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.