer pain relief, nor does it cause death; it simply masks the prisoner’s reaction to the process, making it nearly impossible to know, when administered properly, if the execution is going as planned.
As Dr. David Lubarsky, who chairs the University of Miami Department of Anesthesiology, opined in a sworn statement in pending Florida litigation challenging the Midazolam Protocol, “Further compounding the risk of using midazolam … is the fact that a neuromuscular blocking agent, vecuronium bromide, is used as the second drug in the Midazolam Protocol. The vecuronium bromide would paralyze Plaintiff and render him unable to convey pain or suffering. Plaintiff would experience a sensation akin to being buried alive, but not be able to convey the feeling of pain or suffocation, and the paralysis would camouflage any voluntary movement that might result from an incomplete lack of consciousness.”
This is why it’s illegal under Florida state law for veterinarians to use a paralytic agent during euthanasia on animals, because it masks pain and suffering, rendering the animal unable to react with movement.
And yet Florida’s so-called perfect record of midazolam executions — using paralytics — was cited in an Oklahoma hearing following the botched execution of Clayton Lockett. The state argued that: “Florida has established an impressive track record of successful executions using midazolam.”
But this characterization is inaccurate and misleading. America’s first execution using midazolam was that of William Happ in Florida in October 2013. It was an unusual event, taking about twice as long as previous executions had. Media witnesses noticed that Happ took longer to lose consciousness and that they saw more body movement than in previous lethal injections.
Since that time, multiple executions using midazolam have not gone as planned, including Dennis McGuire, who gulped and gasped for air for over 20 minutes in his Ohio execution; Clayton Lockett, who writhed, tried to speak and rise up on the gurney in his 40-minute execution in Oklahoma, and Joseph Wood, who gasped like a fish out of water according to media witnesses, over 600 times during his nearly two-hour execution in August.
Happ’s execution displayed problems consistent with all the other midazolam botches — the drug is simply not able to provide a level of unconsciousness, at any dose, that pain can’t break through. More importantly, “Florida’s impressive track record” of midazolam executions without incident rests entirely upon the use of a drug in lethal injections that is terrifying — a paralytic agent that prevents us from knowing what the prisoner is experiencing.
Under the sheet, on the gurney, through the witness window, Florida’s executions may have looked uneventful. Peaceful, even.
But due to Florida’s choice to administer paralytics that mask the prisoners’ reactions to the drugs they are given, no one will ever know.
Michael C. Lewis, M.D., is a board-certified anesthesiologist.