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| Oklahoma Death Chamber |
Failed IV line was started by a medical professional whose credentials are a secret under state law.
Clayton Lockett's death took nearly 4 times as long as most Oklahoma executions because a failed IV line started by a medical professional whose credentials remain secret under state law slowly leaked a drug combination that experts had warned could potentially be inhumane, a Tulsa World investigation has found.
When state officials realized what was happening, they technically halted Lockett's execution, but they had no backup drugs to restart the process. Unlike protocols in other death-penalty states, Oklahoma's policy contains few - if any - fail-safes or backup plans in case something goes wrong during an execution.
Gov. Mary Fallin's office knew an hour before Lockett's execution began about complications finding a suitable vein for the injection but left the decision of whether to continue up to prison officials, a spokesman said.
And state officials have not said whose decision it was to use the 3-drug combination in Lockett's execution, which began with an injection of midazalom - a sedative that many medical experts say doesn't qualify as a true anesthetic and could be replaced with more humane options. According to the Department of Corrections policy, the prison's warden "shall have the sole discretion as to which lethal agent will be used for the scheduled execution."
Lockett, 38, reportedly died of a heart attack 43 minutes after his April 29 execution at the Oklahoma State Penitentiary began. Several minutes after a doctor declared him unconscious and executioners had injected 2 other lethal drugs, Lockett writhed, strained and appeared to be in pain on the gurney, lifting his head and mumbling. Officials closed the curtains to media witnesses, cut off the microphone to the execution chamber and shuttled the witnesses out of the building before declaring Lockett dead.
The state of Oklahoma is now investigating his death and reviewing its execution protocol.
While lethal injection is legal in Oklahoma and 31 other states, the Eighth Amendment to the U.S. Constitution bans "cruel and unusual" punishment.
The Oklahoma Court of Criminal Appeals has issued a 6-month stay for Charles Warner, a convicted murderer and rapist who was supposed to be executed immediately after Lockett.
Lockett was sentenced to death for the 1999 killing of Stephanie Neiman, 19, of Perry. Neiman was shot twice, and Lockett ordered an accomplice to bury her in a shallow grave while she was still alive.
The faulty IV
The official timeline of Lockett's execution reported to the governor's office by Department of Corrections Director Robert Patton states a "phlebotomist" searched for arm, leg and foot veins to place the IVs and couldn't find "a viable point" to insert one.
The timeline states the doctor then "went to the groin area," but doesn't say who inserted the IV.
If the state allowed a phlebotomist to either insert or help insert an IV into Clayton Lockett's body to deliver the lethal drugs, it violated its own protocol.
The protocol, updated April 14, states the warden of OSP will recruit a "licensed/certified health care specialist in IV insertion" before the execution. The protocol states the specialist must be an EMT-paramedic "or person with similar qualifications and experience in IV insertion."
In Oklahoma, phlebotomists are unlicensed, unregulated and not trained to insert IVs, according to Karen Holmes, the director of Tulsa Community College's medical lab technology and phlebotomy program.
Alex Weintz, a spokesman for Gov. Mary Fallin, said: "We were told it was a phlebotomist administering the IV."
When the Tulsa World asked DOC officials to verify whether a phlebotomist was present at the execution as Patton's report states, spokesman Jerry Massie said the person was actually an EMT, as required by the protocol.
An Oklahoma law passed in 2011 designed to conceal key facts of its execution procedures prevents anyone from finding out who the medical participants were and what qualifications they may or may not have.
Oklahoma's law states: "The identity of all persons who participate in or administer the execution process and persons who supply the drugs, medical supplies or medical equipment for the execution shall be confidential and shall not be subject to discovery in any civil or criminal proceedings."
It's also unclear when DOC officials became aware that Lockett's execution could be complicated by trouble finding a vein. DOC's protocol requires the prison's medical unit to examine a condemned inmate within 30 days before the execution "for ease of intravenous accessibility for identification purpose that may interfere with or affect the execution process."
It took the prison's medical team nearly an hour to insert the IV, records show.
Weintz said the governor's legal staff "is more or less on speaker phone in the run up to the execution ... so the governor's office was aware that there were issues finding a vein."
"We were also aware of course that he had tried to cut himself earlier in the day. As you would expect, we defer to the medical and corrections professionals," he said.
State officials chose to proceed with Lockett's execution and insert the IV into a femoral vein in the groin area instead, a procedure more complicated than traditional IVs.
The April 29 botched execution is not the 1st time Patton has been questioned about such problems.
As part of a lawsuit brought by death-row inmates in Arizona's prison system, where Patton worked before he came to Oklahoma, Patton acknowledged that a member of the prison's execution team lacked qualifications related to IV placement. He said in a 2011 deposition that he never checked to determine whether any execution team members had experience placing femoral IVs, a requirement of the Arizona prison system's protocol.
Patton was division director of operations at the time and responsible for planning and directing all execution-related activities.
An expert who reviewed medical records of 5 executed inmates testified that four of the IVs were improperly placed in the femoral vein.
The Arizona prison's medical team leader explained in his deposition that "with each execution we were learning probably a little bit more about the natural course of performing the execution."
Dr. Jay Chapman, a former Oklahoma state medical examiner who developed the state's first execution protocol, said he doubted DOC's initial explanation that Lockett's vein "exploded."
"From reading the media and of course having no first-hand knowledge, it appears that the line was not well placed. It was not an intravenous ... The drugs that were injected infiltrated into the tissues around the vein and of course this would cause pain."
While acknowledging the need for an investigation, Fallin has pushed back at criticism of the state following the botched execution.
"The people of Oklahoma do not have blood on their hands," she wrote in a monthly column distributed by her office. "They saw Clayton Lockett for what he was: evil. His execution means he will never again harm or terrorize another person."
A unique cocktail
Oklahoma used 3 drugs in Lockett's execution: midazolam, vecuronium bromide and potassium chloride.
State officials consulted no experts in developing the recipe for this new lethal drug cocktail, relying mainly on legal research to come up with a method experts in the field have predicted would fail.
Used as the 1st drug in place of barbiturates the state had relied on for decades, the sedative midazolam would likely not render inmates unconscious, especially when executioners delivered the second and third drugs, experts testified in a recent Florida case.
It would be akin to injecting "liquid fire" into the inmate, said one expert who testified in the Florida case.
The Florida suit was brought by an inmate challenging use of midazolam in that state's executions.
Testimony from the case has been cited by Oklahoma's Attorney General in defending the new protocol. Florida, the only other state using midazolam as the 1st drug in its executions, uses 5 times more of the drug than Oklahoma does.
Experts in the case also warned that the drug poses a troubling side effect - called a "paradoxical reaction" -demonstrated in numerous studies in people with a history of aggressiveness and impulse control problems. Instead of sedating such patients, midazolam made them react violently.
In addition to Lockett's execution, there have been reports in other states of problems during executions with midazolam.
In 2013, witnesses reported Florida inmate William Happ did not close his eyes for 10 minutes after the drug was administered and then began moving his head.
In January, Ohio inmate Dennis McGuire's death took more than 25 minutes. Witnesses said McGuire was gasping and snorting during the process.
The same Massachusetts expert touted in Oklahoma by Attorney General Scott Pruitt -- Dr. Mark Dershwitz -- had testified in Ohio that McGuire wouldn't feel pain and possibly would feel "euphoria."
A 2008 case known as Baze v. Rees prompted the U.S. Supreme Court's most significant ruling regarding lethal injection protocol in recent years. The justices ruled that Kentucky could legally execute the inmate in that case but stated plainly: If the 1st of 3 drugs failed to render an inmate unconscious, it was "uncontested" there was a "substantial, constitutionally unacceptable risk" of suffocation and pain from the 2 drugs that followed.
Due to what state officials deemed a "collapsed vein" or failed IV insertion, no one knows yet how much midazolam Lockett received.
At least 10 minutes after the drug had supposedly rendered him unconscious, Lockett was able to speak, lift his head and shoulders off the gurney and he writhed for 3 minutes, according to witnesses.
The vecuronium bromide, in theory, should have acted as a paralytic and slowed his breathing, experts said. But it had already been administered when he was seen straining and was heard saying "man" in the execution chamber.
The potassium chloride -- which interferes with the electrical signals of the body to stop the heart and is severely painful without an anesthetic -- apparently worked as it was supposed to.
Craig Stevens, a professor of pharmacology at Oklahoma State University Center for Health Sciences, questions why the state chose midazolam as the initial drug and didn't consult any experts in pharmacology or anesthesiology in developing its plan.
"Midazolam has no analgesic properties. It's a whole different drug class than sodium thiopental or barbiturates," Stevens said.
Barbiturates can technically be called anesthetics; midazolam cannot, he said. It's a benzodiazepine with amnesic effects, so it can sedate someone and erase their memory of the event, but wouldn't necessarily block pain, Stevens said.
And because the condemned inmate is then given a muscle paralyzer, it would also mask signs the sedative may not be working as it should, he said.
If an inmate was given doses of vecuronium bromide and potassium chloride without a proper dose of an anesthetic drug, it would be a "horrific" way to die, Stevens said.
OSP Warden Anita Trammell, in an affidavit signed the day of Lockett's execution, called midazolam an "anesthetic" and stated: "Both I and the physician in attendance will monitor the inmates to be satisfied the inmates are sufficiently unconscious before the final two drugs are administered."
Legal questions
Lockett wasn't supposed to be the only man Oklahoma executed on April 29.
Warner, sentenced to die for the 1997 rape and murder of an 11-month-old Oklahoma City girl, had been prepped for the execution chamber and fed his requested last meal. After Lockett's execution went so wrong, Patton requested a stay of Warner's execution for 14 days.
Attorneys for Lockett and Warner repeatedly raised the issue of the execution drug dosages in various court filings before April 29. At one point, DOC officials even revised the protocol "to correct the dosages to ensure that Plaintiffs receive the appropriate amount of drugs," court records show.
The Attorney General's Office insisted in court filings it had "fully and adequately produced relevant information concerning the drugs used for Plaintiff's executions."
Officials at DOC and the Attorney General's Office have repeatedly declined to explain why they chose a dose of midazolam that is 5 times less than what Florida uses in executions.
Diane Clay, a spokeswoman for Pruitt, said the office defends legal challenges to the state's execution protocol and "it's up to DOC to write the protocol."
DOC referred questions about the execution to the Department of Public Safety, which is conducting the investigation. A DPS spokesman did not provide answers to the World's questions.
Source: Tulsa World, May 11, 2014
