Death Row Doctoring: The Dicey Medical Ethics of Prison Executions

Seema Yasmin, MD


June 06, 2017

I had seen people die, but I had never watched a person be killed—until I moved to Texas. It was a warm day in September 2014 when my editor sent me to death row in Huntsville. I had joined the Dallas Morning News as a reporter that summer, never expecting my job to land me in a small, musty room overlooking an execution chamber.

Through green metal bars and a window, I watched Lisa Ann Coleman lying on a crucifix-shaped gurney, yellow leather straps wrapped around her arms and legs. Coleman, a 38-year-old African American woman, was scheduled to die at 6 PM for the murder of a 9-year-old boy in 2004. A microphone hung from the ceiling of the execution chamber and hovered an inch or two above her round brown face.

Instead of dying quick deaths, men injected with a lethal cocktail of drugs had writhed, seized, and foamed at the mouth.

To her left was a green wall with a one-way mirror and a hole the size of a medicine cabinet. Behind it were three executioners. Someone who knew how to place IV lines had inserted cannulae into the crooks of both of her elbows. Thin plastic tubes ran from her arms and disappeared into the hole in the wall.

A lethal cocktail of medicines would be injected into those tubes, and Coleman would die. That was the plan. But a spate of executions in the run up to her execution had been botched. Instead of dying quick deaths, men injected with a lethal cocktail of drugs had writhed, seized, and foamed at the mouth.

I was sent to witness Coleman's death in case it was a long and drawn-out affair.

A Recipe for Lethal Injection

In the seventies, when death row prisoners were gunned down or electrocuted, an Oklahoma legislator asked the state's medical officer to find a more "humane" way to kill inmates.

Pathologist Dr Jay Chapman suggested a three-drug protocol including an anesthetic, a paralytic agent, and potassium chloride. He gave the recipe to state legislator Bill Wiseman, who shared it with politicians across the country. Dr Chapman's recipe came to be used in the majority of death chambers in the United States, and the three-drug combo is still referred to as the Chapman protocol, earning him the moniker "the father of lethal injection."

The first drug in Chapman's protocol is the barbiturate sodium thiopental, the number-one choice for executions since he suggested its use in 1977—until now. In the last 7 years, the drug has become increasingly difficult for death row officials to procure.

Hospira, the only company approved to make sodium thiopental in the United States, shut down its production lines in 2010 when US Food and Drug Administration investigators found that some of its drugs were contaminated with fragments of stainless steel.

With their US supply of sodium thiopental shut down, prison officials turned to a drug salesman operating out of a driving school in West London.

Then came months of protests from anti–death penalty advocates, shareholders, and the medical community. Hospira was urged to keep its sodium thiopental production lines closed.

With their US supply of sodium thiopental shut down, prison officials turned to a drug salesman operating out of a driving school in West London. Mehdi Alvi kept a filing cabinet stocked with lethal execution drugs. For $6000, Alvi would ship a packet containing vials of sodium thiopental, pancuronium bromide, and potassium chloride, which were then used to execute American prisoners.

The operation was shut down by the UK government, and prison officials turned to pharmaceutical companies in Switzerland and India. When those lines ran dry, they switched to a new drug: pentobarbital.

In 2011, Roy Willard Blankenship jerked and gasped for air in a Georgia death chamber. "I can say with certainty that Mr Blankenship was inadequately anesthetized and was conscious for approximately the first 3 minutes of the execution," said Dr David Waisel, associate professor of anesthesia at Harvard Medical School. "His eyes were open throughout," he said.

That didn't stop Oklahoma from using pentobarbital in 2014. Moments after he was injected with the drug, Michael Lee Wilson said to those watching, "I feel my whole body burning."

Sixty-three doctors signed a letter urging the maker of pentobarbital, Lundbeck, to stop supplying its drug to prisons. Lundbeck asked its US distributors to sign a contract saying that they would not distribute pentobarbital to prisons.

A Botched Execution

A few months before Lisa Ann Coleman was scheduled to die, Oklahoma prison officials turned to a different drug. They bought midazolam for the executions of Clayton Lockett and Charles Warner. Both men were scheduled to die on April 29, 2014.

Lockett was up first. At 5:27 PM, a paramedic approached the gurney. She stuck a needle in his left arm but couldn't find the tape she needed to secure the IV. The needle slipped out of Lockett's vein. His arm began to bleed.

After her third failed attempt at finding a vein, the paramedic asked for help. She turned to the doctor, a man who had assisted in one execution and who expected his only involvement to be the pronouncement of Lockett's death. Instead he was being asked to give the executioner access to the veins through which lethal drugs would flow to Lockett's heart.

The doctor went straight for the jugular. The paramedic continued to search for a vein, sticking Lockett three times in his right arm. Neither of them was successful—she couldn't find a vein, and he had poked the needle all the way through the vessel.

The doctor tried again, this time aiming for a vein near Lockett's collarbone. The paramedic tried two veins on his foot. They failed. The doctor tried to access the femoral vein using a needle that was too small for the vessel. Almost 1 hour and one dozen attempts later, the pair believed they had secured an IV line in Lockett's groin.

Almost 1 hour and one dozen attempts later, the pair believed they had secured an IV line in Lockett's groin.

But they noticed that the saline flush was not flowing properly, a possible sign that the line had slipped out of the vein. They told the executioners to begin the lethal injection.

The first drug to flow into Lockett's groin was midazolam. Five minutes later, he turned his head to look toward the witnesses. Next, the paralytic drug vecuronium bromide was injected into his groin. One of the executioners noticed that something was wrong. It was almost impossible to push the liquid through the line. He pushed harder and heard a moan emanate from the chamber.

They continued. Next came potassium chloride. Lockett kicked his right leg and rolled his head. He clenched his teeth and writhed on the gurney. Court records say that he struggled violently, twisted his body, and tried to speak.

"He's trying to get off the table!" someone shouted.

Lockett said, "Man."

The doctor saw a tennis ball–sized lump protruding in Lockett's groin. Blood and clear fluid were seeping into the sheets. The vein had blown. Midazolam, vecuronium bromide, and potassium chloride had been pumped beneath Lockett's skin and into the muscle.

Court records state that the paramedic tried to reassure Lockett. "Take deep breaths," she said. Then she swabbed his groin to find another vein. The doctor stabbed the other side, again using a needle too small for the femoral vein. He hit the femoral artery instead, and blood squirted onto his white jacket.

"It'll be alright," the doctor told the paramedic. He pulled the needle out of Lockett's groin and tried again.

Lockett's heart rate was 20 beats/min. The warden approached and asked if they could resuscitate Lockett. The doctor said that if he started CPR in the death chamber, they could transport him to the local emergency department.

While they were planning his resuscitation, Lockett died. It had been 43 minutes since he was injected with the cocktail of lethal injection drugs.

The Doctor's Role

I wondered if Coleman would die the same way. The Texas Department of Criminal Justice wouldn't tell me who supplied the pentobarbital for fear of losing their provider, and they wouldn't reveal the name of the doctor who would oversee her death.

One death row doctor has spoken out about his role in executions. Dr Carlo Musso is an emergency physician who runs Rainbow Medical Associates, an organization that provides medical services to correctional facilities in Georgia.

"Medical organizations have strongly worded opposition to physician participation in execution, and—believe me—I've read them and I understand them. I just don't agree with them," Musso said in the documentary, Death Row Doctor. He went on to explain his participation. "My role in execution is one of end of life. Instead of a carcinoma, that individual is dying of a court order. But he's still dying."

Musso is in violation of the American Medical Association's Code of Medical Ethics, which says that medical personnel should not assist in executions. But some states provide immunity to doctors who participate in executions by preventing medical boards from taking disciplinary action against them. Many states, including Texas, provide anonymity to healthcare professionals who work on death row.

It was 6:10 PM, and a white fan in the witness room circulated warm air. Coleman's aunt stood in front of me sobbing into a tissue. A short woman with a Playboy bunny tattooed on her wrist wiped her nose and comforted the aunt. We waited for the drugs to be injected.

Only a spiritual adviser stood in the execution chamber with Coleman. He rested his right hand on her legs and read from the New Testament. He asked if she had a last statement. Coleman turned to look at her aunt and declared her love for her family. She turned to the ceiling and closed her eyes.

I was studying her face. With her body bound by leather straps and her hands wrapped in bandages, only Coleman's eyes and mouth would reveal any signs of pain and distress in her final minutes.

At 6:12 PM, executioners behind the wall injected pentobarbital into Coleman's veins. Her eyes were closed; her body was still.

At 6:23 PM, a doctor entered the death chamber with his back to us. All I could see were slender shoulders and a shock of white hair. He felt Coleman's carotid arteries, listened to her chest with a stethoscope, and said, "Time of death, 6:24." It had taken her 12 minutes to die.

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