Book author slams Tennessee's lethal injection drug choice for executions

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On May 22, Oscar Smith, who was convicted of killing his wife and her two teenage sons, was executed in Tennessee by lethal injection. The state used the chemical pentobarbital only instead of the three-drug cocktail previously employed in its lethal injection protocol.
Lethal injection has been used in 98% of U.S. executions since 1982.
Smith's execution was delayed multiple times because the drugs that were to be used for lethal injection three years ago had not been properly tested for bacterial toxins. His execution earlier this year was Tennessee's first use of the death penalty since 2020 when Nicholas Sutton was executed by electrocution. Smith had been on death row for 35 years. He was convicted in the 1979 deaths of his grandmother, a high school friend and another man, The Tennessean newspaper reported.
Was the injection of the barbiturate pentobarbital (which is used for all federal executions) a humane choice for an execution? In her first stop in early June in Oak Ridge on her book tour through Tennessee, Corinna Barrett Lain, author of the newly published book 'Secrets of the Killing State: The Untold Story of Lethal Injection,' compared the injection of pentobarbital to 'waterboarding.'
Waterboarding is a form of torture used during interrogations. Water is poured over the covered mouth and nose of a person strapped to a board, making him feel as though he is drowning. For an injected prisoner, this sensation could last five minutes before the heart stops.
Lain, daughter-in-law of Oak Ridge's Nancy Highfill and S.D. Roberts and Sandra Moore, law professor at the University of Richmond School of Law, said that in her book she cites evidence that lethal injection is not 'performed by well-qualified medical professionals, regulated and carefully conducted and usually able to provide a 'humane' death.'
She surmised that states prefer to use lethal injection to execute prisoners on death row because it hides and internalizes the 'physical force' needed to cause cardiac arrest. Execution by firing squad produces blood; by gas mask, coughing, retching and spitting up; and by electric chair, the smell of burning flesh. Witnessing evidence of those physical forces can be traumatic for observers and prison guards, Lain suggested.
'Legislators have expressed doubt that the American public has the stomach to see these really gruesome deaths,' she said.
Lain said she believes lethal injection is the preferred form of execution because it appears to make the prison staff and others think the prisoner just fell quietly, quickly and painlessly into a deep sleep.
But is lethal injection more humane for the person on death row?
Lain, who worked on researching and writing her book for seven years, said she first thought that medical doctors devised lethal injection protocols and performed injections, just as veterinarians do to euthanize pets (using pentobarbital). She found out that the American Medical Association, which was asked for assistance in prison executions, told legislators that no physicians 'wanted anything to do with lethal injections for reasons of medical ethics.'
She said the three-drug protocol commonly used for lethal injection was proposed in 1977 by Jay Chapman, Oklahoma's medical examiner, who she noted was not a medical doctor, anesthesiologist or pharmacologist.
Chapman's proposal for the three-drug cocktail was a combination of sodium thiopental as an anesthetic, pancuronium bromide as a paralytic, and potassium chloride, which 'chemically burns each vein as it makes its way to the heart, inducing a cardiac arrest and stopping the heart,' Lain said.
Starting in 2011, certain drugs needed for anesthesia prior to surgery in hospitals, such as sodium thiopental, were in short supply and difficult for prisons to buy. States seeking alternatives often chose pentobarbital.
The paralytic in the three-drug cocktail, Lain said, 'relaxes the muscles in the prisoner's face and then freezes them to give the impression of a nice, drifting-off-to-sleep look.' The problem, she added, is that this drug 'eventually paralyzes the diaphragm, which is the muscle that pumps air into the lungs. The medical experts say that the prisoner will soon experience the sensation of slow suffocation and being buried alive.'
According to one source, Chapman made his proposal in consultation with Oklahoma state legislator Bill Wiseman, who was seeking a more humane alternative to existing execution methods like the electric chair. The Chapman Protocol was widely adopted by many states, including Texas, which was the first to use lethal injection in 1982.
A National Public Radio investigation in 2020, Lain said, reviewed more than 200 autopsy reports from lethal injection executions in nine states between 1990 and 2019, including those using pentobarbital only. This study found evidence of acute pulmonary edema in 84% of the cases. In this disorder, fluid in the lungs builds up, causing shortness of breath and potential respiratory failure.
Lain said another problem with lethal injection is that many prisoners on death row are old when their time for execution comes and thus have 'terrible veins," not only because of age, but also because many had been intravenous drug users. This common situation makes it difficult for prison guards to access a prisoner's best vein because they will refuse to 'push the syringes.'
She said most guards today do the lethal injection remotely from another room, with seven feet of tubing connecting the injector on one side of a wall to the prisoner on the other side.
'This isn't bedside,' Lain added.
The case of Brian Dorsey
After hearing about the five minutes of suffering that convicted criminals being executed by lethal injection must endure before being declared dead, one person in the audience said, 'But they deserve it!'
'Let's talk about that,' Lain said. 'I've been writing about the death penalty for almost two decades and have always viewed condemned prisoners as people who committed horrible and unspeakable crimes.' But, she noted, not all prisoners on death row are guilty of a crime, and prisoners who committed murders when they were young often morph into admirable human beings over time.
'According to a study by the National Academy of Sciences, it is estimated that 4.1% of American prisoners on death row are innocent,' she said.
Then she spoke about a man on death row who was convicted of double homicide in Missouri. Seventeen years after he was sentenced to receive the death penalty, he was allowed to live in 'the honor dorm.' He was trusted and appreciated for his skills at cutting hair. For over a decade, he was the prison barber for his inmates and the prison staff, including the warden.
'Imagine a condemned capital murderer allowed to have a pair of scissors and a razor blade at the warden's neck,' commented Lain before telling what happened to Dorsey.
She quoted prison staffers' statements in an op-ed in a newspaper that failed to save his life: 'Mr. Dorsey is an excellent barber and a kind and respectful man. There isn't a nicer guy than Brian. We know he was convicted of murder, but that is not the Brian Dorsey we know.'
Lain said even though more than 70 prison staff and officials petitioned the governor of Missouri to commute Dorsey's sentence, the governor refused 'and the prison guards who had come to know and respect this man were then forced to kill him.'
Prison staff must endure the emotional cost of executing people they knew, and the taxpayers in each state with the death penalty must bear the financial cost of capital punishment, Lain said.
The Columbia (Missouri) Daily Tribune reported that on Dec. 23, 2006, broke and in debt to drug dealers, Dorsey was looking for cash. His cousin, Sarah Bonnie, and her husband, Ben, took him to their place, where the trio drank and played billiards with some friends.
After everyone had left, Dorsey used a shotgun to shoot and kill the Bonnies as they slept and then raped Sarah's body. He then poured bleach over her and stole cash, her car and some property to sell to pay off his drug debts. Her parents found their bodies the next day. Dorsey turned himself in. He was executed on April 9, 2024.
'Arizona spent $1.5 million on drugs for three executions in 2022 and botched all three,' she remarked, noting that one Department of Corrections official consulted Wikipedia to determine how much of a drug to inject on the eve of an execution.
She said officials in both Florida and Ohio have recently determined the total costs of the death penalty for their states.
'The costs include what is paid to two lawyers, a mitigation specialist and an investigator for two trials, one to determine whether the defendant is guilty and one to determine if the penalty should be death or life in prison with no parole.' Usually the final verdicts are appealed, adding to the cost.
The Florida evaluation indicated that the cost per execution is $24 million. The Ohio Legislative Service Commission concluded that it may cost the state between $1 million to $3 million more per case to sentence someone to death instead of life without parole.
Critics of the death penalty, such as Stacy Rector, executive director of Tennesseans for Alternatives to the Death Penalty, have stated that the savings from eliminating the death penalty could be used to support the families of the victims of the crimes committed by perpetrators sentenced to life without parole.
Lain started her book tour through Tennessee and other states at the Oak Ridge Public Library.
The Oak Ridger's News Editor Donna Smith contributed to this story.
This article originally appeared on Oakridger: Author slams Tennessee's lethal injection drug choice for executions