Lethal injection.

Lethal injection is now virtually the universal method of execution in the United States, with all but one of the 39 executions carried out during 2013 being by this method. Of the 1,359 executions in the USA to the end of 2013, 1,184 have been by lethal injection, including those of 11  women. The 1000th lethal injection was carried out on July 21st, 2009 at the Southern Ohio Correctional Facility in Lucasville on multiple murderer Marvallous Keene.  A state by state analysis is below – this is kept up to date.

State

First used

Executions

State

First used

Executions

 

mm/dd/yyyy

1982-1999

2000-2014

 

mm/dd/yyyy

1982-1999

2000-2014

Alabama

12/02/2002

0

32

Mississippi

07/17/2002

0

17

Arizona

03/03/1993

17

16

Montana

05/10/1995

1

0

Arkansas

06/25/1990

20

6

Nevada

12/06/1985

7

4

California

02/23/1996

5

6

North Carolina

03/16/1984

13

28

Colorado

10/13/1997

1

0

Ohio

02/19/1999

1

52

Connecticut

05/13/2005

0

1

Oklahoma

09/10/1990

19

91

Delaware

03/14/1992

9

6

Oregon

09/06/1996

2

0

Federal*

06/11/2001

0

3

Pennsylvania

05/02/1995

3

0

Florida

02/23/2000

0

42

South Carolina

05/31/1996

19

19

Georgia

10/25/2001

0

30

South Dakota

07/11/2007

0

3

Idaho

01/06/1994

1

2

Tennessee

04/19/2000

0

6

Illinois

09/12/1990

12

0

Texas

12/07/1982

199

316

Indiana

07/18/1996

4

13

Utah

08/28/1987

4

0

Kentucky

05/25/1999

1

1

Virginia

01/24/1995

48

32

Louisiana

03/05/1993

5

3

Washington

10/13/1998

1

2

Maryland

05/16/1994

3

2

Wyoming

01/22/1992

1

0

Missouri

01/06/1989

41

33

 

 

 

 

* Carried out at Terre Haute Indiana

 

Total at

04/24/2014

1202

 

Lethal injection was first considered as a means of execution in the USA in 1888 when New York's J. Mount Bleyer, M.D., put it forward in an article in the Medico-Legal Journal suggesting that it would be more humane, cheaper and rob the prisoner of the hero status that was often attached to hangings at the time. He suggested the intravenous injection of six grains of Morphine. The idea did not catch on and New York introduced the electric chair instead.

With the resumption of the death penalty in 1977, Oklahoma was looking for an execution method to replace the state’s electric chair which was derelict. A three drug lethal injection protocol was proposed for use in Oklahoma by Chief Medical Examiner, A. Jay Chapman in 1977.  This was approved by Dr. Stanley Deutsch, who at the time chaired the Anaesthesiology Department of Oklahoma University Medical School and passed into law in 1977. Deutsch described a way to administer drugs through an intravenous drip so as to cause death rapidly and without pain. "Having been anaesthetised on several occasions with ultra short-acting barbiturates and having administered these drugs for approximately 20 years, I can assure you that this is a rapid, pleasant way of producing unconsciousness," he wrote in February 1977.
Although Oklahoma became the first to legislate for it, Texas introduced similar legislation later in the same year to replace their electric chair and carried out the first execution by lethal injection on December 7th, 1982. This was of Charles Brooks who was put to death at Huntsville for the murder of second-hand car salesman, David Gregory, in 1976. Brook's girlfriend, Vanessa Sapp, witnessed the procedure which began at 12.07 a.m. He was certified dead at 12.16 a.m. There was no apparent problem and Brooks seemed to die easily. At first he raised his head, clenched his fist and seemed to yawn or gasp before passing into unconsciousness. A further 463 inmates were executed by this means in Texas up to the end of 2010.

Thirty four American states have lethal injection protocols either as their sole method or as an option to one of the traditional methods. These being Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Idaho, Indiana, Kansas, Kentucky, Louisiana, Maryland, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington and Wyoming. Only 32 states have actually carried out executions up to the end of 2010.
Florida offered lethal injection as an option to electrocution from 1999, Alabama followed suite from July 1st, 2002 and Nebraska replaced electrocution by lethal injection in 2009.  Many states have modified their old execution chambers to save the cost of building a new facility.  California has constructed a new and as yet unused lethal injection suite at San Quentin prison during 2009.  Lethal injections at the Washington State Penitentiary in Walla Walla are carried out in the area under the trapdoors of the gallows.  In Utah, the same death chamber is used for shooting and lethal injection executions.

US Federal and military executions.
The American Federal Bureau of Prisons has a $300,000 lethal injection facility at the federal prison in Terre Haute, Indiana. The death house is located inside a non-descript brick building outside the main penitentiary compound and consists of five viewing rooms surrounding the execution chamber.
The chamber is a stark, hospital-like room lined with green tiles and bare except for the large gurney equipped with five Velcro restraints and a sink in one corner. (
see picture)
The intravenous tubes pass through a small opening in the wall and into the executioner's room nearby. All but one room, the executioner's, are equipped with large two-way windows with curtains. The executioner's room is fitted with one-way glass. During an execution, prison officials will maintain an open telephone line to the Justice Department in Washington. The President has sole authority to grant a last minute clemency. Overhead, a camera linked to a monitor inside the executioner's room will watch the process to note whether the prisoner suffers any pain during the procedure.
On the 11th of June 2001, Timothy McVeigh, (
see picture) the Oklahoma City bomber, became the first person to be executed under Federal law since 1963. He had placed a bomb outside the Alfred P Murrah Federal Building, killing 168 people and injuring 850. The intravenous drip that delivered the lethal chemicals went to a catheter in McVeigh's right leg. The first drug was administered at 8.10 a.m., with the second being given at 8.11 and the final one at 8.13 and he was pronounced dead at 8.14 a.m. On the 19th of June 2001, Juan Raul Garza, a Mexican-American drug lord and murderer was executed on the same gurney.  Louis Jones, Jr. was executed for rape and murder on the 18th of March 2003.
The American military has also moved to lethal injection (from hanging) and now has a facility in the basement of the military prison at Ft. Leavenworth, Kansas which is currently housing seven inmates.

Typical US execution procedure.
Lethal injection protocols vary from state to state.
Typically, the prisoner is strapped to a gurney (which is a wheeled hospital style trolley bed) or a fixed execution table, rather like an operating room table by leather or webbing straps over the body and legs. Click here for picture of the Texas gurney.
Their bare arms are strapped to boards projecting from the sides of the gurney. Trained technicians then insert a 14 gauge (2.0mm diameter) catheter, the largest commercially available needle into a vein in each arm, a process that sounds much simpler than it often is. Once the catheters are in place, they are flushed with 10cc of a Heperin solution, to prevent clots forming inside the catheter, then a 1,000cc bag of saline solution is connected to the catheter ends and the inmate is either wheeled into the execution chamber or the curtains surrounding it are drawn back to allow the witnesses to see the procedure. Once the condemned has made any final statement, the prison warden gives the signal for the execution to begin and the technician(s) begins to manually inject the three chemicals comprising typically of 2-3 grams of sodium thiopental (C11H17N2NaO2S) in 80cc of aqueous solution, 50 -100mg of Pavulon (the trade name for Pancuronium bromide, formula C35H60N2O4
) and of 100 milliequivalents (MEQ) potassium chloride (formula KCl) in 50cc of aqueous solution. There is a short interval between each chemical during which the saline solution continues to flow in the IV line to prevent any chemical reaction which could block it. Typically, the actual injections will take from 3 to 5 minutes to complete.  The amount of sodium thiopental used is between eight and ten times the amount used for medical anaesthesia.

Texas used the three drugs in the following quantities : 120cc of solution containing three grams of sodium thiopental; 50cc of solution containing 100 milligrams of pancuronium bromide, and 70cc of solution containing 140 milliequivalents of potassium chloride. The drugs are administered in this order, sequentially, with intervening saline flushes over a period of approximately five minutes.

All the chemicals used in the USA are standard medical drugs. Sodium thiopental is an ultra short acting barbiturate which was used widely as an anaesthetic and causes unconsciousness very quickly if injected into a vein. Pancuronium bromide (Pavulon) is a muscle relaxant that paralyses the diaphragm and thus arrests breathing whilst potassium chloride finishes the job by causing cardiac arrest. It is used in cardiac surgery to stop the heart.
In most cases, the inmate is unconscious in less than half a minute after the sodium thiopental is administered, it’s effects also wear off rapidly which is why in surgery, once the patient is unconscious, gaseous anaesthetic is used to maintain them in that state.  A British medical journal, The Lancet, published an article critical of lethal injection (Volume 365, 4/16/05) which claimed to have identified 21 cases of execution where the level of post mortem sodium thiopental was below that used in surgery, thus concluding that consciousness during the administration of the other two drugs may have been possible.  However, sodium thiopental is rapidly absorbed by the body fat so any testing should be done as soon as possible after death.  This was done in the case in the execution of Michael Ross in Connecticut in May 2005.  A blood sample was taken 25 minutes after death and showed 29.6 milligrams per litre of thiopental.  A second sample taken some five hours later showed a concentration of 9.4 milligrams per litre. There is no conclusive evidence that an inmate has still been conscious while the second and third drugs were administered.  After death, the inmate’s face may show a bluish tinge that is a typical consequence of respiratory failure as oxygen levels fall in the blood stream.

In the state of Kentucky, condemned inmate Ralph Baze appealed against the use of lethal injection on the grounds that it was a “cruel and unusual punishment” which is therefore unconstitutional under the 8th Amendment.  His case was heard by the Supreme Court on January 7th, 2008.  On Wednesday, April 15th, 2008,  the Supreme Court ruled by a majority of 7-2 that lethal injection does not violate the US Constitution by inflicting cruel and unusual punishment, which cleared the way for executions to resume in 2008.  As a result of the earlier ruling, there were no executions in the US from September 25th, 2007 to May 5th, 2008.  The Supreme Court ordered the release of the Kentucky protocol for lethal injection which can be read here.  Kentucky uses the same three drug cocktail that most other states use and has carried out two executions by injection, both of which appeared to go smoothly. (Eddie Harper in May 1999 and Marco Alan Chapman in 2008).

In some states, a fully automated lethal injection machine has been used that runs off a 12-volt battery. It injects the chemicals in the right order and amount once the catheters are in place. The machine has six syringes activated by mechanical plungers. Three syringes hold the lethal drugs, the other three contain harmless saline solution. Two buttons control the machine, one for the lethal syringes and one for the identical looking harmless ones.
The two executioners each press a button, and the syringes release the drugs into the IV line.

Multiple executions.
In Arkansas in 1994, prison officials citing the disruptive impact of executions on staff and other prisoners and the high cost of "rehearsal time" and overtime pay, took steps to reduce both problems by conducting multiple executions. They carried out two unrelated executions on the night of May the 11th and a further three on August 3rd of that year with 45 minutes interval between them, so that the chamber could be cleared between each prisoner and to allow prison officials time to replace needles and tubes used to administer the injection. The sheet on the gurney was also changed between executions.
Texas has also carried out multiple executions. On the 30th of January 1995, in that state's first multiple execution in 44 years, 33 year old Clifton Russell was put to death just after midnight and Willie Williams, 38, was injected about an hour and a half later. Texas carried out a further double back to back execution in 1997. (Dorsie Johnson-Bey and Davis Losada on June 5th)

Click here to read the first hand account of witnessing a lethal injection execution written by the inmate’s spiritual advisor and published here at his request.

Ohio’s lethal injection protocols.
In the wake of the failed execution of Rommel Broom on September 15th, 2009, Ohio Corrections Department drew up plans to use a single injection of 5 grams of sodium thiopental for future executions.  This amounts to a massive overdose of anaesthetic – 2 ˝ times the amount previously used.  As the other two controversial chemicals are not used, there is no possibility of the inmate being caused physical pain as they drift into coma and death.  Sodium thiopental depresses the heart rate and respiration and at the quantity used, does so sufficiently to cause death. This is the same procedure used in animal euthanasia.  However, in view of the problems with the Broom execution there will be a back up method, where suitable veins cannot be located in the pre-execution assessment.  This will use the intra-muscular injection of two drugs, 10mg of Midazolam and 40mg hydromorphone which will be injected in to the shoulder, thigh or buttock muscles.  After five minutes, the prisoner will be examined by a doctor and if necessary, the process will be repeated.  Midazolam is an ultra short-acting benzodiazepine derivative with powerful anaesthetic properties.  It is used for local anaesthetic, e.g., in dentistry. Hydromorphone is a derivative of morphine and is a strong pain killer.  The first execution using the single dose of sodium thiopental was successfully carried out on Tuesday, December 8, 2009, when Kenneth Biros was executed at the Southern Ohio Correctional Facility in Lucasville, Ohio.  Biros was pronounced dead 43 minutes after the commencement of the process.  It took 10 minutes for the single drug to cause death, some 2-3 minutes longer than is typical for the three drug process.  Reportedly Biros' chest heaved up and down several times, and he moved his head a couple of times over about two minutes before his body became still. Ten executions using this new protocol have been performed without problem up to the end of 2010. Ohio announced on January 25th, 2011 that it too will move to using a single dose of pentobarbital sodium from March 2011, after its supply of sodium thiopental was used up.  The sole FDA approved US manufacturer of pentobarbital, Illinois based Lundbeck Inc. has written to the Ohio Corrections Department protesting the use of their product in executions.  Johnnie Baston became the first person to be executed with a single dose of pentobarbital when he was put to death on March 10th, 2011.  Baston was pronounced dead at 10:30 a.m., about 13 minutes after the 5 gram dose of the drug began flowing. About a minute into the execution he appeared to gasp, then grimace and wince but then was quickly still, according to reporters.  Ohio’s second execution using just pentobarbital took place on the April 12th, 2011 when Clarence Carter was put to death.  Again the process went without a hitch.  Problems locating a vein were encountered during the execution of Daniel Lee Bedford on May 17th.  Ohio’s supply of this was exhausted with the execution of Harry Mitts Jr. in September 2013.

On January 16th, 2014 Ohio executed 53 year old Denis McGuire using two never before tried drugs, midazolam, a sedative (see below), and hydromorphone, a painkiller, due to unavailability of thiopental and pentobarbital sodium.  It took 25 minutes for McGuire to die, the longest time ever recorded.  According to eyewitnesses for the first five minutes he lay motionless and then emitted a loud snort, as if snoring, and continued to make that sound over the next several minutes. He also silently opened and shut his mouth several times as his stomach rose and fell.  A coughing sound was Dennis McGuire’s last apparent movement, at 10:43 a.m. He was pronounced dead 10 minutes later.  McGuire’s family intend to sue the state of Ohio over this.  At a court hearing on January 12, the state’s expert, Dr. Mark Dershwitz, said, “I truly don’t know how many minutes it will take the inmate to stop breathing,” and later, “There is no science to guide me on exactly how long this is going to take.”

The sodium thiopental shortage.
Illinois based Hospira Inc. was the sole US supplier of and suspended production in late 2009 due to problems in obtaining raw materials.  Initially it planned to continue production at its plants in Italy but decided not to resume production of it on January 22nd 2011 after the Italian parliament banned the export of sodium thiopental for lethal injections.  This shortage led to several states having to postpone executions in the fall of 2010 and some states obtaining supplies from outside the US.  Arizona did so for the execution of Jeffrey Landrigan in October 2010. Their supply came from Archimedes Pharma in the UK, the only licensed manufacturer of sodium thiopental in Britain, but the British government banned Archimedes from exporting further supplies of sodium thiopental in November 2010. Several other states, including California, Georgia and Tennessee, managed to beat this ban and obtain supplies too.  Archimedes Pharma’s sales agent, Dream Pharma, a licensed pharmaceutical wholesaler, has apparently exported sufficient thiopental for 90 executions.  Georgia used UK sourced thiopental for the execution of Emanuel Hammond on January 25th 2011 but has since had its supply seized by the DEA as have Kentucky and Tennessee (April 1st 2011).  Three Arizona death row inmates filed a law suit on February 3rd to try and prevent this UK sourced thiopental being used and demanding its withdrawal from all four states which have it. As of January 2011, 17 states do not possess any usable sodium thiopental.  Texas announced in mid March 2011 that it is switching to pentobarbital sodium as the first drug from April 1st. 5 grams of this will be used in place of the previous 3 grams of sodium thiopental.  Nebraska revealed in January 2011 that it has obtained a supply of 500 grams of sodium thiopental from Kayem Pharmaceuticals in India in December 2010 and that it has had tested by an independent US laboratory to ensure that it is usable. Kayem Pharmaceuticals announced in April 2011 that it was no longer willing to supply sodium thiopental to US Corrections Institutions.  Kentucky, California, Maryland and Nebraska are states that have Administrative Procedures Acts requiring any change to their execution protocols to pass through a review procedure and public scrutiny.

Pentobarbital sodium replaces sodium thiopental.
Pentobarbital sodium has been used by Alabama, Arizona, Delaware, Florida, Georgia, Ohio, Mississippi, Oklahoma, South Carolina, Texas and Virginia to replace sodium thiopental as of September 2011.
Pentobarbital (formula
C11H17N2NaO3) (trade name Nembutal, solely manufactured in the US by Lundbeck Inc. in Illinois) is a fast acting barbiturate that causes a rapid slow down in the central and peripheral nervous system activity and in large doses can mimic brain death. This is the drug that vets use to euthanize animals and is also used for human euthanasia.  It was first synthesized in 1928 and is FDA approved.
On December 16th, 2010 Oklahoma executed John David Duty for the murder of his cell mate Curtis Wise.  Due to the problems of obtaining supplies of sodium thiopental, outlined above, Oklahoma decided to use a 5 gram dose of pentobarbital sodium instead, as the first drug administered.  The lethal drugs began to flow at 6:12 p.m., and Duty's breathing became labored one minute later. At 6:15 p.m., he appeared to stop breathing and the color began to drain from his face and he was pronounced dead at 6.18 pm.  There seemed to be no obvious problems to substituting pentobarbital for thiopental and indeed Duty died very quickly.  At the level of overdose used (5 grams) pentobarbital would have been lethal on its own without the other two drugs.  Billy Don Alverson was successfully executed using pentobarbital sodium on January 6th, 2011 and Jeffrey David Matthews followed him on January 12th, again without any apparent problems.  Joseph Paul Franklin was executed in Missouri on 11/20/13 using a single dose of
pentobarbital sodium, becoming the first use of this drug in that state.

Texas’ first execution using pentobarbital was that of Cary Kerr on April 3rd 2011.  The Texas Department of Criminal Justice reported that the first of the three drugs, the pentobarbital, was administered at 6:10 pm, followed by the other two with the injection completed at 6:14 pm. Kerr was pronounced dead at 6:19pm. There were no reported problems. 
On Friday May 6th, South Carolina used the same three drugs for the execution of Jeffrey Motts.  It appeared to take 30 seconds for him to become unconscious and a further 60 seconds to stop breathing.
On May 10th 2011, Mississippi executed Benny Joe Stevens with a three drug cocktail, with Rodney Gray following on May 17th.  Alabama executed Jason Oric Williams on May 19th using a three drug process which appeared to run smoothly.  Arizona used the same three drugs for the execution of Donald Edward Beaty on May 25th. Texas executed Gayland Bradford on June 1st without any problems. A further three executions were carried out in June in Alabama and Texas. 
On June 23rd Georgia became the 8th state to substitute pentobarbital for thiopental when it executed Roy Blankenship.  This execution did not go smoothly and Blankenship took some time to loose consciousness although the reason for this is not known.  Arizona executed Richard Bible on June 30th without problem.  Bible was certified dead 11 minutes after the commencement of the process.
On the same day pentobarbital manufacturer, Lundbeck, announced a ban on supplying the drugs to state Correctional facilities for use in executions. Texas executed Humberto Leal Jr. on July 7th without any apparent difficulty.  He was pronounced dead ten minutes after the injections began. Thomas West was executed in Arizona on July 19th without any problem after a last minute flurry of appeals, centering in part on the use of pentobarbital.  He was pronounced dead four minutes after being declared sedated. The following day Texas executed Mark Stroman. Georgia put Andrew DeYoung to death without apparent problem on July 21st.  This execution was videotaped.  On July 29th Delaware became the 9th state to use pentobarbital when Robert Jackson III was put to death without any apparent problem at the James T. Vaughn Correctional Center in Smyrna.  Virginia joined the list of states using pentobarbital on August 18th for the execution of Jerry Terrell Jackson.  This went smoothly and he was pronounced dead after 6 minutes.  Florida carried out its first execution using pentobarbital on September 28th when Manual Valle was put to death for the murder of a police officer.
Idaho carried out its first execution in 17 years on November 18th 2011 when Paul Ezra Rhoades was given a lethal injection for the rape/murders of two women in 1988.  The execution took 22 minutes according to reports.
The first execution of 2012 was carried out on Gary Roland Welch in Oklahoma on Thursday, January 5th. Arizona used a single dose of Pentobarbital sodium for the execution of Robert Moormann on February 29th, 2012 because it discovered that the supply of one of the other two drugs it intended to use had passed its expiration date.  The execution appeared to go smoothly. 
Robert Charles Towery was similarly executed there on March 8th. On June 12th, Idaho carried out its first execution using a single dose of pentobarbital, that of Richard Leavett. Texas carried out its first single drug execution on July 18th when Yokamon Hearn was put to death for a car jacking murder.  He was certified dead 25 minutes after the injection began.  Texas was no longer able to obtain fresh supplies of pancuronium bromide.  The Virginia Department of Corrections announced in late July 2012 that rocuronium bromide can is to be substituted for pancuronium bromide, as the muscle relaxant. 

Florida becomes the first state to use midazolam hydrochloride.
On October 15th 2013 Florida executed 51 year old William Happ for the rape/murder of Angie Crowley in 1986.
The first chemical injected was 500mg of the sedative midazolam hydrochloride which has never previously been used for an execution.  T
he execution began at 6.02pm. Happ's eyes opened and he blinked several times. He closed them and opened them again two minutes later. He then yawned and his jaw dropped open.  At 6.08pm, a prison official stimulated Happ's eyelids and shook his shoulder to check for a response. There was none.  A minute later, Happ's head began moving back and forth and shortly thereafter he stopped breathing. He was pronounced dead at 6.16pm.  Happ appeared to remain conscious longer and made more body movements after losing consciousness than other people executed using thiopental or pentobarbital.

Midazolam is a short-acting benzodiazepine central nervous system depressant, that is typically used by doctors for sedation and is a water-soluble benzodiazepine.  Midazolam is a white to light yellow crystalline compound, insoluble in water. The hydrochloride salt of midazolam, which is formed in situ, is soluble in aqueous solutions. Chemically, midazolam HCl is 8-chloro-6-(2-fluorophenyl)-1-methyl-4H-imidazo[1,5-a][1,4]benzodiazepine hydrochloride. Midazolam hydrochloride has the molecular formula C18H13CIFN3 HCl.  Darius Kimbrough was executed using the same combination of chemicals in Florida on November 12th.  The injection began at 6:01 p.m. He lay motionless for 17 minutes, when a doctor shined a light in his eyes, placed a stethoscope to his chest and pronounced him dead at 6:18.  There were none of the body movements seen in the Happ execution.

The end of lethal injection in the USA?
On July 1, 2011, Lundbeck Inc.’s parent company in Denmark banned the sale of pentobarbital to state corrections departments through its distributors in the USA and Europe. In a statement it said that it “adamantly opposes the distressing misuse of our product in capital punishment.”
On March 27, 2012, a federal court in Washington, D.C., ordered the FDA to prohibit the import of sodium thiopental because foreign sources had been approved by the FDA. The court ordered the FDA to contact every state that it believes has any foreign manufactured thiopental and instruct them to surrender it to the FDA. It also permanently prohibited the future importat
ion of the drug.  By May 2012 several states (e.g. Missouri, Kansas & Kentucky) do not possess the necessary drugs to carry out an execution and several others will run out of them before the end of 2012, e.g. Oklahoma. In May 2012 Texas disclosed that it had sufficient of all three drugs for a further 23 executions. So it seems that by the end of 2012 states will either have to find a new sedative drug with all the legal challenges that that involves or move to a different method altogether.  Also in May 2012, Missouri announced that it is looking at using propofol (trade name Diprivan, chemical name 2,6-diisopropylphenol, formula C12H18O) instead of pentobarbital for future executions.  This is short acting non-barbiturate drug that is commonly used in anaesthesia.  It was the cause of Michael Jackson’s death.  Gov. Jay Nixon halted Allen Nicklasson's planned October 23 execution following doctor protests along with threats from the anti-death penalty European Union to prevent the drug's export. Nixon ordered the state corrections department to come up with a different lethal injection protocol.  Propofol had been obtained through a U.S. distributor of its manufacturer, Fresenius Kabi in Germany.

Lethal injection in other countries.
Lethal injection is used by China, which is progressively replacing shooting with it, although it is impossible to know how many people have died by this method so far, as execution figures are a state secret there. Guatemala, the Philippines and Thailand have adopted lethal injection as their sole method. Thailand carried out its first executions in December 2003 when four men were put to death in Bang Khwang prison for drug trafficking and murder. Two men were executed there for drug trafficking during 2009. Vietnam is switching to lethal injection in place of shooting by firing squad from July 2011. In May 2012 Vietnam news announced that the country had been unable to source the necessary drugs and had not carried out any executions by injection, despite having more than 400 on death row, 100 of whom had completed their appeals.  A decree that came into force on June 27, 2013 permitted authorities to use Vietnamese made chemicals for executions.  The first execution by lethal injection was carried out August 6, 2013 when 27 year old Nguyen Anh Tuan was put to death in Hanoi for a 2009 robbery/murder.  Vietnam has adopted a three drug protocol using sodium thiopental, pancuronium bromide and potassium chloride.  596 people remain on death row at this date.

The Philippines decided to use lethal injection to replace the electric chair and carried out its first injection execution on the of February 4th, 1999, when Leo Echegaray was put to death for child rape. A further six men have been executed by this method to the end of 2000 but there have been no executions since and the Philippines abolished capital punishment in June 2006.
Guatemala also switched to lethal injection, after a botched firing squad execution in 1996, and has carried out three executions since then. The first occurred on February 10th, 1998, when 42 year Manuel Martinez was put to death for killing four children, their parents and their aunt in 1995 in a dispute over a small plot of land.
On June 29th, 2000, two members of a Guatemalan kidnapping ring were executed in consecutive and televised executions. Amilcar Cetino Perez and Tomas Cerrate Hernandez were members of a notorious kidnap gang believed to be responsible for death threats against the family of President Alfonso Portillo. (
Click here for photo of the execution of Cerrate)

An amendment to China’s Criminal Procedure Law in 1996 allowed for executions by lethal injection.  Kunming, the provincial capital of Yunnan, was the first Chinese city to adopt lethal injection when two unnamed men were executed on March 28th, 1997. Other cities and provinces followed, these being Changsha, Shanghai, Guangzhou, Nanjing, Chongqing, Hangzhou and Shenyang.  The next city to adopt lethal injection was Chengdu from March 1st, 2008.  China's north-eastern province of Liaoning has moved to injection from February 2009. Around half of the 404 Intermediate Peoples’ Courts have now adopted this method.  Beijing will move to lethal injection from the beginning of 2010.
During 2003, China introduced a fleet of mobile execution vehicles, converted from large Iveco vans. The windowless execution chamber at the back contains a metal bed on which the prisoner is strapped down. The executioner presses a button that starts an automatic injection process which can be watched on a video monitor next to the driver's seat and be recorded if required. Efficiency and cost were apparently the main reasons for the introduction of these vehicles, according to Yunnan officials. One was quoted as saying, "With lethal injection, only four people are required to execute the death penalty: one executioner, one forensic doctor, one member of the court and one other official. A dozen guards are also required to keep watch around the van".  It is thought that China uses a single large dose of pentobarbital sodium, administered by a mechanical pump through an IV line and catheter.

Is lethal injection the humane alternative?
Execution by lethal injection takes much longer from start to finish than any other method, typically 20-30 minutes, depending on the execution protocol and ease or otherwise of locating a vein. For the majority of this time, the inmate receiving a lethal injection is fully aware of what is happening to them and able to experience their execution. They know that they will be dead at the end of it and the fear of dying (particularly in front of an audience) and of the unknown, is strong in most of us. It is difficult to see, therefore, how it can be considered more humane, as the prisoner is subjected to far more mental anguish over a much longer period.
It is fair to say that injection is much less dramatic than the electric chair or hanging and probably easier for the staff and witnesses as it looks more like a surgical procedure than an execution. Looking at the Guatemala photo above, it is not obvious that this is an execution, rather than a surgical procedure.  But does it cause the prisoner less suffering overall?
When all goes well, the only physical pain is the insertion of the catheters. If the person's veins are easy to find, this can be done in a minute or so. The catheters are connected to the saline drip and the prisoner is either wheeled into the execution chamber or the curtains drawn back so that they are in full view of the witnesses and journalists. After they have made their final statement, the injection of the lethal chemicals can begin and they may pass almost instantly from full consciousness into unconsciousness or they may feel themselves becoming drowsy and know that they are beginning to die. 
Rogelio Cannady was put to death by lethal injection in Texas on May 19th, 2010.  Just before he became unconscious he told witnesses, “I am going to sleep now. I can feel it - it’s affecting me.”  So he was able to feel something although he did not claim to be in any pain. 
Not everyone is of the opinion that death by lethal injection is painless - Dr. Edward Brunner, chairman of the Department of Anaesthesia at North-Western University Medical School, submitted an affidavit on behalf of death row inmates in Illinois in which he states that lethal injection, "create[s] the substantial risk that prisoners will suffocate or suffer excruciating pain during the three chemical injections but will be prevented by the paralytic agent from communicating their distress."

The problems with injection.
The most common problem seems to be where the needle either misses the vein or passes through it.  Even for trained medical staff, getting a needle into a vein is not always that easy.  I have had it happen to me twice during routine blood work (blood test), where a skilled nurse failed at the first attempt.  This could be easily checked, however, by using a vacuum vial to ensure that blood flows freely after the needle is inserted, as is done when taking a normal blood sample.  Missing the vein appears to be what happened in the case of Angel Nieves Diaz in Florida as described below.
Another problem with lethal injection is the aqueous pressure in the executee's veins. Veins have an internal pressure (blood pressure) which has to be overcome to allow injection into them. A doctor, when giving a normal intravenous (IV) injection, has to equal and then slightly exceed this pressure. If he produces a pressure that is too great, he will rupture the vein. The doctor accomplishes this through his training, fingertip dexterity and experience built up from giving repeated injections. He feels the pressure in the vein against the top of the plunger of the syringe. In the case of a lethal injection, the volume of the fluid required to fill the IV tubes running between the executioner's cubicle and the prisoner, means that the syringes must be of 50-60cc capacity. Syringes of this size are too big to give any real feel to the person administering the injection. Thus, too much pressure can easily be applied and a rupture of the vein may occur. This can happen in the case of giving a non-lethal injection into good healthy veins in a normal person.
It is not unusual for the inmate to be a former intravenous drug abuser, with delicate, collapsed veins that can stand far less overpressure. This is also true of people who are insulin injecting diabetics. When a person with normal veins is frightened, their veins contract and become hard to find.
Before insertion of the catheters, a good vein must be located. It is not unusual for a "cut-down operation" to have to be performed to find a usable (not necessarily suitable) vein. This entails a minor surgical procedure on the arm, leg or groin carried out under local anaesthetic, using a subcutaneously injected dose of Xylocaine or similar local anaesthetic, administered by a technician. The public are seldom made aware of this and the witnesses would not typically see any evidence of it during the execution.

To produce a quick and painless death, it is vital that the chemicals are injected into a vein, rather than an artery. Veins carry blood to the heart and arteries away from the heart. The path of the chemicals (particularly the potassium chloride) should be via the quickest route to the heart so as not to prolong the execution. If an artery is used by mistake, instead of a vein, the blood carrying the chemicals has to go the "long way round" significantly increasing the time taken to stop the heart. The distinction between a vein and an artery is not an easy one to make. Even a doctor can make a mistake! It is clear from reading reports of executions that the time between commencing the injection and certifying death varies a great deal. 

Problematic injections.
As with the introduction of any new method, lethal injection has not been without its problems, some of which are examined below. It is clearly, by no means a foolproof method, but perhaps the learning curve has now been surmounted as reports of problems seem to have greatly reduced.

March 14th, 1984 James Autrey. Texas.
Autrey took at least 10 minutes to die after the chemicals began to be injected. Throughout much of those 10 minutes, he was fully conscious and complained of pain. This was caused by the catheters clogging so delaying the transmission of the chemicals. It is also probable that the needle either did not enter the vein or passed through it. When the lethal chemicals enter the muscles instead, they cause considerable pain.

March 13th, 1985. Stephen Peter Morin. Texas.
Technicians had to probe both arms and legs with needles for 45 minutes before they found the vein.

August 20th, 1986 Randy Woolls. Texas.
A drug addict, Woolls, had to help the execution technicians find a good vein for the execution.

June 24th, 1987 Elliot Johnson. Texas.
It took 35 minutes to insert the catheter into his vein.

December 13th, 1988 Raymond Landry. Texas.
Pronounced dead 40 minutes after being strapped to the execution gurney and 24 minutes after the drugs first started flowing into his arms. Two minutes into the execution, the catheter came out of Landry's vein, spraying the chemicals across the room towards witnesses. The execution team had to reinsert the catheter into the vein. The curtain was closed for 14 minutes so witnesses could not observe the intermission.

May 24th, 1989. Stephen McCoy. Texas.
McCoy had such a violent physical reaction to the drugs (heaving chest, gasping, choking, etc.) that one of the witnesses (male) fainted, crashing into and knocking over another witness. The Texas Attorney General admitted the inmate "seemed to have somewhat stronger reaction," adding, "The drugs might have been administered in a heavier dose or more rapidly."

September 12th, 1990. Charles Walker. Illinois.
According to Dr. Edward A. Brunner, over five minutes after the activation of Illinois's lethal injection machine and more than two minutes after the plungers had injected the chemicals, Walker’s heart had not stopped, the Illinois Department of Corrections officials ordered the viewing blinds closed. The witnesses were not aware that Walker had not died and were not told that there was a problem.
Without removing Walker from the equipment, officials inspected the equipment and discovered a kink in the intravenous line. They straightened out the line, and a short time later Walker's heart stopped.

January 24th, 1992. Rickey Ray Rector. Arkansas.
It took medical staff more than 50 minutes to find a suitable vein in Rector's arm. Witnesses were not permitted to view this scene but reported hearing Rector's loud moans throughout the process. During the ordeal, Rector tried to help the medical personnel find a vein. Attendants were about to prepare a "cut-down," when a vein in his right hand was finally discovered - an hour after the procedure began. The administrator of the Arkansas Department of Corrections medical programs said (paraphrased by a newspaper reporter), "the moans did come as a team of two medical people that had grown to 5 worked on both sides of his body to find a vein."

March 10th, 1992. Robyn Lee Parks. Oklahoma.
Parks had a violent reaction to the drugs. Two minutes after the drugs were administered, the muscles in his jaws, neck, and abdomen began to react spasmodically for approximately 45 seconds. Parks continued to gasp and violently gag. Death came 11 minutes after the drugs were administered. Wayne Greene a reporter on the Tulsa World newspaper described Park's execution as looking "scary and ugly."

April 23rd, 1992. Billy Wayne White. Texas.
It took 47 minutes for the prison staff to find a suitable vein, and White eventually had to help them.

May 7th, 1992. Justin Lee May. Texas.
May had an unusually violent reaction to the lethal drugs. According to Robert Wernsman, a reporter for the Huntsville newspaper, The Item, May gasped, coughed and reared against his heavy leather restraints, coughing once again before his body froze. Associated Press reporter Michael Graczyk wrote, "He went into a coughing spasm, groaned and gasped, lifted his head from the death chamber gurney and would have arched his back if he had not been belted down. After he stopped breathing, his eyes and mouth remained open."

May 10th, 1994. John Wayne Gacy. Illinois.
John Wayne Gacy, who had tortured and murdered 33 young men and boys during the 1970’s, was executed by lethal injection at the Stateville penitentiary in Joliet, Illinois.
After the injection began, one of the three drugs clogged the tube leading into Gacy's arm, and therefore stopped flowing. Blinds covering the window through which witnesses observed the execution were then drawn. The clogged tube was replaced with a new one, the blinds were opened and the execution process resumed. Gacy actually took 18 minutes to die. Anaesthesiologists blamed the problem on the inexperience of prison officials who were conducting the execution, saying that proper procedures would have prevented the error.

May 3rd, 1995. Emmitt Foster. Missouri.
Foster was not pronounced dead until 30 minutes after the flow of chemicals began into his arms. After seven minutes, the blinds were closed to prohibit the witnesses from viewing the scene.  They were not reopened until three minutes after death pronounced. According to the coroner who pronounced death, the problem was caused by the tightness of the leather straps that bound Foster to the execution gurney.  It was so tight that the flow of chemicals into the veins was restricted. It was several minutes after a prison worker finally loosened the strap that death was pronounced. The coroner entered the death chamber 20 minutes after the execution began, noticed the problem, and told the officials to loosen the strap so then the execution could proceed.

May 3rd, 2000. Christina Marie Riggs, Arkansas.
Christina Marie Riggs was the first woman to be executed in the state of Arkansas. The execution began 18 minutes late because of the difficulty in finding a suitable vein to insert the catheters into. She agreed to have the catheters placed in veins in her wrists. It is not unusual for the prisoner to have help staff in this way.

February 5th 2006 Joseph Lewis Clark, Ohio.
Prison staff took 22 minutes to initially insert a single IV line, but Clark's vein collapsed 3-4 minutes later and he raised his head and cried out “It don’t work. It don’t work.” It took the execution team a further half hour to find another vein and he was eventually pronounced dead 90 minutes after the execution had begun.

December 13th, 2006. Angel Nieves Diaz, Florida.
Diaz took 34 minutes to die and required a second injection when the needle went through his vein rather than into it. His arms showed burn marks from the chemicals.

September 15th, 2009 Rommel Broom Ohio.
Technicians spent two hours trying to find a usable vein to inject into before Governor Strickland ordered a stay for Broom.  He was reportedly traumatised by this.  This led to Ohio adopting a single drug injection protocol with a back up procedure of two drugs given intra-muscularly if a vein cannot be found (see above).

Injections on film.
Sharon Stone's, "Last Dance," gives a good insight into what goes on as well as examining many of the issues surrounding capital punishment in a balanced and sensitive way.

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