ATMORE, Ala. — An Alabama inmate coughed repeatedly and his upper body heaved for at least 13 minutes during an execution using a drug that had been used in problematic lethal injections in at least three other states.
Ronald Bert Smith Jr., 45, also appeared to move slightly during two tests meant to determine consciousness before he was finally pronounced dead at 11:05 p.m. Thursday — about 30 minutes after the procedure began at the state prison in southwest Alabama.
Alabama uses the sedative midazolam as the first drug in a three-drug lethal injection combination.
Oklahoma’s use of midazolam as the first in a three-drug protocol was challenged after the April 2014 execution of Clayton Lockett, who writhed on a gurney, moaned, and clenched his teeth for several minutes before prison officials tried to halt the process. Lockett died after 43 minutes. A state investigation into Lockett’s execution revealed that a failed line caused the drugs to be administered locally instead of into Lockett’s blood.
Ohio and Arizona have used midazolam as the first in a two-drug protocol. Ohio inmate Dennis McGuire repeatedly gasped and snorted over 26 minutes during his January 2014 execution. The state abandoned that method afterward and has yet to resume executions.
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Arizona halted executions after the July 2014 lethal injection of convicted killer Joseph Rudolph Wood, who took nearly two hours to die.
Smith and other Alabama inmates argued in a court case that the drug was an unreliable sedative and could cause them to feel pain, citing its use in problematic executions. The US Supreme Court ruled in a challenge by Oklahoma death row inmates that they had failed to prove that the use of midazolam was unconstitutional.
Robert Dunham is executive director of the Death Penalty Information Center, a nonprofit that does not take an official stance on capital punishment but is critical of its application. He said Smith’s execution reinforces the argument that midazolam shouldn’t be used in executions.
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‘‘What occurred during the execution itself is exactly what the medical experts have been saying is likely to occur when midazolam is asked to do something that drug is not designed to do,’’ he said. ‘‘It is not designed to render somebody unconscious and insensate.’’
Smith was convicted of capital murder in the Nov. 8, 1994, fatal shooting of store clerk Casey Wilson. A jury voted, 7-5, to recommend a sentence of life imprisonment, but a judge overrode that recommendation and sentenced Smith to death.
At the beginning of his execution, Smith heaved and coughed repeatedly, clenching his fists and raising his head. A prison guard performed two consciousness checks before the final two drugs were administered.
In a consciousness test, a prison officer says the inmate’s name, brushes his eyelashes, then pinches his left arm. During the first one, Smith moved his arm. He slightly raised his right hand after the second test. The meaning of those movements will probably be debated. One of Smith’s attorneys whispered to another attorney, ‘‘He’s reacting,’’ and pointed out the inmate’s repeated movements. The state prison commissioner said he did not see any reaction to the consciousness tests.