NPR Investigation of Lethal-Injection Autopsies Finds Executed Prisoners Experience Sensations of Suffocation and Drowning

A new National Public Radio (NPR) analysis of more than 200 autopsies of death-row prisoners executed by lethal injection has found that 84% of those executed showed evidence of pulmonary edema, a condition in which a person’s lungs fill with fluid that creates the feeling of suffocation or drowning that experts have likened to waterboarding.

The pulmonary edema findings were endemic to deaths by lethal injection, remaining consistent irrespective of the state that carried out the execution or the drug protocol employed in putting the prisoner to death. Autopsy results showed the presence of pulmonary edema in lethal injections involving sodium thiopental, pentobarbital, midazolam, and etomidate.

Midazolam, the controversial drug employed by eight states that was the focus of the U.S. Supreme Court’s 2015 lethal-injection decision, Glossip v. Gross, caused the highest prevalence of pulmonary edema of any lethal-injection drug. NPR reports that doctors who reviewed the autopsy reports said the findings “raised serious concerns that many inmates are not being properly anesthetized and are therefore feeling the suffocating and drowning sensation brought on by pulmonary edema.”

Autopsies also showed froth and foam found in many prisoners’ lungs, an indication that they were struggling to breathe as their lungs were filled with fluid caused by pulmonary edema. The froth provided evidence that the first drug in the lethal-injection protocol causes the pulmonary edema, since the second drug paralyzes the lungs and stops the defendant’s breathing. The third drug usually stops the heart.

Frothing was found in prisoners executed by a single drug, as well as by multi-drug protocols. Executions with midazolam had the highest rate of frothing and fluid build-up.

The report also found striking changes in the weight of prisoners’ lungs after execution, caused by fluid and froth. While the average weight of a human lung is between 400 and 450 grams, NPR reports that “the inmate autopsies obtained by NPR showed average lung weights of 813 grams for the right lung and 709 grams for the left lung. Some surpassed 1,000 grams each.” One doctor who reviewed the findings said that the fluid would create “a feeling of drowning, a feeling of suffocation — a feeling of panic, imminent doom.”

Evidence of pulmonary edema has already halted executions in one state. In January 2019, citing medical experts, federal magistrate Judge Michael Merz in Ohio wrote that pulmonary edema, brought on by the state’s use of Midazolam, was “painful, both physically and emotionally, inducing a sense of drowning and the attendant panic and terror, much as would occur with the torture tactic known as waterboarding.” Governor Mike DeWine cited the court’s opinion when he halted executions in the state later that month. A similar condition, flash pulmonary edema, was found in an autopsy of Wesley Purkey, who was executed in August 2020 by the federal government using a one-drug protocol with pentobarbital.

The NPR Investigation

NPR’s investigation was sparked when two renowned doctors at Emory University Hospital in Atlanta, Dr. Joel Zivot (pictured) and Dr. Mark Edgar, were examining autopsy reports of executed prisoners in 2016. They noticed that many of the defendants’ lungs were twice as heavy as they should have been. Eventually, after gathering records from about three dozen more autopsies, they found pulmonary edema in approximately three-quarters of the executions. Their findings raised questions — lethal injections were supposed to be relatively painless. But, Zivot explained, “I began to see a picture that was more consistent with a slower death.” What he saw, he told NPR, was “[a] death of organ failure, of a dramatic nature that I recognized would be associated with suffering.”

“How do we ask an inmate whether or not they experience their own death as cruel?” asked Zivot. “Here was, to my mind, the beginning of a piece of evidence that has been critically absent.”

NPR continued the investigation and obtained 305 autopsy reports. Only 216 of those autopsies contained information about the lungs. NPR’s findings are based on those 216 autopsies.