Recent failures by states to properly insert intravenous lines during executions have brought increased scrutiny to the most widely used death penalty method in the United States. Problems in Arizona and elsewhere last week exposed cracks in what critics of lethal injection call a “veneer of medicalization.”
In Arizona, which resumed the death penalty this year after an eight-year hiatus, corrections officials have struggled to set IV lines during all three lethal recent lethal injections, resorting to inserting a catheter in the condemned man's femoral vein on two of those occasions.
Attorneys for Clarence Dixon, who was executed on May 11, said it took 40 minutes to insert IVs into his body. Dixon's execution team resorted to inserting an IV line into his femoral vein, which caused him to experience pain, and resulted in a "fair amount of blood," according to media witnesses.
The execution team for the June 8 execution of Frank Atwood also struggled to insert IVs, prompting technicians to consider the femoral vein also. However, Atwood asked the team to try his arms again, eventually guiding them to successfully make the insertion into one of his hands.
And last Wednesday, Murray Hooper turned and asked the viewing gallery, “Can you believe this?” as the execution team tried and failed repeatedly to insert IVs in his arms before inserting a catheter into his femoral vein.
In Texas later the same day, a prison spokesperson said the execution of Stephen Barbee was prolonged because Barbee is physically unable to straighten his arms, something his attorneys had warned about in court. Prison officials ended up inserting IVs in Barbee’s hand and neck, according to the Texas Tribune.
The next day in Alabama, corrections officials failed for the second time in a row to place IV lines in a condemned prisoner, which resulted in the execution of Kenneth Eugene Smith being postponed. The Montgomery Advertiser reported the execution team tried to find a vein on Smith for “about an hour” before giving up.
Alabama called off the execution of Alan Eugene Miller for the same reason two months earlier. On Monday, Alabama Governor halted Kay Ivey halted all executions in the state, calling for a “top-to-bottom” review of the process.
Arizona Department of Corrections execution protocols says members of the execution IV team “shall be currently certified or licensed within the United States to place IV lines.”
Additionally, “A femoral central line shall only be used if the person inserting the line is currently qualified by experience, training, certification or licensure within the United States to insert a femoral central line.”
Medical experts say no such certification or license exists.
The American Medical Association’s Code of Medical Ethics directs physicians to not participate in executions. This means corrections departments often rely on training members of their staff to serve on execution teams.
Retired corrections Officer Jim Klein, who participated in 15 lethal injection executions, told The Republic he and other members of execution teams in the 1990s had absolutely no experience in administering IVs. Klein said a medical consultant taught them to practice on a prosthetic arm before eventually practicing on one another.
“Well-trained medical personnel generally do not want to be involved in executions, because they've taken an oath to do no harm,” said Ngozi Ndulue, the deputy director of the Death Penalty Information Center. “So we shouldn't be surprised when people without proper training are not able to successfully complete these IV insertions without going to fairly extreme measures.”
Those who do work in medicine say the continued failures by corrections departments show they have likely not been able to recruit execution team members with much experience. Medical experts told The Republic it can take up to a month to train someone on proper IV insertion.
According to Arizona Department of Corrections protocols, IV team members are only required to go through one training session before an execution.
“It sounds like these folks don’t know what they’re doing if they're having to poke around all over the place to find a vein,” said Dr. Nathan Laufer, medical director at Heart & Vascular Center of Arizona. “Anybody with any kind of medical training should be able to start an intravenous line in the arm.”
A review performed by Frank Atwood’s attorneys of 14 previous lethal injections in Arizona before Clarence Dixon’s found the total IV insertion time ranged from 7 minutes to 54 minutes, with a median time of 23 minutes.Laufer said the repeated use of the femoral central line is another red flag.
“It really should not get to that point,” he said. “I think that's almost an act of desperation.”
The Arizona Department of Corrections Friday declined to answer questions about its execution process, or the recent struggles with IV insertion, claiming the information was protected under state law. The Arizona Attorney General's Office and Maricopa County Attorney's Office did not respond to requests for comment.
Attorney Joseph Perkovich watched in disbelief as his client, Frank Atwood, guided his executioners through the IV insertion process at the Florence state prison in Arizona in June.
He says the secrecy shrouding the qualifications of executioners obstructs the ability to verify their fitness for the task.
“The premise that these participants must be shielded for their safety has no factual basis,” Perkovich said. “It is manufactured to avoid accountability. Arizona's humiliation and butchery of its condemned betrays the pretense of dignity in using medical paraphernalia to kill.”
Texas and Alabama do not allow witnesses to view the IV insertion portion of executions.
But Arizona was forced to allow witnesses to see the whole execution process, beginning from the time the prisoner enters the execution chamber, after a federal court judge ruled in favor of The Arizona Republic and other media outlets who sued for access in 2016.
Media and constitutional law attorney David Bodney said witnessing the entirety of executions is of paramount importance.
“The public has a right to monitor those activities, to scrutinize them, to bear witness, and ensure that the process is consistent with the people's will,” Bodney said.
The Death Penalty Information Center, which Ndulue is the deputy director of, is a Washington, D.C.-based nonprofit that publicizes studies related to the death penalty. She said the secrecy around lethal injection executions and the people who conduct them increases the likelihood of more procedural problems.
“A review of protocols and personnel training would be a logical next step,” she said. “But the entities in charge of that information are not willing to admit there are problems occurring here. The layers of secrecy and denial really limit the remedies.”
“The veneer of medicalization is not holding up,” Ndulue said. “Lethal injection isn’t a medical procedure - it’s an execution.”
Cassandra Stubbs, project director of the Capital Punishment Project at the ACLU, said while states’ recent struggles to carry out executions amount to cruel and unusual punishment, there are more problems with the lethal injection process than failing to access veins.
“We’ve seen attempts to try different drugs, methods and protocols in recent years, and we’re continuing to see major problems with botched executions,” she said. “States continue to conduct executions in ways that are torturous and incompatible with the Eighth Amendment’s bar against punishments that pose a substantial risk of severe pain.
Stubbs said The Eighth Amendment prohibits cruel and inhumane punishments that pose a risk of “superadded terror, pain, or disgrace.”
"The use of methods that leave prisoners writhing in excruciating pain, often strapped for hours to a gurney, is terrorizing and crosses the bounds of human decency," she said.
Perhaps more troubling, Stubss says we have entered an unusual new chapter of the death penalty where condemned people who win stays of execution are being sent to the death chamber after a shadow docket ruling from the Supreme Court. The shadow docket is normally used for procedural matters that do not receive a thorough briefing or a hearing.
“So many of these recent botched executions came after a federal court of appeals court had upheld a stay and said ‘You know what, there are some real problems here.’” Stubbs said. “Because the lawyers were saying, ‘Look, they're not gonna be able to find a vein, there are all these problems. There should be a trial here. There should be some discovery. There should be some court process.’”
“The federal courts say, ‘Yes, we need to look at this, we're going to stop execution.’ And then the Supreme Court just wipes it out without, but they don’t say why,” Stubbs said. “So if the Supreme Court can't be counted on to uphold the Constitution, we're going to need to turn to the states and we're going to need to turn to the department of corrections.”
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This article originally appeared on Arizona Republic: Arizona and others under scrutiny for recent lethal injection failures