FAQ: Why Arizona executions face scrutiny
PHOENIX — Even before convicted murderer Joseph Rudolph Wood was strapped to a gurney and the state of Arizona's executioner ran intravenous lines into his arms, the drug used to kill him in an unusually drawn-out execution, midazolam, had proven controversial.
A federal judge had termed earlier executions in which it was used as "flawed."
From the time the drugs started flowing, it took Wood almost two hours to die. Witnesses watched as he gasped and snored for much of that time.
Execution by other lethal-injection drugs usually takes about 10 minutes.
But those drugs are no longer available.
State officials, from Department of Corrections Director Charles Ryan to Gov. Jan Brewer, insist that the execution was not botched.
But what happened and why are still under review by Corrections and, separately, by a federal court.
Wood's long, slow death drew international attention and condemnation.
And it raised anew questions about the viability of lethal injections, about how executions are carried out, and why the state keeps having to change the combination of drugs it uses.
Here are answers to some of the common questions that have been asked since Wednesday's execution:
Why shouldn't killers suffer the same way their victims did?
The Eighth Amendment of the U.S. Constitution forbids cruel and unusual punishment.
How are executions usually carried out?
In 1992, Arizonans voted to replace the gas chamber with lethal injection as the preferred method of execution. Killers who committed their crimes before 1992 still have the option of being executed in the gas chamber, but only one has chosen that alternative in 22 years.
Historically, the condemned person was injected with a short-acting anesthetic or barbiturate, followed by a drug that causes paralysis, and a drug that stops the heart. In recent years, most state departments of corrections in death-penalty states have moved to one-drug protocols, causing death by an overdose of the first drug. Usually the process takes about 10 minutes, though some executions can last 20 or 30 minutes. Wood was the first Arizona inmate put to death using the combination of midazolam, a Valium-like sedative, and hydromorphone, a narcotic painkiller.
Who is the executioner and how much is he paid?
The identities of executioners are shielded under state law, but the task requires medical training. The Corrections Department's execution protocol calls for at least two people on the IV team; they are chosen by Director Ryan and they must be physicians, nurses, physician's assistants, emergency medical technicians or corpsmen.
The protocol does not specify how much they are paid, but depositions during litigation in 2011 revealed that the head of the team was paid $18,000 in cash — $6,000 for the executions and $6,000 for each of two days of training.
Why is so much about the execution secret?
Under state law, identities are concealed so that the medical personnel will not be harassed or threatened by anti-death-penalty lobbies or punished by their professional organizations; executing people goes against the ethical codes of doctors, nurses and other medical professionals.
In recent years, Arizona and other states have extended the secrecy to include the people and companies who procure or produce the drugs used in executions. The state and its attorneys argue that anti-death-penalty activists will pressure pharmaceutical firms and compounding pharmacies not to supply drugs to departments of corrections for executions.
This has been an ongoing legal battle and was the reason the Wood execution was stayed twice before he was finally put to death.
Defense attorneys for years have argued that they need to know the backgrounds of the people carrying out the executions and where the drugs are coming from.
Why is there a scarcity of drugs for lethal injection?
When lethal injection was introduced in 1977, it depended on a fast-acting anesthetic called thiopental, more commonly used, among other things, to sedate patients to put tubes down their throats or to deliver babies by Caesarean section. But it was an old drug that even predates the Food, Drug and Cosmetic Act of 1938, and it has largely been replaced by newer anesthetics like propofol. The supplies started to run out in 2010; it was no longer being manufactured in the United States.
When propofol was taken off the market temporarily after Michael Jackson died from misusing it, doctors turned again to thiopental, and stores were depleted to the point where the Ohio Department of Corrections had trouble finding enough for an execution.
Later that year, Arizona obtained thiopental for an October 2010 execution and claimed that the same law that protected executioners' identities protected suppliers when defense attorneys asked where it came from.
The Arizona Republic reported that the drug had been obtained in England, and that Arizona's Department of Corrections had bypassed federal drug regulations to bring it into the country. It is illegal in the European Union to assist in executions in any country, so England and Italy shut down exports of thiopental for use in executions.
The U.S. Drug Enforcement Administration later confiscated, in several states, thiopental supplies imported from Europe.
Arizona and other states were forced to switch to the barbiturate pentobarbital, but its manufacturers in Europe and the U.S. also cut off access for executions. Several states, including Arizona, switched to the Valium relative, midazolam.
Why don't pharmaceutical companies want to provide drugs for executions?
The pharmaceutical companies are close-lipped about their policies, generally referring reporters to official statements on their websites. In litigation, the Arizona Attorney General's Office claimed that publicity and anti-death-penalty activists influence the companies, which may be partly true.
But there are other factors. The drugs used in executions by lethal injection all have valid clinical uses. They were invented to save lives and improve health, and the companies object to their use to kill people. Nor is it good marketing to be the company that makes death drugs.
The European manufacturers of thiopental and pentobarbital are subject to European Union laws forbidding participation in executions.
Why don't they use the same drugs that veterinarians use to euthanize animals?
Veterinarians use pentobarbital, and the manufacturers of that drug refuse to sell it for executions. It was last used in Arizona in October 2013, and if there was any left over after two executions that month, it has since passed its expiration date.
Why is midazolam controversial?
Midazolam is not an anesthetic or a painkiller. It is a sedative and an amnesiac, used as a first drug in many minor medical procedures; you don't remember the unpleasantness of the procedure. Florida and Oklahoma incorporated it into a three-drug protocol. Ohio and Arizona used it in conjunction with the narcotic hydromorphone.
But witnesses to an execution in Florida last October noted that it took longer to do its job. The Associated Press reported that the prisoner "remained conscious longer, and made more body movements after losing consciousness than other people executed recently by lethal injection under the old formula."
An execution in Ohio in January raised eyebrows because the condemned man fought for breath and took more than 20 minutes to die.
And in April, an Oklahoma killer appeared to be sedated and then started writhing in agony and died of an apparent heart attack after more than 40 minutes. An autopsy showed that the executioner had passed the catheter needle all the way through a vein in the man's groin, meaning the drugs were delivered into soft tissue instead of into the bloodstream.
What happened in Wednesday's execution?
Joseph Wood was very quickly sedated by the injection of midazolam and hydromorphone, but about five minutes into the procedure, he began gasping and snoring, and continued to struggle for breath for an hour and a half. It took nearly two hours for him to die.
Corrections Director Ryan said that Wood was brain-dead, but continued to breathe. Assistant Arizona Attorney General Jeffrey Zick told a federal judge that it was an involuntary reaction, like that of a person in a coma taken off life support. He said that the medical team visually determined that Wood was brain-dead; Wood was not attached to an electroencephalogram, which measures brain activity and is commonly used to confirm brain death.
What will happen next?
Brewer ordered a review of the execution to determine what went wrong and what should happen next. Ryan said that he was already undertaking such a review without being told to do so.
A federal judge and the Arizona Supreme Court on Wednesday ordered that medical samples be taken and preserved, along with other evidence.
There will be no executions until the review is completed, the Attorney General's Office said.
How Arizona proceeds with executions in the future remains to be seen, though an assistant Arizona attorney general hinted that one option would be to continue to use midazolam as part of a three-drug protocol as in Florida.
Why don't they go back to other methods of execution?
Pundits and politicians have said that we should return to older methods of execution, like firing squad, hanging or the electric chair.
Even the chief judge of the 9th U.S. Circuit Court of Appeals, in his dissent to the court's refusal to lift a stay of execution, said that execution by lethal injection gives the impression that it is more humane than other forms of killing.
"If some states and the federal government wish to continue carrying out the death penalty, they must turn away from this misguided path and return to more primitive — and foolproof — methods of execution," wrote Judge Alex Kozinski.
He mused over the guillotine, the electric chair, hanging, the gas chamber and decided that firing squads made the most sense.
"Firearms have no purpose other than destroying their targets," he wrote. "... If we, as a society, cannot stomach the splatter from an execution carried out by a firing squad, then we shouldn't be carrying out executions at all."