Pain, lethal-injection drug gauged; expert witnesses for 18 death-row inmates in Arkansas testify

Echoing testimony from a pharmacologist earlier in the week, a Seattle anesthesiologist testified Friday that midazolam -- the first drug used in Arkansas' three-drug lethal-injection protocol -- has no pain-relieving properties and cannot block an inmate from feeling the pain that is likely to follow with the injection of the remaining drugs.

Dr. Gail Van Norman, an expert witness for 18 Arkansas death-row inmates who contend the state protocol violates their Eighth Amendment right to be free from cruel and unusual punishment, was one of 15 witnesses to testify so far -- two by deposition only -- in a trial that began Monday.

U.S. District Judge Kristine Baker is expected to conclude testimony late next week and later issue a written ruling on whether to grant a permanent injunction barring the procedure. In 2017, she issued a preliminary injunction to that effect, temporarily stalling the executions of several inmates, but she was later overturned by the 8th U.S Circuit Court of Appeals in St. Louis.

Baker is being asked to decide whether the drug produces sufficient clinical effects to render patients unable to feel the effects of the second and third drugs, vecuronium bromide and potassium chloride. The inmates' attorneys say the injection of the latter drug, which stops the heart, is the equivalent of being "burned alive."

Van Norman said the only reason midazolam is listed as an anesthetic drug in Miller's Anesthesia, an authoritative text on providing pain relief during and after surgery, is because "it is one of many drugs used in the course of anesthesia," but never by itself.

"I never give that drug in isolation," said the doctor who has participated in 19,000 to 21,000 anesthesia-related procedures in her 35 years of practice and is a professor of anesthesia and pain medicine at the University of Washington.

Van Norman also confirmed that "there is a very strong consensus" in the medical community that "a ceiling effect" exists with midazolam. A ceiling effect occurs when, after a certain dose, the drug stops providing any additional relief. A problem with midazolam, she said, is that the amount of the drug that must be ingested before the ceiling effect is reached varies from person to person.

She said it is believed to be the equivalent of about 50 mg for a 200-pound man. Arkansas' protocol calls for a 500 mg dose of the sedative.

On Wednesday, Dr. Craig Stevens, a professor of pharmacology at Oklahoma State University in Tulsa, testified that the chemical structure of midazolam prevents it from sedating anyone so deeply that the person cannot feel pain. In fact, he said, the class of drugs that includes midazolam -- benzodiazepines -- cannot sedate anyone deeply enough to put them into a state of anesthesia, an unconscious state that renders the person unaware and unable to feel pain.

Part of what an army of attorneys for the inmates hope to show to win their case is that there are other methods of carrying out death sentences that are readily available to the state Department of Correction.

To that end, they also presented testimony Friday from Dr. James Williams, an emergency medicine doctor from Corpus Christi, Texas, who said the use of a firing squad would be more humane.

His testimony followed the reading-in of depositions taken from officials at the Utah Department of Correction, which has facilities that will accommodate either lethal injection or execution by firing squad. Before hearing that testimony, Baker briefly closed the courtroom to the public to allow the inmates' attorneys to present photographs of Utah's execution chamber that the attorneys said were made available only on the condition that they remain confidential.

In 2010, the state of Utah used a firing squad to execute prisoner Ronnie Lee Gardner, who was allowed to choose between that and lethal injection. It was the last time a firing squad has been used, but in 2015, Gov. Gary Herbert signed legislation allowing it as a backup option when there is a shortage of lethal-injection drugs. It is the only state in the nation that authorizes execution by firing squad.

Williams didn't witness Gardner's execution, but described how it was carried out after the condemned man was strapped into a chair, his head covered with a hood, and a bright orange, 4-inch target placed on his jumpsuit, to indicate the location of his heart. He said that from 7 yards away, at the warden's command, five marksmen simultaneously fired .30-caliber rifles, one of which was loaded with blanks so no one would know who fired the bullets.

Williams, who said he has treated "hundreds and hundreds" of gunshot victims, is also a competitive shooter who is classified as a marksman by several organizations. He said he teaches law enforcement officers "how to neutralize their opponents quickly," with an understanding of "human dynamics and anatomy."

He said he was accidentally shot "by a very powerful blow to the chest" by a drunken friend many years ago, when he was 18, and experienced what he has since learned that the chest isn't as sensitive to pain as other parts of the body. He testified that someone shot by an accurate marksman is likely to feel only a numbing sensation and will die too quickly to experience any significant pain.

In an execution by firing squad, he said, bullets that strike the "cardiovascular complex" induce lethal cardiac arrhythmia and cause the brain to lose all organized function within seven to 10 seconds, rendering the person unconscious. He said death is guaranteed "much more quickly" when bullets are fired simultaneously from five rifles, greatly reducing the possibility of suffering caused by being shot outside the target area.

"There's not a lot of pain fibers in the chest and torso," he said. "Gunshot wounds to the chest aren't generally painful immediately."

Williams said the procedure was similar to firing squads once used by the U.S. military. He noted that firing squads "have been in use ... at least since the middle of the 16th century."

Under cross-examination by Assistant Attorney General Ka Tina Guest, Williams agreed that he can't say that an execution by firing squad would be pain-free. He also agreed that Gardner's face was covered by a hood, so observers couldn't see if he grimaced, cried or otherwise made expressions indicating he felt pain.

He agreed that if the inmate wasn't shot within the 4-inch target, he would be "unlikely to die immediately" and "possibly, yes," would be in pain.

Metro on 04/27/2019