Lethal injection.

Lethal injection is now virtually the universal method of execution in the United States, with all but one of the 527 executions carried out there during 2009 being by this method. Of the 1,188 executions in the US to the end of 2009, 1016 have been by lethal injection, including those of 9 women. The 1000th lethal injection in the US was carried out on 21st July 2009 at the Southern Ohio Correctional Facility in Lucasville on multiple murderer Marvallous Keene.
Lethal injection is also 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 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 4 men were put to death in Bang Khwang prison for drug trafficking and murder. Two men were executed here for drug trafficking during 2009.
Three men were executed in Taiwan during 2005 which has also adopted lethal injection.

Lethal injection was first considered as a means of execution 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 6 grains of Morphine. The idea did not catch on and New York introduced the electric chair instead.

The British Royal Commission on Capital Punishment (1948-1953) examined lethal injection but decided against it, partly due to pressure from the BMA, who were concerned about the ethics of doctors participating in executions.

A three drug lethal injection protocol was proposed for use in Oklahoma by Chief Medical Examiner 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, replacing the state’s electric chair which was derelict. 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," Deutsch 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, Texas 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.

Thirty five American states now use lethal injection 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, Illinois, 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. Alabama offered lethal injection as an option to electrocution from July 1st, 2002. Texas has carried out the majority of lethal injections in the US. 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 in Walla Walla prison in Washington are carried out in the area under the trapdoors of the gallows.

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 the 10th of February 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 the 29th of June 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 an option to shooting. Kunming, the provincial capital of Yunnan, was the first Chinese city to adopt lethal injection in 1997, followed by Changsha, Beijing, Shanghai, Guangzhou, Nanjing, Chongqing, Hangzhou and Shenyang. The next city to follow this trend 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".

US Federal 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 5 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 5 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.
A prisoner found guilty after 1994 of a federal capital crime (of which there are now over 60), in states that do not allow for lethal injection as a method of execution, cannot legally be executed in Terre Haute. For those prisoners, the federal government will "contract out" the executions and they will use that state's normal method.

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 6 or 7 inmates.

Typical American 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 10ml of a Heperin solution, to prevent clots forming inside the catheter, then a 1,000 ml bag of saline solution is connected to the catheter ends and the prisoner 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 person 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 grams of Sodium thiopental in 80cc of aqueous solution, 50 mg of Pavulon (the generic name for Pancuronium bromide) and of 100 MEQ potassium chloride in 50 cc 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.

All the chemicals used in America are standard medical drugs. Sodium thiopental is a short acting barbiturate which is used widely as an anaesthetic and causes unconsciousness very quickly if injected into a vein. 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 prisoner is unconscious in less than a minute after the Sodium thiopental has been injected and is dead in around 8 minutes, with no obvious signs of physical suffering. Since October 2003, concerns have surfaced in American appeal courts about the use of Pancuronium bromide, which due to its paralysing effects, could mask a prisoner’s suffering if they have not been rendered fully unconscious by the Sodium thiopental. The execution of Angel Nieves Diaz in Florida on the 13th of December 2006 was badly botched as the needle was found to have gone through his vein causing the chemicals to go into his arm muscles and taking him 34 minutes to die. A second injection had to be given to kill him and chemical burns were observed on his arm by the medical examiner afterwards. State Governor Jeb Bush has suspended further executions in Florida which resumed executions in 2008 and carried out two. Executions remain suspended in California and Missouri with legal challenges being mounted in several other states against their lethal injection protocols. In the state of Kentucky, condemned prisoner Ralph Baze, successfully 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 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 6 syringes activated by mechanical plungers. Three syringes hold the lethal drugs, the other 3 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.

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

Ohio’s new lethal injection protocol.
In the wake of the failed execution of Rommel Broom on September 15th 2009, Ohio Corrections Department have drawn 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 ½ 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. 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 5 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 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.

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 3 on August the 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 injection in 1997. (Dorsie Johnson-Bey and Davis Losada on the 5th of June)

Is lethal injection the humane alternative?
Execution by lethal injection takes much longer from start to finish than any other method, typically 30-45 minutes depending on the execution protocol and ease or otherwise of locating a vein. In the U.K., a hanging took around 15 seconds to carry out in the later part of the 20th century. For the majority of this time, the condemned person 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 suffering (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 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 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 wheeled into the execution chamber where 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.
In modern hanging, they are alive one second and unconscious the next (if everything goes to plan). It is unlikely that they feel themselves slipping into death.

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." It is notable also that Albert Pierrepoint, who was one of Britain's most prolific hangmen and who witnessed an early lethal injection execution, considered that the process was "sadistic," mainly due to the length of time it took to render the prisoner unconscious.

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 missed 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 above.
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 50-60 cc 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 the good healthy veins in a normal person.
It is not unusual for the condemned prisoner 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 medical 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 some seriously botched executions, 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 5 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 3 lethal 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 taught in IV 101 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 7 minutes, the blinds were closed to prohibit the witnesses from viewing the scene. They were not reopened until 3 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 were initially able to insert a single IV line, but Clark's vein collapsed, delaying the execution for an hour while new lines were attached.

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. Ohio has now adopted a single drug injection protocol with a back up procedure of two drugs given intra-muscularly if a vein cannot be found.

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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