Lethal Injection

Public Health Experts, Generic-Pharmaceuticals Association Warn Lethal-Injection Policies Put Public Health at Risk

State lethal-injection practices may have collateral consequences that place public health at risk, according to briefs filed in the U.S. Supreme Court on July 23, 2018 by public health experts and an association representing generic drug manufacturers. In amicus (or friend-of-the-court) briefs filed in connection with a challenge brought by death-row prisoner Russell Bucklew (pictured) to Missouri's use of lethal injection, the Association for Accessible Medicines (AAM)—a professional association representing generic and biosimilar drug manufacturers and distributors—and eighteen pharmacy, medicine, and health policy experts warn that questionable state practices in obtaining and hoarding drugs for use in executions undermine law enforcement efforts to combat black markets in controlled substances and jeopardize the availability of some medicines for their intended therapeutic use. The AAM, which takes no position on the death penalty or the specific issues in Bucklew's case, told the court that its membership "strongly oppose the use of their medicines ... to carry out executions." The Association wrote: "Like doctors and other medical professionals, many drug manufacturers (including the members of AAM) recognize that they have an ethical obligation to ensure that their products are used only to heal, not to harm. Yet despite many manufacturers’ best efforts, drugs that are essential to the healthcare system—including some that are in short supply—have been diverted to state prison systems for use in capital punishment. AAM and its members cannot support such misuse of their products." The AAM brief stressed that their products are developed and tested for particular approved medical uses, but in executions, "powerful injectable drugs such as sedatives and barbiturates are being used at untested levels for an untested purpose, often without adequate physician supervision." The AAM called "the off-label use of these prescription drugs" in executions "medically irresponsible." Further, they wrote, some of the drugs used in executions that "are considered 'essential medicines' by the World Health Organization ... are in short supply," but have been diverted from medical use by death-penalty states. Citing a 2017 study by The Guardian, the AAM said "four states had stockpiled enough of these drugs to treat 11,257 patients—if the drugs were used as intended for medical treatment rather than in executions." Eighteen public health experts filed a brief in support of Bucklew's lethal injection challenge. The portion of that brief addressing public health issues warned that "States have created serious public health risks in their efforts to conduct lethal injections" and that continued improper practices "could lead to a public health crisis." The health experts argue that states have violated federal law by importing unapproved drugs for use in executions, obtained compounded drugs of questionable quality from unlicensed and secret pharmacies, breached supply chain controls and misled healthcare providers to obtain drugs for executions, and employed secrecy laws to "hide potentially illegal and unsafe conduct from scrutiny." These practices, they say, circumvent and undermine the country's "carefully and extensively regulated [medical] supply chain .... The result is twofold: it undermines federal laws that protect the public health, and it circumvents pharmaceutical companies’ ability to ensure the safety and effectiveness of drugs in the supply chain." 

Arkansas Prisons Suspend Search for Execution Drugs, Ask For Even Broader Drug Secrecy Law

Unable to legitimately purchase lethal-injection drugs or carry out executions without revealing who manufactured its drugs, Arkansas has suspended efforts to obtain a new supply of execution drugs until state law is amended to keep secret the identity of the drug manufacturers. The Arkansas Department of Corrections confirmed on July 17, 2018 that it had halted its search for execution drugs earlier this year following a November 2017 Arkansas Supreme Court decision requiring the state to disclose portions of the pharmaceutical drug and packaging labels for the drugs it intended to use in executions. Those labels permitted the public and the pharmaceutical industry to identify the manufacturers of the execution drugs, who then sued the state or charged state officials with violating the companies' contract rights. Solomon Graves, spokesperson for the Department of Corrections said the department has been working with the governor's and attorney general's offices on amending the Arkansas Method of Execution Act to prevent disclosure of information that would identify drug manufacturers. "We are not actively looking for additional drug supplies at this time," he said. Arkansas does not currently have any execution dates set, but it scheduled eight executions in an unprecedented 11-day period in April 2017 in an attempt to carry out the executions before its supply of the sedative midazolam expired. Four of the executions went forward, but not before controversy surrounded the state's purchase of all three drugs in its execution protocol. Prior to the executions, Associated Press learned that the state's second drug—the paralytic vecuronium bromide—had been manufactured by Hospira, a subsidiary of the drugmaker Pfizer. Pfizer, which made international news with its May 2016 announcement of strict distribution controls designed to block states from obtaining and using its medicines in executions, informed its drug distributor, McKesson Medical-Surgical, that the sale violated their distribution agreement. McKesson then sued Arkansas, alleging that the state had deliberately misled the company to believe that the drug would be used for legitimate medical purposes. The companies Fresenius Kabi USA, LLC, and West-Ward Pharmaceuticals Corp.—the manufacturers of the potassium chloride that Arkansas used as the third drug in its executions—also attempted to intervene in federal litigation to stay the April executions, writing that "use of their medicines for lethal injections violates contractual supply-chain controls that [they] have implemented ... to prevent the sale of their medicines for use in capital punishment." Following the expiration of its supply of midazolam, the director of the Department of Correction, Wendy Kelley, purchased a new supply of the drug in cash. The package identified a New York company, Athenex, as the manufacturer, who said Arkansas acquired the drug in violation of the company's agreements with distributors barring the use of its products in executions. McKesson's lawsuit remained active until the state's supply of vecuronium bromide expired this Spring and the parties agreed the suit had become moot. However, the expiration of the drug left Arkansas without the means to carry out any executions until it obtains a new supply of the paralytic. Graves said that the Department of Corrections has no intention of resuming its search for execution drugs until the state legislature exempts the suppliers and manufacturers from the state's public disclosure laws. The legislature does not meet until 2019, at which point the other two execution drugs will have expired.

Court Order: No Executions in Louisiana For Another Year

A Louisiana federal court judge has ordered that executions in the state be stayed for at least another year. On July 16, 2018, in proceedings brought by Louisiana death-row prisoners challenging the state's lethal-injection protocol, U.S. District Court Judge Shelly Dick granted a request by state officials to extend by one year the temporary stay of execution that has been in effect in Louisiana since 2014. Jeffrey Cody, the state's lawyer in the case, told the court that continuing the lethal-injection litigation now would be "a waste of resources and time." He asked for the one-year extension "because the facts and issues involved in this proceeding continue to be in a fluid state." The request for an extension has triggered a partisan dispute among Louisiana state elected officials. Jeff Landry, the state's Republican Attorney General, blamed Democratic Governor John Bel Edwards for Louisiana's inability to execute prisoners and for facilitating a court ruling further delaying executions. In a July 18 letter to the Governor that Landry simultaneously distributed to the media, the attorney general said he was withdrawing his office from participating in the lethal-injection lawsuit and would no longer represent the Department of Corrections in that case. Landry claimed that Edwards was "unwilling[ ] to proceed with any executions" and called that "the biggest obstacle" to resuming executions in the state. Edwards called the attorney general's actions "political grandstanding," saying "[h]e issued this release today without trying to contact me at all." He said, "[i]n the one year since the state last requested a stay, which the Attorney General signed on and supported at the time, nothing has changed – the drugs are not available and legislation has not passed to address concerns of drug companies or offer alternative forms of execution." Louisiana currently authorizes the use of a one-drug protocol of the anesthetic pentobarbital, with a backup two-drug method consisting of the sedative midazolam and the painkiller hydromorphone. According to Department of Corrections spokesperson Ken Pastorick, the state does not have a supply of any of those drugs. The latest stay marked the fourth time since 2015 that the state has requested a delay of the lethal injection litigation. By the time Judge Dick's order expires on July 18, 2019, it will have been nearly ten years since the last execution in Louisiana, which was carried out on January 7, 2010. Bobby Jindal, a Republican, was governor from 2010 until January 2016, after the first federal stay of execution was in effect. 

Alabama Prisoners End Execution Lawsuit, State Will Drop Lethal Injection in Favor of Nitrogen Gas

Alabama will not execute eight death-row prisoners by means of the problematic lethal-injection protocol they have been challenging, but will instead carry out the executions using lethal gas. In a Joint Motion to Dismiss the prisoners' federal litigation over the state's execution protocol, filed on July 10, 2018, the parties agreed that the lawsuit had been rendered moot by the state's passage of legislation authorizing execution by nitrogen gas and the prisoners' election to die by nitrogen hypoxia. Alabama's lethal-injection process uses the controversial sedative midazolam, which has been implicated in numerous executions across the country that have been described as "botched." In October 2017, witnesses to Alabama's 35-minute execution of Torrey McNabb reportedly "expressed repeated concerns to each other that he was still conscious during the lethal injection." Alabama federal defender Christine Freeman, the director of the Alabama Post-Conviction Relief Project, testified on July 10 in separate litigation over Tennessee's lethal-injection process that she had witnessed McNabb grimacing and raising his arm up twenty minutes into the execution, well after the midazolam was supposed to have rendered him unconscious. Witnesses also reported that Alabama prisoner Ronald Smith heaved, coughed, clenched his left fist, and opened one eye during one 13-minute period of his 34-minute execution in December 2016. After Alabama added nitrogen gas as an option for carrying out the death penalty, the prisoners had a June 30 deadline to select gas as the method of their execution. In a nitrogen hypoxia execution, the prisoner breathes pure nitrogen, which displaces oxygen in the bloodstream, suffocating them. Experts characterized the prisoners' choice as preferring the unknown risks of execution by nitrogen gas to the known risks of execution by lethal injection. Nitrogen gas has never been used as a method of execution in the United States, but has been approved as an option by three states—Alabama, Mississippi, and Oklahoma. Of the three states, only Alabama leaves the choice of execution method to the prisoner. Mississippi and Oklahoma allow nitrogen executions only if lethal injection is held unconstitutional or is "otherwise unavailable," although Oklahoma has indicated that it is developing a lethal gas protocol to replace lethal injection. According to the federal defender's office representing the Alabama prisoners, their clients in the case, "and anyone else who elected the new method, cannot now be executed by lethal injection." Alabama still must develop a nitrogen-hypoxia protocol before it can carry out any executions using that method, and the prisoners have not waived their right to challenge that protocol. Federal public defender John Palombi, who represents the prisoners, said "While the best way to reduce the risks of botched executions would be to abolish the death penalty, if the death penalty does exist, it must be carried out in a constitutional manner with the respect and dignity that is required of such a solemn event." Alabama's lethal-injection protocol is the most secretive in the nation. Palombi encouraged the state to make the nitrogen hypoxia protocol public "so that the people of the state of Alabama know what is being done in their name."

Nevada Execution Halted On Claims State Obtained Execution Drug Through “Subterfuge”

In response to a lawsuit filed by pharmaceutical manufacturer Alvogen, Inc., a Clark County, Nevada District Judge has stayed the July 11, 2018, execution of Scott Dozier and issued a temporary restraining order barring Nevada from using drugs produced by Alvogen to execute Dozier. Saying Nevada had obtained a supply of the drug-maker's sedative midazolam “by subterfuge,” the multibillion-dollar generic drug company sued Nevada and the state Department of Corrections on July 10 to prevent the state from using its drugs in any execution. The lawsuit alleged that Nevada “intentionally defrauded Alvogen’s distributor” by concealing its intention to use Alvogen’s medicine in Dozier‘s execution and by “implicitly ma[king] the false representation that they had legitimate therapeutic rationale” for buying the drug. In granting the restraining order, District Judge Elizabeth Gonzalez wrote that the misuse of midazolam in an execution would result in “irreparable harm to [Alvogen’s] reputation as a company that produces life-enhancing and life-saving drugs” and that the damage to its business reputation could adversely affect investor and customer relations. Alvogen has a policy not to accept direct orders from prison systems or departments of correction and “does not condone the use of any of its drug products, including midazolam, for use in state sponsored executions.” Alvogen's lawyers said that the company also had sent a letter in April to the governors, attorneys general, and prison directors of all of the death-penalty states in the U.S. expressing “in the clearest possible terms that Alvogen strongly objects to use of its products in capital punishment.” After Nevada's supply of another drug expired and it decided to switch to midazolam, prison officials bought the drug from pharmaceutical distributor Cardinal Health without disclosing its intended purpose. Alvogen said Nevada officials directed Cardinal Health to ship the drug to a state office more than 200 miles from the state prison “to further the implication that the midazolam was for a legitimate medical purpose.” Alvogen's suit is the second time a pharmaceutical company has taken legal action to stop its drugs from being used in executions. In April 2017, McKesson Medical-Surgical sued the state of Arkansas over the use of the paralytic drug vecuronium bromide, but ultimately was unsuccessful in blocking the state from using the drug. The Clark County court has ordered a status conference in this case for September 10. 

Nevada Announces New Drug Protocol Eight Days Before Scheduled Execution

Eight days before the scheduled July 11, 2018 execution of Scott Dozier, the Nevada Department of Corrections issued a new lethal-injection protocol, switching the drugs the state intends to use in carrying out his execution. On July 3, the Department announced that it plans to use an untested three-drug protocol of the sedative midazolam, the opioid fentanyl, and the paralytic cisatracurium. The last-minute change prompted an emergency filing by the ACLU of Nevada seeking additional information about the drugs the state will use. In November 2017, Nevada had announced a different, but also untried execution method involving diazepam (Valium), fentanyl citrate, and cisatracurium besylate. A Nevada trial court declared that protocol unconstitutional in November after considering medical evidence that the paralytic drug, cisatracurium, could cause Dozier to experience “air hunger” and suffocate to death, while masking signs that he was conscious and suffering during the execution. Nevada prosecutors appealed, and the Nevada Supreme Court overturned the ruling on procedural grounds, allowing the execution to go forward. During the course of the state’s appeal, however, its supply of diazepam expired, leaving the Nevada with the choice of delaying the execution or changing its protocol. The ACLU was particularly critical of the protocol’s switch to midazolam, which has been involved in the botched executions of Dennis McGuire in Ohio, Clayton Lockett in Oklahoma, Joseph Wood in Arizona, and Ronald Smith in Alabama and in problematic executions in Arkansas and Virginia. “I think the state of Nevada should think very carefully about whether it wants to use it, especially because of its very concerning history and its association with botched executions,” said Amy Rose, the legal director of the ACLU of Nevada. “I don’t think Nevada wants to be known for having a botched execution.” The paralytic, they argue, could potentially mask serious pain that prisoners experience during executions. The lawsuit seeks information about the process used to arrive at the protocol, the purchase orders for the drugs, and the use of a new execution chamber. Dozier has waived his appeals, allowing his execution to proceed without completing judicial review of the constitutionality of his conviction and death sentence. He would be the first person executed in Nevada since 2006, and his execution would be the first to take place in the new execution chamber that the state built in 2016 at taxpayer expense of $860,000. The state has executed twelve prisoners since the 1970s, eleven of whom waived their appeals.

Federal Judge Orders Alabama to Disclose Execution Records

A federal district court has ordered the Alabama Department of Corrections to release its lethal-injection protocol and unseal transcripts and pleadings related to the failed execution of Doyle Hamm. In a May 30, 2018, order, Judge Karon Owen Bowdre, Chief Judge of the United States District Court for the Northern District of Alabama said "how Alabama carries out its executions" is "a matter of great public concern," and ruled that the public's "common law right of access to the sealed records relating to Alabama’s lethal injection protocol" outweighed arguments to keep the records secret. Doyle Hamm was scheduled to be executed in Alabama on February 22. Despite Hamm’s repeated warnings that his terminal illness would make it impossible to establish IV lines, and after an initial stay of execution issued by Judge Bowdre was overturned by the appellate courts, Alabama unsuccessfully tried for more than two hours to set an IV before calling off the execution. Hamm had filed suit against the state seeking to bar Alabama from making a second attempt to execute him. The parties reached a confidential settlement in which Alabama agreed it would not execute Hamm, leaving questions about Alabama's protocol and execution process unanswered. Three media outlets—the Associated Press, The Montgomery Advertiser, and the Alabama Media Group—intervened, seeking public release of the protocol and judicial records. Alabama argued that providing the records to the media would be improper because "the media attempts to gin up public scandal" about the death penalty. The court rejected that accusation as unsupported by any facts, emphasizing that "Public discussion is not the same as public scandal. The public," she wrote, "needs to know how the State administers its laws; without such knowledge, the public cannot form an educated opinion on this very important topic." The court's order allows the state to redact from the records information that could reveal the identities of the individuals who participated in the execution. State officials have not indicated whether they will appeal.

With Drugs Expiring and Lawsuits Pending, Nebraska Prosecutors Seek to Expedite Execution

Facing an August 2018 expiration date for two of the drugs in Nebraska's experimental execution protocol, state Attorney General Douglas Peterson (pictured) has asked the Nebraska Supreme Court to expedite consideration of the prosecutor's request to set a July execution date for condemned prisoner Carey Dean Moore. The attorney general has petitioned the court to schedule Moore's execution for July 10 "or alternatively for a date in mid-July," despite the pendency of several lawsuits, which will not be resolved before August, that challenge various aspects of the state's authority and ability to carry out executions. Nebraska intends to use a four-drug execution protocol featuring three drugs—the opiod pain medication fentanyl, the sedative valium, and the paralytic drug cisatracurium—that have never before been used in an execution, followed by the heart-stopping drug potassium chloride. Potassium chloride has been described as feeling like liquid fire if administered to a person who has not been adequately anesthetized. Several challenges to the state's administration of the death penalty that have been filed by the ACLU of Nebraska are currently before the courts. These include a case on appeal before the Nebraska Supreme Court arguing that Governor Pete Ricketts and other state officials "improperly seized and exercised legislative power" when they allegedly "proposed, initiated, funded, organized, operated, and controlled the referendum campaign against" the death-penalty repeal law enacted by the state legislature over the governor's veto in 2015; and a second lawsuit challenging the state's lack of transparency surrounding execution drugs and team members, which is currently awaiting a trial-court ruling. The state Department of Corrections recently released some documents regarding execution team training in response to a public records request by the ACLU, but refused to provide documents indicating whether and to what extent execution team members had specialized experience or training in intravenous-access procedures or any documents relating to correspondence with doctors or experts regarding lethal injection. ACLU of Nebraska Legal Director Amy Miller said that the documents released by the state provide "no adequate assurance that we would be looking at a smooth, well-conducted execution," and remarked that "[t]he veil of secrecy that has dropped on all matters relating to the death penalty is very concerning." Nebraska has never carried out an execution using lethal injection. Moore, who was sentenced to death in 1980, is Nebraska's longest incarcerated death-row prisoner. At trial, he waived his right to a jury and presented no evidence in his defense. He recently fired his current appointed counsel and has asked to be executed. In a statement released in April, ACLU of Nebraska's Executive Director Danielle Conrad said, "it is precisely because [Moore] is not fighting that our institutions bear extra responsibility to check themselves by ensuring that the laws are followed and that an unlawful and potentially cruel and unusual execution does not take place." 

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