Leading experts on the use of medical drugs in capital punishment have accused death penalty states of conducting a “failed experiment” with new drug combinations following a recent run of drawn-out executions in which prisoners have shown signs of distress on the gurney.



Some of the country's most prominent authorities on the science of lethal injections have begun publicly to question the use of the sedative midazolam. In particular, doubts are growing about its use in combination with the painkiller hydromorphone.

A concoction of the two drugs was used in this week's execution in Arizona of a convicted double-murderer, Joseph Wood, which took nearly two hours to complete. It was also used in the earlier judicial killing in Ohio of Dennis McGuire, convicted of rape and murder, who gasped for air over the course of 26 minutes.

“There have been two executions using midazolam and hydromorphone, and both have led to problems. That indicates that it's possible that the combination doesn't work. These are failed experiments with this drug combination,” said David Waisel, associate professor of anaesthesia at Harvard medical school who has acted as an expert defence witness in many capital cases. “Given the two recent events it seems irresponsible to continue trying this combination.”

Mark Heath, a Columbia University anaesthesiologist in New York, and also a lethal injection expert, pointed out that of the 12 executions in which midazolam has been deployed, “four did not really go as you'd expect or want”. He said: "The common theme is that in all of them the prisoner seems to go to sleep but keeps moving or breathing for long after you'd expect that to happen.” He added that the use of midazolam was “at this point clearly a failed experiment”.

The experts' warnings add to pressure on the death penalty states that are wrestling with the fallout of recent botched or prolonged executions, most recently that of Wood on Wednesday. Eyewitnesses reported that the prisoner gasped for more than an hour, like “a fish on shore gulping for air”. John McCain, the Arizona senator, said the procedure had been “bollocks-upped” and said it was tantamount to torture – a charge all the more potent because McCain was a victim of torture in Vietnam.

The department of justice is investigating the way executions are carried out. President Obama ordered the review in the wake of the lethal injection of Clayton Lockett in Oklahoma in April, which also involved midazolam, in which he writhed and groaned on the gurney for 43 minutes.

It took so long for Wood to die on Wednesday that his lawyers even tried, one hour into the procedure, to persuade a judge to order it be stopped and Wood resuscitated. The transcript of the phone conversation between Wood's lawyer, a federal judge and Arizona state officials revealed both the primitive medical set-up inside the death chamber and the ignorance of officials about basic medical matters.

Jeffrey Zick, a lawyer with the Arizona attorney general's office, told Judge Neil Wake that “Mr Wood is effectively brain dead.” Asked by the judge whether the prisoner had probes attached to his head to prove that he was brain dead, Zick said no, but insisted that a medically trained individual had observed Wood to be in that condition.

But Waisel, the Harvard professor, told the Guardian that someone who is brain dead will stop breathing unless kept alive on a ventilator. “There is no way anyone could ever look at someone and make that kind of diagnosis. He was still breathing, so he was not brain dead. This is an example where they threw out a term that has a precise medical definition, but they didn't know what it means.”

Other independent experts agreed. “If you are taking breaths, you are not brain dead. Period,” said Dr Chitra Venkat, clinical associate professor of neurology and neurological sciences at Stanford University. “That is not compatible with brain death, at all. In fact, it is not compatible with any form of death.”



Vikrat said that lethal injection is not compatible with declaring someone brain dead because the drug cocktail used in the process is not meant to cause brain death. The drugs used in Arizona are intended to stop someone from breathing, while drugs used in other states are directed at ending cardiac functions.

“To declare somebody brain dead really, you have to go through all these steps and all these checklists to say: 'yes this person has some irreversible, catastrophic structural damage to the brain,' which this person didn’t have," she said. "So you have to have that. You should not be under any influence of heavy sedative drugs, as this person was.”

Brain stem activity and brain death are mutually exclusive, said Dr Robert D Stevens, associate professor at Johns Hopkins University School of Medicine. “Gasping is really just a variance of breathing, and breathing is mediated specifically via the brain stem,” Stevens said. “Any type of breathing, gasping, whatever it is, immediately indicates that the patient is not brain dead.”

Underlining much of the controversy that has engulfed the death penalty in recent months is the shroud of secrecy that many states have thrown around the drugs they use in lethal injections. States, including Arizona, are refusing to divulge who manufactured the drugs in the hope of keeping supply lines open amid a worldwide blockade of the chemicals being sold to corrections departments.

In the case of Arizona, it indicated that its supplies of midazolam and hydromorphone were approved by the US Food and Drug Administration (FDA) but it produced no evidence to that effect. The state also refused to disclose the medical or other qualifications of its execution team.

Lawyers acting on behalf of condemned prisoners have protested that the secrecy exposes the men to potential cruel and unusual punishment – a violation of the eighth amendment of the US constitution. The courts, including the US supreme court, have dismissed the argument so far, but now medical experts are also warning about potentially dire consequences.

“We don't know where the drugs came from, their quality, or whether they were produced in an FDA-approved manufacturing site. That means we don't know the quality or concentration of the drugs, and that could cause the problems we saw in Arizona,” Waisel said.

Waisel expresses no view on whether or not America should practise the death penalty. But he told the Guardian: “If we are going to have the death penalty – one of the most solemn things the state can do – then it has to be done perfectly. If states cannot do it perfectly, then they should not do it.”