[Deathpenalty] death penalty news----MO., OKLA., NEB., COLO., USA

[Rick Halperin]

April 27




MISSOURI:

Death penalty upheld for man who shot 2 Randolph County Jail deputies


A man's death penalty conviction was upheld on Tuesday after an appeal was 
issued.

Michael Tisius was charged in 2000 for shooting and killing 2 deputies at the 
Randolph County Jail. Tisius shot the deputies to help his cell mate try and 
escape from the jail.

The opinion was issued after the Missouri Supreme Court concluded that no error 
was made in the judgment of Tisius' case.

(source: ABC news)






OKLAHOMA:

Plenty for Oklahoma to consider in commission's death penalty report


On Jan. 16, 2003, three days after Brad Henry was sworn in as Oklahoma's 
governor, the state executed a man for killing a 13-month-old boy 16 years 
earlier. It was the 1st of 14 executions carried out in 2003, and one of 40 
that would occur during Henry's 2 terms in office.

To be sure, Henry, a Democrat, wasn't squishy about signing off on the ultimate 
punishment as the state's chief executive. His record makes his current views 
on Oklahoma's death penalty process - that it needs considerable work - all the 
more compelling and worthy of policymakers' attention.

Henry was 1 of 3 co-chairs of a special Oklahoma Death Penalty Review 
Commission, a group of 11 Oklahomans who spent a year studying this issue "from 
arrest to execution," as the report noted. After meeting with victims, 
prosecutors, defense attorneys and others involved in the process, the panel 
unanimously recommended that the state extend a moratorium on the death penalty 
that's been in place since October 2015.

"We were all disturbed by the volume and the seriousness of the flaws in 
Oklahoma's capital punishment system," Henry said at a news conference Tuesday.

This report arrives as the Oklahoma Department of Corrections works to finalize 
its own report on the death penalty. Both efforts follow problems with Oklahoma 
executions, including the use of a wrong drug in one execution and the near-use 
of the same drug in another.

The commission report noted that "it is undeniable that innocent people have 
been sentenced to death in Oklahoma" and that "the burden of wrongful 
convictions alone requires systemic corrections recommended in this report." 
Indeed, 1 member of the panel was the cousin of an Ada woman killed in 1982. 2 
men were convicted, one of whom was sent to death row, before both were 
exonerated and freed as a result of DNA evidence.

The commission produced 46 recommendations, ranging from additional training 
for judges on forensics and trying capital cases, to recording all interviews 
with suspects in homicide cases, to using 1 drug to carry out executions 
(instead of the current 3-drug method), to broadening the scope of those who 
can serve on the state Pardon and Parole Board.

In an especially important section of recommendations, the commission said 
attorneys and staff at the Oklahoma Indigent Defense System should receive pay 
comparable to their colleagues who work in district attorneys' office. We have 
written about the uphill climb facing the OIDS, which handles about 44,000 
cases per year in its 75 counties (Oklahoma and Tulsa counties have their own 
systems). OIDS attorneys can have as many as 30 to 40 open cases at a time, 
including murder cases.

The report referenced Oklahomans' support for the death penalty, as reflected 
in voters' approval in November of a state question ensuring that it remains an 
option. Yet Henry said the commission's findings leave the state facing another 
question: Does it want to get the death penalty right?

Commission members said they hope their report will "help foster an informed 
discussion among all Oklahomans" about the death penalty. It's sure to do that, 
and should. We thank the members for their work regarding the state's most 
solemn responsibility.

(source: Editorial, The Oklahoman)

****************

Keep executions on hold 'until significant reforms are accomplished,' Oklahoma 
Death Penalty Review Commission says----Significant reforms are needed, study 
group says


A bipartisan private commission recommended on Tuesday that a court-ordered 
stay on executions in Oklahoma remain in effect until "significant reforms" are 
accomplished, citing concerns about resources available to those facing death 
sentences and the faulty application of execution procedures.

The Oklahoma Death Penalty Review Commission released its findings and nearly 4 
dozen recommendations in a nearly 300-page report on a study of capital cases 
from initial contact with police to the day defendants are put to death.

Former Gov. Brad Henry, who helped lead the effort, announced that the 
commission unanimously recommended that the moratorium be extended due to what 
he said were serious flaws in the way Oklahoma handles death-penalty cases. He 
said the number of death-row exonerees from Oklahoma - 10, according to the 
Death Penalty Information Center - was among his biggest worries, along with 
the discovery of the limitations capital defendants have when presenting legal 
defenses.

"If you look at the various defense counsel organizations, whether it's (the 
Oklahoma Indigent Defense System) or Oklahoma County or Tulsa County public 
defenders, they are just overwhelmed with felony cases," Henry said. "They 
don't have enough attorneys. They don't have the funding that they need, 
especially in death-penalty cases, to hire investigators (or) to hire experts. 
You have to decide whether you want to pay to do it right, and either you do or 
you don't."

Oklahoma has put more than 100 people to death in the modern era of capital 
punishment, and according to commission member and trial lawyer Robert 
Alexander, it's almost certain that at least 1 of them was innocent and 
couldn't prove it because of financial reasons.

"Our report has found, 41 years (after the death penalty resumed), systemic 
flaws in our death-penalty system," Alexander said. "Whenever there's a 
systemic flaw in the system, any injustices that system could cause ... fall on 
the people with the fewest resources to navigate that system."

The commission also noted that 2 forms of evidence - forensics and witness 
identification - were determined to be among the most unreliable.

Henry said he came to the conclusion that the process as it stands needs to be 
"overhauled" by policymakers, and he said there are good reasons for 
conservatives to be concerned about the practice despite voters' November 
decision to protect the death penalty in the state constitution with State 
Question 776.

"What we all agreed on was that if you're going to have the death penalty, it 
ought to be done right," Henry said of the commission. "It ought to be done in 
a way that, as best we can, ensures no innocent person is ever put to death by 
the state of Oklahoma."

Co-Chairman Andy Lester, a former federal magistrate, said the fact that an 
execution is permanent makes it paramount that everyone involved be certain 
that those on death row are in fact guilty and that they've received the best 
possible legal aid.

"Nobody wants to execute an innocent person," he said. "If 1 of (the 10 
exonerees) slipped through, just think how horrible that would be. It's bad 
enough that somebody gets wrongfully convicted. It's possible to recreate a 
life after a wrongful conviction, but it is not possible after a wrongful 
execution."

Gov. Mary Fallin released a brief statement Tuesday evening after the report 
was made public indicating that she's not yet well-versed on its contents.

"My office has not received a copy of the report, but my staff will obtain a 
copy and review it," she said.

Issues with drugs highlighted

The Oklahoma Attorney General's Office requested a moratorium in October 2015 
once it learned about issues with a lethal-injection drug used in the January 
execution of Charles Warner and the scheduled execution of Richard Glossip. 
Those mistakes occurred after Oklahoma received international attention for the 
43-minute execution of Clayton Lockett in April 2014.

A multicounty grand jury issued a highly critical report in May 2016 about the 
handling of Glossip's and Warner's cases by multiple state agencies. The grand 
jury recommended that the Department of Corrections overhaul its protocol yet 
again but did not recommend any indictments.

(source: Tulsa World)

*************

"Innocent People Have Been Sentenced to Death in Oklahoma," Commission 
Concludes


The Oklahoma Death Penalty Review Commission after more than a year of work has 
recommended that a moratorium on carrying out capital punishment in the state 
be continued indefinitely. "It is undeniable that innocent people have been 
sentenced to death in Oklahoma," the report concludes.

The bipartisan commission's findings span nearly 300 pages, covering every 
stage of the state's death penalty system. It addresses such issues as the 
problematic interrogation of suspects, overworked defense attorneys in capital 
cases, and an execution process with a disastrous track record. Headed by 
former Gov. Brad Henry, former federal magistrate Judge Andy Lester, and Judge 
Reta Strubhar, the 1st woman to sit on the states Court of Criminal Appeals, 
the commission urges the state to correct the "systemic flaws" in its death 
penalty system before seeking to restart executions, or sentencing any new 
defendants to death row.

It is not the 1st time a report has found deep problems with the death penalty 
in Oklahoma. A blistering grand jury report released last year found myriad 
failures by state officials entrusted to carry out lethal injection. But this 
is a more far-reaching review, conducted by an 11-member commission that, 
beginning in 2015, "gathered data, reviewed scholarly articles, commissioned 
studies, and conducted interviews" to thoroughly examine the state's capital 
punishment system from top to bottom. Its specific findings and recommendations 
are divided into 10 chapters spanning subjects from the handling of forensic 
evidence to the clemency process. "The commission hopes this report will help 
foster an informed discussion among all Oklahomans about whether the death 
penalty in our state can be implemented in a way that eliminates the 
unacceptable risk of executing the innocent, as well as the unacceptable risks 
of inconsistent, discriminatory, and inhumane application of the death 
penalty," the co-chairs write.

The commission was formed in the fall of 2015, not long after the state 
attempted to kill Richard Glossip on September 30 of that year. It was his 
third date with death. Only after courts had cleared the way for Glossip's 
execution - and as witnesses were waiting to be brought to the viewing chamber 
- did state officials discover they had procured the wrong drug with which to 
kill him, impermissibly substituting an untested drug in place of one that was 
specified in the official execution protocol. In a dramatic 11th-hour stay by 
Gov. Mary Fallin, the state called off the execution.

The high-profile mistake - the latest in a series of ugly incidents casting 
negative attention on Oklahoma executions - prompted then Attorney General 
Scott Pruitt to impose the current, indefinite moratorium in order to give 
officials a chance to sort out what "had transpired" leading up to Glossip's 
failed execution. That inquiry morphed into a multi-county grand jury 
investigation after news broke less than a week later that the state had 
previously killed another man, Charles Warner, in January 2015 using the same 
untested and improper drug that it had erroneously obtained to execute Glossip.

As The Intercept reported following the release of the grand jury report in May 
2016, its findings showed dizzying incompetence and disregard for protocol in 
the run-up to Glossip's planned execution, as well as deceit on the part of 
state officials, who afterward lied to the public about key aspects of what 
happened. Particularly egregious were the actions of the general counsel for 
Gov. Fallin, who, when confronted with evidence that Warner had been killed 
using the wrong drug, protested that stopping Glossip's execution "would look 
bad for the state of Oklahoma," because officials would then have to admit they 
had carried out an execution with the wrong drug.

The commission expanded on the grand jury findings by widening the review to 
consider the system as a whole. Although Glossip is just one example cited in 
its report, the case is particularly emblematic of the range of failures the 
commission urged the state to address. Glossip was once mainly known as the 
named plaintiff in the U.S. Supreme Court case Glossip v. Gross, which upheld 
the state's lethal injection protocol - and specifically the use of midazolam, 
a sedative that remains controversial. But his case exploded onto the national 
stage after it was exposed that, as Glossip has insisted for decades, he may 
well be an innocent man. Shortly after the Supreme Court's June 2015 ruling 
opened the door to Glossip's execution, an investigation by The Intercept cast 
serious doubt about the evidence behind his conviction. In the run-up to 
Glossip's scheduled execution that fall, his attorneys raced to uncover more 
evidence that their client had been wrongfully convicted, while the state 
sought to push his execution through anyway.

Glossip was sentenced to die for the January 7, 1997, murder of his boss, Barry 
Van Treese, who owned a seedy motel in Oklahoma City, where Glossip worked as 
the manager. The state conceded from the start that Glossip took no part in 
carrying out the actual murder - the reason no physical evidence linked him to 
the bloody crime - but argued over 2 trials that Glossip convinced a hapless 
19-year-old named Justin Sneed to do the job for him, in exchange for money. 
Indeed, Sneed confessed to the murder and traded his testimony against Glossip 
for a chance to avoid the death penalty. Sneed is currently serving out a 
sentence of life without parole at a medium security prison.

But in obtaining Sneed's confession, investigators offered Sneed the 
opportunity to implicate Glossip - before Sneed even shared his firsthand 
account of the crime. "We know this involves more than just you, OK?" Oklahoma 
Police Detective Bob Bemo tells Sneed in the interrogation video. In another 
leading question, he asks, "You know Rich is under arrest, don't you?" Sneed 
did not know. But shortly thereafter, he offered up a story that implicated 
Glossip as the mastermind behind Sneed's grisly crime.

Oklahoma courts never vetted Sneed's testimony to determine whether it was 
reliable. Nor did Detective Bemo or other state actors understand the serious 
role that incentivized informant testimony plays in wrongful conviction cases. 
In its report, the commission makes recommendations that would almost certainly 
have impacted the conviction of Glossip had they been standard practice in 
1997. These include a requirement that police receive training "consistent with 
best practices" for interrogation techniques, that courts vet the reliability 
of informant testimony before allowing it before the jury, and that prosecutors 
and law enforcement receive "mandatory" training on the common causes of 
wrongful convictions.

The commission's report comes on the heels of "Killing Richard Glossip," a 
multi-part TV series launched by Investigation Discovery. Directed by Joe 
Berlinger, whose previous work includes the documentaries that helped lead to 
the release of the famed West Memphis 3 in Arkansas, the series draws on The 
Intercept's reporting, taking viewers on a journey through the case to show how 
states' labyrinthine criminal justice systems can entrap and even execute the 
innocent.

While specific to Oklahoma, the report also comes at a time when the death 
penalty is making national headlines and reigniting passions over the issue. In 
Arkansas, 3 executions have been carried out over the course four days this 
month, part of an unprecedented rush to kill that has raised controversy across 
the country. At a rally at the state Capitol earlier this month, Damien Echols, 
who spent more than 18 years on death row as a member of the West Memphis 3, 
spoke alongside Paris Powell, a death row exoneree from Oklahoma, who flew to 
Little Rock to warn the state about the risk of executing innocent people.

In the face of overwhelming legal challenges, Arkansas has failed to carry out 
its original plan of executing 8 people over the course of 11 days - a 
ramped-up schedule prompted by the imminent expiration of the state's stash of 
midazolam. But the cases that have culminated with an execution have placed the 
pitfalls of capital punishment on full display. To those familiar with 
Oklahoma's embattled death penalty system, the problems are all too familiar. 
Ledell Lee was executed on April 20 despite his insistence upon his innocence 
and his pleas that the state give him a chance to test critical DNA evidence. 
More recently, on April 24, Jack Jones Jr. and Marcel Williams were killed back 
to back, in executions that were far from perfectly carried out. While the 
state and some witnesses have said there is no proof the executions were 
botched, prison staff struggled to find a vein in both cases and witnesses 
described movement that should not have occurred following an efficacious dose 
of midazolam.

These problems were entirely predictable; in their many filings on behalf of 
Arkansas prisoners last month, defense attorneys pointed to Oklahoma as a 
cautionary tale, describing the nightmarish execution of Clayton Lockett in 
2014. Lockett's execution was the 1st time Oklahoma used midazolam, a sedative 
relatively untested for use in lethal injection that has also been adopted by 
Arkansas. The drug was first haphazardly substituted into the standard 3-drug 
lethal injection protocol in Florida due to diminishing supplies of other, 
previously relied upon drugs. Other states followed suit, despite signs - and 
warnings from medical professionals - that midazolam is not capable of 
rendering a person fully unconscious for the purpose of a humane execution. In 
Lockett's case, prison staff failed to properly insert the IV lines into his 
body; over 43 minutes, witnesses saw Lockett writhe on the gurney, in a 
spectacle described as a "bloody mess."

Should Oklahoma continue with capital punishment, the commission recommends 
that it adopt the "most humane and effective method of execution possible" - 
they suggest a 1-drug barbiturate protocol - and that it "require verification" 
at every stage of the process that the proper execution drugs have been 
obtained. But as in Arkansas, where an insistence on obtaining drugs in secret 
has led to lawsuits and chaos, Oklahoma has made it impossible to guarantee 
such a thing. Under a secrecy statute passed in 2011, the commission notes, 
Oklahoma officials can now purchase drugs using cash, "without creating a 
record, thereby limiting review by the state, courts, or public concerning the 
legality or propriety of the purchase, or concerning other accountability 
issues such as the origin, cost, and reliability of the drugs."

By asking the state of Oklahoma to revise its capital punishment system through 
and through, the commission presents a challenge that is sure to be costly, 
time consuming, and likely impossible given the entrenched problems that have 
defined the death penalty over the course of U.S. history. With the number of 
death row exonerees climbing to 158 this month, the state would do well to 
listen to Paris Powell, a man Oklahoma once planned to kill. As he said in 
front of the Arkansas state Capitol this month, "There's a lot of kids that are 
gonna get up over the next couple weeks and ask their parents what it means to 
be executed. And they're not gonna be able to understand it."

(source: The Intercept)

******************

Oklahoma AG Says State Moving Forward With Execution Plans----Oklahoma's new 
attorney general says the state is moving forward with new protocols for 
executing death row inmates, despite a recommendation from a bipartisan study 
group that a death penalty moratorium remain in place.


Oklahoma is moving forward with new protocols for executing death row inmates, 
despite a unanimous recommendation from a bipartisan study group that a 
moratorium on the death penalty remain in place, the state's new attorney 
general said Wednesday.

Republican Mike Hunter said while he respects the independent work of the 
Oklahoma Death Penalty Review Commission , he "respectfully disagrees" with the 
panel's findings.

"We're going to get a handle on the execution process," Hunter said. "There's 
new management at the (Department of Corrections), and I'm confident they're 
going to come up with a new execution protocol and that we'll move forward 
after that."

The 11-member commission, led by former Oklahoma Gov. Brad Henry, released a 
nearly 300-page report on Tuesday that had more than 40 recommendations related 
to the death penalty, including several on the execution process itself. The 
panel suggested those recommendations should be implemented before executions 
resume.

Hunter said he believes Oklahoma voters sent a clear message in November when 
they approved with 66 % of the vote a state question to enshrine the death 
penalty in the state constitution.

"I believe in democracy ... and the people in the state spoke very clearly with 
respect to the death penalty and its applicability to capital offenses in the 
state," Hunter said.

Since the death penalty was reinstated in 1976, Oklahoma has executed more 
people per capita than any other state. But a moratorium was imposed following 
a botched execution in 2014 and drug mix-ups during 2 other scheduled lethal 
injections in 2015. A multicounty grand jury empaneled by Hunter's predecessor, 
Scott Pruitt, looked into the drug mix-ups and made a series of recommendations 
last year about how the protocols should be revised.

The attorney general's office has said in court filings that it will not 
request any execution dates until at least 150 days - or about 5 months - after 
the new protocols are released. Meanwhile, 15 death row inmates in Oklahoma 
have exhausted all of their appeals and are awaiting execution dates.

Oklahoma and some other death penalty states have turned to new lethal 
injection drugs amid opposition from drug manufacturers to their products being 
used to execute people.

The commission recommended Oklahoma return to using a single dose of a 
barbiturate for executions instead of the current 3-drug method that has been 
used for the last several scheduled executions. But the multicounty grand jury 
suggested Oklahoma consider developing protocols for the use of nitrogen gas, a 
method approved by the Oklahoma Legislature 2 years ago but that has never been 
used to execute humans.

Both Hunter and prison officials have declined to say whether the new protocols 
will include the option of nitrogen gas.

"Where we are is we're finalizing the protocol with the DOC, and that will be 
released to the public, hopefully in the very near future," Hunter said. "Given 
that, I'll reserve comment on it until we get it finalized and it's released."

(source: Associated Press)






COLORADO:

Colorado might not be able to execute an inmate, even if it wanted to


If there's such a thing as a joke about the death penalty, I'm reminded of an 
old line from the comedian Ron White, who joked that while some states were 
outlawing the death penalty, his state of Texas, was putting in an express 
lane.

A bill to outlaw the death penalty in Colorado failed in the legislature this 
year, while Arkansas puts in an express lane, executing inmates one after 
another before a lethal injection drug expires. Colorado still has the death 
penalty, but this state might not be able to kill someone even if it wanted to.

Governor Hickenlooper says he won't execute anyone on his watch. His watch ends 
next year.

Colorado does have a death chamber in Canon City, but there isn't a death row 
there. The 3 men sentenced to die are at the prison in Sterling.

An ACLU lawsuit revealed Colorado struggled to come up with legal injection 
drugs a few years ago. and the ACLU says the drugs would be "exponentially 
harder" to get now. Many states are struggling with that.

Plus. Colorado's death penalty law references a "continuous injection" of a 
single drug -- a single drug the state probably can't get and the common, 
three-drug cocktail would be challenged in court.

Colorado has executed 1 man, Gary Davis, in 4 decades. Davis didn't really 
fight his execution in 1997.

Bottom line: it would be more difficult than ever for Colorado to carry out a 
rare execution here, even if the next governor is willing.

(source: Kyle Clark, KUSA news)






NEVADA:

Rebutting letter on death penalty


The writer of the April 19 letter headlined "Death penalty should endure" 
claims that the death penalty acts as a deterrent to future crimes. He argues 
that death penalty opponents ignore "the obvious fact" that executing someone 
deters that individual "100 %" from committing another crime.

His specious argument confuses the concept of "specific deterrence," which 
seeks to prevent a particular criminal from committing a subsequent crime, with 
the concept of "general deterrence," which is the goal of the death penalty and 
which seeks to prevent all members of the general population from committing a 
crime.

He also ignores "the obvious fact" that executing a criminal is not the only 
way to prevent that person from committing another crime. Life imprisonment 
without the possibility of parole would accomplish the same result.

Most significantly, the writer acknowledges that "[i]t is impossible to 
determine the deterrent value of the death penalty" on people who have not 
committed crimes.

So if the writer's goal is to prevent people convicted of murder from being 
repeat offenders, that purpose is served if they are confined to prison for 
life without the possibility of parole. Especially in a time when many death 
row inmates are being exonerated by DNA or other evidence, the writer might 
wish to reconsider his apparent desire to see people get executed.

(source: Letter to the Editor, Steve Danning, Las Vegas Sun)






USA:

Deadly Druggists: Pharmacists and the Death Penalty


What is our duty to patients? Does this change if we believe they are 
abominable? Individual morals will sway our decisions in differing ways but 
pharmacists have common ethical expectations.

Professional Ethics

The APhA Code of Ethics (last updated in 1994) includes the following passage: 
"III. A pharmacist respects the autonomy and dignity of each patient."1 My 
interpretation is that assisting in an execution against a competent patient's 
wishes is unethical. The Oath of the Pharmacist states "I will apply my 
knowledge, experience, and skills to the best of my ability to assure optimal 
outcomes for my patients" but death is a suboptimal outcome.2

Other medical professions have similar ethical prohibitions against actions 
inherent to the death penalty. For example, the AMA Code of Medical Ethics 
states "physicians have a responsibility to provide information and help 
patients understand their medical condition and options for treatment." This 
leaves room for physicians to take part in executions if they have the freedom 
to tailor therapy, yet impossible in a system requiring certain judicially 
determined methods of execution. The AMA Code of Medical Ethics explicitly 
states "sedation to unconsciousness must never be used to intentionally cause a 
patient's death." This applies to executions based on intentional sedative or 
narcotic overdoses. The AMA???s stance on physician-assisted suicide clarifies 
physicians must avoid abrogating their role as a healer.3

The American Medical Association, American Society of Anesthesiologists, 
American Nurses Association, International Council of Nurses, National 
Association of Emergency Medical Technicians, American Pharmacists Association, 
and International Academy of Compounding Pharmacists are in agreement that 
their members must take no part in executions even under coercion or upon 
abetment.

Lethal Injection Triple Cocktail

Generally the triple cocktail is a barbiturate, paralyzing agent, and potassium 
solution delivered by the intravenous route. The barbiturate sedates, the 
paralyzing agent reduces movement, and the potassium solution stops the heart 
and causes death through anoxic brain injury. An overdose of either the 
barbiturate or paralyzing agent can cause a fatal anoxic brain injury by 
respiratory arrest. A prolonged delay between the 2nd and 3rd cocktail step 
would cause death by respiratory arrest as well because the patient is not 
breathing after the 2nd medication is given. Notably, no pain reliever is given 
but sedation may reduce awareness and the paralyzing agent reduces distressing 
actions toward execution personnel (e.g. grimacing, hand spasms, and/or 
decerebrate posture).

The typical triple cocktail in the 2010s United States has been sodium 
pentothal ("thiopental"), pancuronium bromide, and potassium chloride. It is 
difficult to find full signeturs (especially doses) because of privacy laws 
protecting the executed, executioners, and suppliers.

Pentobarbital has increased in popularity because states have had difficulty 
finding a willing sodium pentothal source. European sodium pentothal 
manufacturers and US distributors refuse to provide product for executions. In 
fact, states have completed single-agent pentobarbital executions. Some states 
have substituted midazolam for a barbiturate and Ohio used hydromorphone to 
execute patients through respiratory rather than circulatory arrest.4

States circumvent the suppliers' embargo on lethal injection medications by 
ordering the cocktail from compounding pharmacies. In one case, a Missouri 
judge found pharmacists compounding a commercially available lethal injection 
ingredient broke state and federal pharmacy laws.5 This principle applies 
across the United States. Sodium pentothal and pancuronium bromide are 
commercially available but manufacturers and distributors specifically refuse 
supply of these products for executions.

Executioners must ensure proper storage and use within the shelf-life even if 
appeals or governor stays delay the execution. Will execution personnel dispose 
of the cocktail if there is pathogen growth? They may wonder "isn't the 
executed going to die of the drugs' pharmacology before they die of a 
nosocomial infection?" Yet loss of potency (another result of poor storage or 
expiration) is relevant because the execution could be prolonged or fail 
entirely. Potassium intoxication symptoms include nausea, vomiting, diarrhea, 
abdominal pain, extremity paresthesia, flaccid paralysis, listlessness, mental 
confusion, leg weakness and heaviness, hypotension, cardiac arrhythmias, heart 
block, and cardiac arrest.6 This alone is unpleasant.

Lethal Injection Complications

The infusion of concentrated potassium can cause local extravasation and 
burning sensation in the veins beyond intoxication symptoms. One would treat 
extravasation by stopping the IV infusion and infiltrating the affected area 
with procaine hydrochloride 1% (with or without hyaluronidase). These actions 
reduce vasospasm and dilute the tissue potassium. Applying heat to affected 
areas can provide some additional symptomatic relief.6

Extravasation and other adverse outcomes are more likely if the executioners 
lack medical backgrounds. For example, a precipitate in the IV line interrupted 
John Wayne Gacy's execution. The sodium pentothal rendered Gacy unconscious and 
then pancuronium bromide paralyzed him. However the flow of paralyzing agent 
stopped until the personnel switched the IV lines.7 Sodium pentothal, a base, 
reacted with pancuronium bromide, a acid, producing a solid salt. The execution 
personnel could have avoided this by flushing the line after administrating 
sodium pentothal. The executioners and attentive media would have seen Gacy's 
reaction to the potassium injection if they had failed to clear the IV line. 
Potassium chloride 20 mEq/100 mL (400 mosmol/L) can be given peripherally with 
limited vasospasm but 40 mEq/100 mL (800 mosmol/L) should be infused centrally. 
Should these recommendations change under the unusual circumstances?

Both central and peripheral IV infusions require identifying a vein and placing 
the opening of the needle inside the vein lumen with minimal trauma. I expect 
non-medical personnel will have particular difficulty with central infusions. 
Non-science personnel would lack knowledge of precipitates, as seen in the Gacy 
execution, or proper storage requirements. The sedation and paralysis would 
fail if either of the 1st 2 components in the triple cocktail lost significant 
potency. Additionally, non-medical personnel have limited training to recognize 
non-obvious signs of pain (e.g. increased pulse or changes on an 
electroencephalogram). This spares them the realization that they are 
inflicting pain but also makes them poor sources on the incidence of pain 
during executions.

Conclusion

The gamut of professional organizations, including the American Pharmacist 
Association and International Academy of Compounding Pharmacists, demands their 
members dissociate themselves from the death penalty for ethical reasons. 
Pharmacists should uphold the same standards of care enjoyed in daily patient 
care toward judicially sanctioned executions by discouraging drug smuggling, 
the use of expired medications, absence of pain relief during procedures, and 
administration of intravenous regimens by untrained personnel.

Works Cited

1. Code of Ethics. American Phamacists Association website. 
https://pharmacist.com/code-ethics. Published October 27, 1994. Accessed April 
25, 2017.

2. Oath of a Pharmacist. American Phamacists Association website. 
http://www.pharmacist.com/oath-pharmacist. Accessed April 25, 2017.

3. AMA Code of Medical Ethics. American Medical Association website. 
https://www.ama-assn.org/delivering-care/ama-code-medical-ethics. Accessed 
April 25, 2017.

4. State by State Lethal Injection. Death Penalty Information Center website. 
https://deathpenaltyinfo.org/state-lethal-injection. Updated May 2017. Accessed 
April 25, 2017.

5. Court rules pharmacist compounding for execution is illegal. American 
Pharmacists Association. 
http://www.pharmacist.com/court-rules-pharmacist-compounding-execution-illegal. 
Published February 1, 2014. Accessed April 26, 2017.

6. Potassium Chloride and Sodium Chloride injection solution [Package Insert]. 
Lake Forest, IL: Hospira Inc; 2006.

7. Karwath R, Kuczka S. Gacy execution delay blamed on clogged IV tube. Chicago 
Tribune. May 11, 1994. ht

(source: Pharmacy Times)

*********************

Most Favor Death Penalty, But Don't Think It Deters Crime in Politics


On Monday, Arkansas executed 2 death-row criminals in the nation's 1st double 
execution since 2000. Americans in general still favor the death penalty, but 
they're not convinced it actually helps deter crime.

A new Rasmussen Reports national telephone and online survey finds that 54% of 
American Adults favor the death penalty, while 31% oppose it. Another 15% are 
not sure how they feel about capital punishment.

The national survey of 1,000 American Adults was conducted on April 23-24, 2017 
by Rasmussen Reports. The margin of sampling error is +/- 3 % points with a 95% 
level of confidence. Field work for all Rasmussen Reports surveys is conducted 
by Pulse Opinion Research, LLC. See methodology.

(source: rasmussenreports.com)

*************

Court's death penalty vote will impact current stayed executions


How the U.S. Supreme Court rules on a case examining whether a mentally ill 
criminal defendant is entitled to defense by an independent mental health 
expert will have an immediate impact.

When the Arkansas Supreme Court stayed the executions of 2 of the 8 men slated 
for April executions, Don Davis and Bruce Ward, it said it was awaiting 
guidance from the U.S. Supreme Court's decision in McWilliams v. Dunn, the case 
it heard April 24.

The U.S. Supreme Court is re-examining the 1986 death sentence of James 
McWilliams, who was convicted of raping and killing an Alabama convenience 
store clerk in 1984. Just days before his sentencing, a court-appointed 
psychologist prepared a report on his mental state.

During oral arguments, the court seemed evenly divided as it examined whether 
an Alabama death-row inmate should get a new sentencing hearing because he did 
not have a mental health expert during his sentencing trial more than 30 years 
ago. The practice of having a mental health expert on hand during sentencing 
has become more common in recent years.

The Supreme Court justices were asked to give further interpretation of the 
court's 1985 decision in Ake v. Oklahoma, which said defendants have the 
constitutional right to the appointment of a mental health professional at the 
state's expense to help prepare an insanity defense.

Atlanta lawyer Stephen Bright, representing McWilliams, said the court's Ake 
decision was meant to make sure that poor defendants have the opportunity to 
get the same kind of expert assistance that wealthy defendants and state 
prosecutors get.

"It at least gives the defense a shot, at least gives them one competent 
mental-health expert that they can talk to, understand what the issues are, 
present them as best they can," Bright said.

But some of the justices said the court ruling was purposely left unclear about 
how much independent expertise defendants needed.

Justice Elena Kagan said the ruling was very clear, pointing to what she called 
its "money sentence" in its words: "the state must assure the defendant access 
to a competent psychiatrist who will assist in evaluation, preparation and 
presentation of the defense." She also said the court-appointed psychologist 
for McWilliams did not meet the court's standard set the previous year in Ake 
v. Oklahoma.

Justice Stephen Breyer said a key issue is not whether the expert help for 
defendants is independent but if it truly provides the necessary help the 
defendants need.

The night after the court heard oral arguments in the McWilliams case, the 
state of Arkansas executed 2 death-row inmates that were part of its group of 
inmates being executed before the state's supply of 1 of the lethal injection 
drugs expired at the end of April. The double execution was the 1st to take 
place in the country since 2000 in Texas.

The Supreme Court denied a request for a stay of execution for inmate Marcel 
Williams, the 2nd inmate executed April 24. One of the eight inmates scheduled 
for execution was killed by lethal injection April 21 and another is set to die 
April 27.

The afternoon of April 24 Arkansas Coalition to Abolish the Death Penalty, 
along with support from Equal Justice USA, Amnesty International, American 
Civil Liberties Union and the Catholic Mobilizing Network, delivered 46,000 
signatures to Arkansas Gov. Asa Hutchinson opposing the executions. The state 
group also said that at least 204,000 people had contacted the governor 
opposing the executions.

(source: Catholic News Service)