As Lethal Injection Turns Forty, States Botch a Record Number of Executions

On December 7, 1982, Texas strapped Charles Brooks to a gur­ney, insert­ed an intra­venous line into his arm, and inject­ed a lethal dose of sodi­um thiopen­tal into his veins, launch­ing the lethal-injec­tion era of American exe­cu­tions. In the pre­cise­ly forty years since, U.S. states and the fed­er­al gov­ern­ment have put 1377 pris­on­ers to death by some ver­sion of the method. Touted as swift and pain­less and a more humane way to die — just as exe­cu­tion pro­po­nents had said near­ly a cen­tu­ry before about the elec­tric chair — the method has proven to be anything but.

Experts say lethal injec­tion is the most botched of the exe­cu­tion meth­ods, esti­mat­ed to go wrong more fre­quent­ly than any oth­er method. And an NPR review of autop­sies of more than 200 pris­on­ers put to death by lethal injec­tion found that, regard­less of the out­ward appear­ance of a tran­quil death, 84% of those exe­cut­ed showed evi­dence of pul­monary ede­ma — a flu­id build-up in the lungs that cre­ates a feel­ing of suf­fo­ca­tion or drown­ing that experts have likened to waterboarding.

“It’s clear that lethal injec­tion cre­ates a cir­cus of suf­fer­ing,” said Emory University Anesthesiologist Dr. Joel Zivot, who exam­ined the lethal injec­tion autop­sies for NPR. 

As lethal injec­tion turns forty, states are botch­ing exe­cu­tions in record num­bers — sev­en out of 19 exe­cu­tion attempts in 2022, an aston­ish­ing 37%. In arti­cles in Slate and The Conversation on November 21 and November 29, 2022, Austin Sarat, the William Nelson Cromwell Professor of Jurisprudence and Political Science at Amherst College and author the 2014 book, Gruesome Spectacles: Botched Executions and America’s Death Penalty, says that from Brooks’ exe­cu­tion through 2009, ​“more than 7 per­cent of all lethal injec­tions were botched … [and] things have only gotten worse.”

American phar­ma­ceu­ti­cal com­pa­nies uni­ver­sal­ly oppose what they con­sid­er the mis­use of their med­i­cines to take the lives of pris­on­ers, and the med­ical com­mu­ni­ty uni­ver­sal­ly deems it uneth­i­cal for med­ical per­son­nel to par­tic­i­pate in exe­cu­tions. That means states are rely­ing on what drugs they can lay their hands on — increas­ing­ly obtained ille­gal­ly or by sub­tur­fege — from often unre­li­able sources and admin­is­tered by inad­e­quate­ly trained prison per­son­nel ill-equipped to han­dle the job and per­form­ing it behind an expand­ing veil of secrecy provisions.

In a two day span November 16 and 17, three dif­fer­ent states — Arizona, Texas, and Alabama — botched the exe­cu­tions of Murray Hooper, Stephen Barbee, and Kenneth Smith, respec­tive­ly. Execution teams failed for more than 25 min­utes to set the nec­es­sary exe­cu­tion lines for Hooper and 35 min­utes for Barbee. For the sec­ond time in two months, Alabama called off an exe­cu­tion in progress, fail­ing in numer­ous attempts to set Smith’s exe­cu­tion line at all.

Speaking of the Arizona exe­cu­tion team, but with words that could just as eas­i­ly apply to any of the botched exe­cu­tions, Zivot told the Arizona Republic, ​“I don’t know why they are so bad at this. But it seems they are try­ing to hide a pat­tern of dan­ger­ous, cru­el, incompetence.”

Sarat defines botched exe­cu­tions as ​“those involv­ing unan­tic­i­pat­ed prob­lems or delays that caused, at least arguably, unnec­es­sary agony for the pris­on­er or that reflect gross incom­pe­tence of the exe­cu­tion­er.” In his arti­cle in Slate, Sarat notes that the prob­lems with lethal injec­tion go beyond just the incom­pe­tence of non-med­ical per­son­nel. ​“Lethal injection’s prob­lems can­not be cured sim­ply by pro­vid­ing bet­ter train­ing to those who must admin­is­ter it,” he says. ​“Problems are endem­ic to a method of exe­cu­tion that is com­pli­cat­ed and depen­dent on unre­li­able drugs and drug com­bi­na­tions. And they are com­pound­ed because state exe­cu­tion pro­to­cols do not effec­tive­ly reg­u­late what hap­pens in the execution chamber.”

In 2022, Arizona and Alabama have botched three exe­cu­tions each, and Texas anoth­er. The first botched exe­cu­tion in the November 16­ – 17 tril­o­gy, that of Murray Hooper, hap­pened when the exe­cu­tion team was unable to find func­tion­al intra­venous lines in his arms and resort­ed to insert­ing a catheter into his femoral vein. While strapped to the gur­ney, Hooper asked ​“What’s tak­ing so long?,” and turned the wit­ness­es and said, ​“Can you believe this?” 

Earlier in the year, on May 11, Arizona Department of Corrections per­son­nel failed for 25 min­utes to set an intra­venous line in Clarence Dixon​’s arms before per­form­ing a bloody ​“cut­down“ pro­ce­dure to insert the IV line into a vein in his groin. It was the first exe­cu­tion the state had car­ried out after a near­ly eight-year hia­tus fol­low­ing the botched two-hour exe­cu­tion of Joseph Wood on July 23, 2014. Then, in what reporter Jimmy Jenkins described as a ​“sur­re­al” event, Frank Atwood helped prison offi­cials find a suit­able vein for the IV line that would admin­is­ter the lethal-injec­tion drugs to end his life. 

“After a few min­utes and what appeared to be sev­er­al attempts, the exe­cu­tion team insert­ed an IV and catheter into Atwood‘s left arm. Then they wheeled the cart to the oth­er side of his body, and told him they were going insert an IV into his femoral vein,” as they had done to estab­lish an IV line in Clarence Dixon’s body dur­ing his botched exe­cu­tion one month prior.

“Why?” Jenkins records Atwood ask­ing. ​“They draw blood from my right arm with no prob­lem all the time.” Jenkins reports that the team did not say why they want­ed to put a sec­ond line into his femoral vein, but they told Atwood they would try to place it in his right arm, as he had sug­gest­ed. ​“The exe­cu­tion team tried and failed to get the IV into his right arm sev­er­al times,” Jenkins report­ed. ​“One of the exe­cu­tion team mem­bers shook his head in frus­tra­tion. ​‘I don’t under­stand,’ Atwood said, ​”they’ve nev­er had this problem before.’”

After the exe­cu­tion team again sug­gest­ed plac­ing the sec­ond IV into Atwood’s femoral vein, the con­demned man sug­gest­ed, ​“Could you try the hand? … They have been able to go in there before as well.” Jenkins wrote: ​“The IV team mem­bers looked at each oth­er, looked at Atwood, looked at each oth­er again, and said ​‘Sure, we‘ll give that a try.’”

“Atwood’s sug­ges­tion to find a vein in his right hand proved effec­tive,” Jenkins wrote.

In Texas, the exe­cu­tion team encoun­tered prob­lems insert­ing intra­venous lines in Barbee’s right hand and in his neck, a process that was even more prob­lem­at­ic because of med­ical con­di­tions that pre­vent­ed Barbee from straight­en­ing his arms. In Alabama, the exe­cu­tion of Kenneth Smith was halt­ed after more than an hour of fail­ures to insert the intra­venous lines in Smith’s arm, hand, neck, and chest. In an inter­view with The Atlantic, Smith described the expe­ri­ence as ​“like a knife.” 

Earlier, Alabama exe­cu­tion­ers had been unable for more than two hours each to set exe­cu­tion lines in failed attempts to put Alan Miller and Doyle Hamm to death. It took Alabama three hours to estab­lish an exe­cu­tion line for Joe James, who, unrep­re­sent­ed, had no one to look out for his legal inter­est against being tor­tured. When the wit­ness­es were let in to the obser­va­tion gallery and the cur­tain final­ly opened, the exe­cu­tion team admin­is­tered the lethal drugs to an unre­spon­sive and appar­ent­ly already uncon­scious James. ​“States con­tin­ue to con­duct exe­cu­tions in ways that are tor­tur­ous and incom­pat­i­ble with the Eighth Amendment’s bar against pun­ish­ments that pose a sub­stan­tial risk of severe pain,” ACLU Capital Punishment Project Director Cassandra Stubbs said. 

In an inter­view with CHNI Newspapers, Death Penalty Information Center Executive Director Robert Dunham explained that the dete­ri­o­rat­ing med­ical and psy­cho­log­i­cal con­di­tion of con­demned pris­on­ers make the process of estab­lish­ing an exe­cu­tion line even more dif­fi­cult. ​“It will get worse as pris­on­ers being exe­cut­ed get old­er because veins become com­pro­mised. … It will be worse with pris­on­ers who have a life his­to­ry of trau­ma because stress affects the body and cumu­la­tive stress affects the body — and the stress of being on death row fac­ing exe­cu­tion affects the body more so than if some­body has a long prison term,” Dunham said. 

The exe­cu­tion botch­es and fail­ures have called into ques­tion state’s com­pe­tence in car­ry­ing out exe­cu­tions. In 2014, Oklahoma botched the exe­cu­tion of Clayton Lockett in a bloody 45-minute exe­cu­tion that caused the state to call of a sec­ond exe­cu­tion sched­uled for the same night. In January 2015, the state vio­lat­ed its exe­cu­tion pro­to­col by exe­cut­ing Charles Warner with the wrong drug. Richard Glossip’s exe­cu­tion was called off at the last minute in September 2015 after the state again obtained an unau­tho­rized drug instead of the drug called for under its exe­cu­tion pro­to­col. Oklahoma resumed exe­cu­tions by lethal injec­tion in 2021, after a grand jury inves­ti­ga­tion found wide­spread fail­ures to com­ply with the state’s exe­cu­tion pro­to­col, with­out hav­ing made any dis­cernible changes in its practices.

On April 21, 2022, Tennessee Governor Bill Lee called off the exe­cu­tion of Oscar Smith less than a half-hour before it was sched­uled to go for­ward after being informed that cor­rec­tions per­son­nel had failed to test the exe­cu­tion drugs for bac­te­r­i­al endo­tox­ins as required by the state’s pro­to­col. On May 2, Lee paused all exe­cu­tions sched­uled for 2022 and called for an ​“inde­pen­dent review” of the state’s exe­cu­tion pro­to­col. Lee said in a news release, ​“the death penal­ty is an extreme­ly seri­ous mat­ter, and I expect the Tennessee Department of Correction to leave no ques­tion that pro­ce­dures are correctly followed.”

Following Alabama’s exe­cu­tion fail­ures, Governor Kay Ivey on November 21 announced an inter­nal ​“top-to-bot­tom” review of the state’s secre­tive execution process. 

Attorney Joseph Perkovich, who watched the exe­cu­tion of his client Frank Atwood in June of 2022, ques­tioned the secre­cy that has accom­pa­nied the lethal injec­tion fail­ures. ​“The premise that these par­tic­i­pants must be shield­ed for their safe­ty has no fac­tu­al basis,” he said. ​“It is man­u­fac­tured to avoid account­abil­i­ty. Arizona’s humil­i­a­tion and butch­ery of its con­demned betrays the pre­tense of dig­ni­ty in using med­ical para­pher­na­lia to kill.”