As the sun began to set over the prayer vigil outside Tennessee’s Riverbend Maximum Security Institution, where 68-year-old Don Johnson was about to die, another execution was underway some 400 miles south of Nashville. “I would like to thank Jesus for everything he’s done for me,” Michael Brandon Samra said as he lay on the gurney in Atmore, Alabama. “I want to thank Jesus for shedding his blood for my sins. Thank you for your grace, Jesus. Amen.” Samra was strapped down and wrapped in a tight white blanket covering his feet. His execution had been scheduled for 6 p.m. on May 16, but for reasons no one explained, it did not start for more than an hour. “At 7:15 p.m.,” a media witness later wrote for the Montgomery Advertiser, “his chest heaved three times in quick succession. After, his breathing appeared significantly labored, with his head slightly jerking with each breath for the next minute.” A consciousness check was conducted at 7:17 p.m.; Samra did not appear to respond. But around 7:19 p.m., another reporter observed, “he stretched both hands and slightly raised his left arm, then curled his fingers and dropped his arm.” Eventually he went still, and the curtain closed. Samra was declared dead at 7:33 p.m.

Photo: Alabama Department of Corrections via AP

Samra, who was sent to death row for his role in a 1997 quadruple murder, was executed using the same lethal injection protocol used in Tennessee: a 500-milligram dose of midazolam, meant to provide anesthesia, followed by a paralytic that stops respiration, and then potassium chloride to stop the heart. For years defense attorneys and medical experts have warned that midazolam — a sedative often paired with an opioid during minor surgeries — is incapable of rendering a person insensate for the purpose of lethal injection, no matter how high the dose. Without sufficient anesthesia, the second and third drugs are known to be excruciating, creating a sense of suffocation and burning that has been labeled torture. One sign that anesthesia has not been properly administered is unusual movement on the gurney — a phenomenon as old as lethal injection itself. But in recent years, autopsies of people executed using midazolam have shown additional red flags: heavy lungs filled with bloody, frothy fluid, a sign of pulmonary edema. This evidence was first presented at a trial in Nashville last summer, in which lawyers with the Tennessee Federal Public Defender unsuccessfully challenged the state’s protocol as cruel and unusual punishment. One veteran pharmacologist, responsible for early clinical trials of midazolam, testified that a 500-miligram dose of the acidic drug would rapidly destroy pulmonary capillaries and lung tissues upon injection, allowing liquid to fill the lungs and resulting in a sense of terror and drowning. Despite losing in court, the lawyers’ argument has been bolstered since then. Eyewitness accounts of Billy Ray Irick’s execution at Riverbend in August 2018 led a medical expert to conclude that he had died a tortuous death. Although a court blocked an autopsy from being conducted on Irick due to his religious beliefs, an autopsy of an Ohio man executed using midazolam that same summer revealed “significant abnormalities” in the lungs of the deceased, including a mix of blood and frothy fluid. The mounting evidence against midazolam was so alarming that Ohio Gov. Mike DeWine put executions on hold and called for a new protocol. Nevertheless, Tennessee and Alabama have forged ahead. As Samra took his last breaths inside the Atmore death chamber last week, those standing in the field in Nashville checked their phones, seeking word about Johnson. “Is he gone?” one woman whispered tearfully as she joined the vigil around 7:30 p.m. “We don’t know,” her friend answered. Many people there that evening had known Johnson for years, describing him as a deeply devout man who had transformed into a spiritual leader on death row. While it remained mostly unspoken, the knowledge that he could suffer loomed heavily. Ohio-based activist Abe Bonowitz of Death Penalty Action had spent the last few days alongside local organizers and faith leaders, including Jeannie Alexander, the former chaplain at Riverbend. They urged Tennessee Gov. Bill Lee to show mercy, stressing Johnson’s positive influence on death row and his relationship with his stepdaughter, Cynthia Vaughn. Johnson had been convicted of killing Vaughn’s mother. Despite years supporting his sentence, she had since forgiven him and pleaded for his life. After Lee announced he would not intervene, activists met at Nashville’s Legislative Plaza. In single file, they crossed the street to the Tennessee state Capitol, carrying a large poster featuring Don Johnson’s face and below it a quote from the Bible: “I was in prison and you visited me.” The hope was that Lee, who ran on a platform of criminal justice reform and Christian values, might consider meeting and praying with Johnson. But the group was turned away from his office without a response.

Left/Top: Former prison chaplain Jeannie Alexander addresses the vigil for Don Johnson outside of Riverbend Maximum Security Institution on May 16. Right/Bottom:Death penalty opponents embrace after Don Johnson is declared dead on the evening of May 16. Behind them is fruit juice and bread used for communion during the vigil.Photos: Liliana Segura/The Intercept

Bonowitz was addressing the crowd in the field when the word came from the prison that the execution was complete. He paused, and Alexander announced: “Don was declared dead at 7:37 p.m.” Soon afterward, media witnesses approached a podium in a nearby parking lot. One after another, they shared what they had seen and heard in the execution chamber. After the drugs began to flow, Johnson sang hymns, eventually falling unconscious. But his breathing appeared labored; different witnesses described it as “snoring” or “slurping” or “gasping.” After a consciousness check — and a signal that the execution could continue — Johnson emitted a sharp “sort of high-pitched ‘ah’ noise,” as one reporter put it. Another “counted 33 of whatever that was — a snoring, or a gurgle or a gasp” before the consciousness check, and 28 afterwards. It was starkly different from executions she had witnessed many years ago, using a previous protocol, and which had been carried out without obvious signs of movement by the condemned. “There was quite a bit of noise coming from Don Johnson lasting for quite a bit of time,” she said. When Federal Public Defender Kelley Henry approached the microphone, she was firm: the midazolam had failed to provide anesthesia, just as expected. While heavy straps kept Johnson tied to the gurney — and his hands were bound with what appeared to be athletic tape — “I believe that he felt the sensation of being buried alive from the paralytic,” she said. “And I believe that he felt the sensation of liquid fire from the potassium chloride.” The gurgling and gasping was the sound of her client experiencing pulmonary edema, she said. But it would take an autopsy to be more certain. The Machinery of Death On the morning after the executions in Tennessee and Alabama, the Montgomery-based Equal Justice Initiative raised alarm over Samra’s death on its website, describing it as “the latest in a series of problematic attempts to execute people by lethal injection.” Among the other examples it listed was the 2017 execution of Kenneth Williams in Arkansas, who “violently lurched forward about three minutes after drugs were injected and continued to convulse about 20 times.” Samra’s movement on the gurney was mild compared to what occurred during executions like Williams’s. But that did not mean all had gone smoothly. As anesthesiologist David Lubarsky wrote following the Irick execution, “a trained observer knows that if a patient moves his fingers or hands, that is a clear indicator that they are not anesthetized.” Curling of the fingers, as seen in Samra’s case, was just the kind of red flag Tennessee seemed intent on concealing.

But even if Samra’s death had been more dramatic, there is no reason to think the state would have acknowledged it. In Alabama and other states, the routine response to seemingly botched executions has been blunt denial. I was in the press room at the Arkansas prison where Williams was killed in 2017, the last of four executions carried out in a rush before the state’s stash of midazolam expired. No sooner had the media witnesses described what appeared to be lurching, gasping, and striving for breath than a governments spokesperson announced that, in fact, all had gone perfectly well. The state maintained the same stance at a recent federal trial over Arkansas’ lethal injection protocol, in which experts gave dueling testimony over what exactly Williams could or could not feel before he died. Eyewitnesses to his execution and others carried out with midazolam took the stand to describe what they saw that night. Such accounts are “critically important,” as anesthesiologist Joel Zivot has told me. “The problem, of course, is that executions in America are curated events, and so the witness doesn’t really get to see what’s really happening.” Indeed, among the critical pieces of context that are withheld from witnesses is any information about when exactly the state is administering the different drugs, making it almost impossible for witnesses to gauge what is occurring. “The state reports in great detail about the amount of pepper on the fried chicken on the last meal,” Zivot says wryly. But “as soon as you get into the execution part, the state record turns into something akin to an impressionist painting. Brushstrokes from a distance.” The result is an incomplete record, he says. “So what remains? Certainly the executed person can’t comment. The witnesses can’t tell. And so, we have to look to the body itself. And here the autopsy reveals, I think unambiguously, the truth of lethal injection.” In the case of Williams, there was evidence of blood-tinged fluid in his respiratory passages, as noted by pathologist Mark Edgar, who has studied all the available autopsies of people executed with midazolam. He concluded that Williams “developed acute pulmonary edema during his execution, which is further supported by the eyewitness accounts.”

Photo: Courtesy of Federal Public Defender Kelley Henry