A death house gurney of the type Louisiana uses to execute prisoners at Angola. Credit: Wikipedia

Tuesday night, an inmate in Oklahoma reportedly writhed on a gurney and gasped for air after being given a dosage of drugs never used before in an execution. Convicted murderer Clayton Lockett had been declared unconscious, but woke up a few minutes later, convulsed, tried to speak and then died of a heart attack, witnesses said.

Three months earlier, Ohio inmate Dennis McGuire reportedly gasped, choked and took about 30 minutes to succumb to a previously untested mix of injected drugs. It was the longest execution in Ohio since the state brought back the death penalty in 1999.

Those two executions have something in common. Both involved a drug called midazolam, a sedative used to render inmates unconscious and, at least theoretically, to forestall pain. Along with another painkiller, hydromorphone, it’s the same drug Louisiana officials plan to use in executing convicted child-killer Christopher Sepulvado.

100 mgMidazolam dosage in botched Oklahoma execution10 mgMidazolam dosage called for in Louisiana

When it was adopted, Louisiana’s execution protocol was the same as Ohio’s: a combination of 10 milligrams of midazolam and 40 milligrams of hydromorphone. By comparison, Florida uses 500 milligrams of midazolam as part of a three-drug execution mix.

In light of a lawsuit following McGuire’s execution, Ohio officials on Monday announced they would increase the dosages of midazolam and hydromorphone to 50 milligrams each.

Oklahoma officials used 100 mg of midazolam in Tuesday’s execution. That’s how much Virginia’s protocol called for, but officials there announced Wednesday that the state would increase its dosage from 100 milligrams to 500 milligrams.

Pam Laborde, communications director for Louisiana’s Department of Public Safety and Corrections, said the state hasn’t changed its execution plan.

States coming up with new drug combinations to execute inmates

Since the manufacturers of drugs once commonly used in death chambers forbade their use in executions, states have scrambled to find substitutes and have experimented with dosages. It’s a gamble that some death-penalty critics say is causing cruel and unusual deaths, in violation of the U.S. Constitution.

“There’s no science to determining the proper amount of drugs to use for the death penalty because this is not something we study,” said Dr. David Waisel, an associate professor of anesthesia at Harvard Medical School who has testified in several death-penalty lawsuits. “They’re are making it up as they go along.”

According to Waisel, a 10-milligram dose of midazolam — the amount used in a Louisiana execution — does not preclude suffering even in combination with another painkiller such as hydromorphone.

“I can say with confidence that in the McGuire execution [in Ohio], 10 milligrams of midazolam did not prevent his suffering,” Waisel said.

Drug dosages will be at issue in a June hearing as death row lawyers challenge the constitutionality of Louisiana’s two-drug protocol.

“The execution protocol proposed by the State of Louisiana, which provides for the use of an experimental drug combination — midazolam and hydromorphone — is woefully inadequate,” Mercedes Montagnes, an attorney for Sepulvado, told The Lens.

“Reckless experimentation with untested drug combinations will lead to nightmarish results, as the botched executions of Dennis McGuire in Ohio and Clayton Lockett in Oklahoma have recently demonstrated,” Montagnes said. “The secretive and inadequate protocol proposed by the state presents an unacceptable risk that executions in Louisiana will be slow and torturous.”

Dosages not tailored to each inmate

In the medical field, midazolam is used to induce sleepiness and relieve anxiety, according to a report issued by the Ohio Department of Rehabilitation and Correction.

Waisel has previously said that an improper administration of drugs can cause “air hunger” — a suffocation-like experience that he calls a “horrible feeling.”

Part of the problem, according to Waisel, is that states have created protocols that call for a “one size fits all” approach using a set amount of midazolam, regardless of the inmate’s size, weight, or medical history.

By contrast, in a hospital setting it’s standard to take those factors into account before administering a drug such as midazolam because it may affect individuals differently, Waisel said.

The drug’s warnings call for “individualization of dosage“ and list negative effects, especially in combination with other drugs. Those effects include hypoventilation, airway obstruction and apnea, conditions that “can lead to hypoxia and/or cardiac arrest unless effective countermeasures are taken immediately.”

 Midazolam dosage by state
Louisiana10 mg
Ohio50 mg (increased from 10 mg)
Oklahoma100 mg
Florida500 mg
Virginia500 mg (increased from 100 mg)

Florida uses fifty times more midazolam than Louisiana to execute prisoners

In October, William Happ became the first condemned inmate to be injected with midazolam. Reportedly, he blinked repeatedly, shook his head back and forth and took 14 minutes to die.

In March, the Florida Supreme Court found the protocol constitutional, based on testimony from Dr. Roswell Lee Evans, a professor and dean at Auburn University’s Harrison School of Pharmacy. Evans said an inmate would no longer feel anything after an initial dosage of 250 milligrams, half the amount specified in the Florida protocol.

According to a Florida Supreme Court ruling, Evans found that a high dosage of midazolam would have a very significant effect on the central nervous system, and the recipient of the drug would “almost immediately lose consciousness and not be able to feel pain.”

Though the Ohio protocol called for administering 10 milligrams of midazolam to McGuire, Waisel has testified that someone of McGuire’s weight — 250 pounds — would need at least 29 milligrams of midazolam to cause unconsciousness.

Although witnesses say otherwise, a report on McGuire’s death by the Ohio Department of Rehabilitation and Correction found that he did not suffer. “He did not experience pain, distress or air hunger after the drugs were administered or when the bodily movements and sounds occurred,” the report reads.

In that same report, however, officials said they intended to increase the drug dosages anyway.

Questions about Oklahoma execution

It’s not clear what went wrong during Oklahoma’s execution.

According to prison officials, Lockett’s vein line ruptured after he was given the midazolam as a sedative. This happened while the other two drugs — the paralytic vecuronium bromide and the heart-stopper potassium chloride — were flowing into his body.

Even though Lockett was declared unconscious after being given midazolam, he jerked and spoke after the other two drugs were administered. Oklahoma officials conceded that the combination of drugs therefore didn’t have the intended effect.

According to an article in The Atlantic, the theory that the vein line ruptured is “dubious.” Lockett’s lawyers have also questioned the effectiveness of midazolam.

A day after the botched execution, Oklahoma Gov. Mary Fallin said she has ordered a review of death chamber protocols.

“The State’s protocol fails to ensure that the execution team will be trained to properly administer the lethal injection drugs or manage any possible paradoxical or negative side effects,” Montagnes said.

Even if midazolam is effective, Sepulvado’s lawyers have questioned how the drug is injected in Louisiana executions. They contend that the Department of Corrections staff lacks the expertise to administer the drug properly because they’re not doctors. That’s likely, they argue, to cause their client to suffer the way Lockett did.

This story was updated after publication to include a comment from the Louisiana Department of Public Safety and Corrections. (May 1, 2014)

Della Hasselle

Della Hasselle, a freelance journalist and producer, reports environmental and criminal justice stories for The Lens. A graduate of Benjamin Franklin High School and the New Orleans Center for Creative...