By Rob Stein
Washington Post Staff Writer
Tuesday, April 24, 2007

The cocktail of drugs used for lethal injections is unreliable and could render inmates paralyzed but not unconscious, unable to cry out as they experience excruciating pain and eventually suffocate, according to a new scientific analysis.

The analysis, released yesterday and based on published data about the three drugs used and public records of executions in North Carolina and California, concluded that the protocol does not dependably induce a quick, painless death.

"This raises the possibility people are being tortured and you can't see it because they are paralyzed," said University of Miami surgery professor Leonidas G. Koniaris, who led the analysis. "I'm not sure a civilized society should be doing this."

The analysis comes at a time of turmoil over the use of lethal injection. At least 11 states have suspended executions after botched injections raised questions about the procedure and its administration.

The analysis, which was conducted to determine whether the process works when done correctly, concludes that the process is fundamentally flawed.

"I find it very disturbing," said Teresa A. Zimmers, a University of Miami research assistant professor who helped write the report.

"There is very little science behind this protocol, and the picture of lethal injection being a humane way to execute someone is completely wrong," she said.

The findings were seized upon by opponents of the death penalty.

"It's horrifying to read this," said Deborah W. Denno of Fordham University's law school. "What states are supposed to do is execute inmates in a humane way. There is clearly pain and suffering occurring."

But death-penalty supporters dismissed the findings as based on faulty assumptions.

"This doesn't pass the smell test," said Michael Rushford of the Criminal Justice Legal Foundation, a victims' rights group. "These people wouldn't be okay with Ethel Merman singing people to death."

Although the exact protocol for lethal injections varies from state to state, all use the same three drugs in large enough doses that any one alone should work. The first is sodium thiopental, a barbiturate intended to render the inmate unconscious at the start of the procedure and to prevent pain and suffering. The second drug, pancuronium bromide, paralyzes the muscles. The third drug, potassium chloride, is used to stop the heart.

The researchers examined what is known about the drugs' ability to achieve those results, based on clinical and laboratory studies in humans and animals. They then examined how the drugs are used based on records from 33 executions in North Carolina and eight in California between 1984 and 2006, such as medical examiners' reports on the inmates' weights. The researchers said their work was hindered by the secrecy surrounding executions in most states.

Nevertheless, in a paper being published online in the April issue of the journal PLoS Medicine, the researchers concluded that the dosages of thiopental and potassium chloride were insufficient. In addition, the dosages of thiopental may not be enough to render inmates unconscious at the outset or to keep them from waking during the process.

As a result, they wrote, some inmates may be fully aware as the paralyzing agent cuts off their ability to breathe. Moreover, pancuronium is known to cause severe pain, but the inmate would be unable to express that.

"It causes all the pain fibers in the body to fire," Koniaris said, noting that the protocol has been banned for use in animals. "It would be akin to feeling like your whole body is on fire. It's extremely painful."

Koniaris noted that even though the inmates are paralyzed, they are still able to cry, and tears have been reported in some executions.

"They are awake, but they would not be able to move their mouth or give any outward signs of being awake except tears," he said.

Jay Chapman, who developed the lethal-injection protocol when he was the state medical examiner in Oklahoma in 1977, disputed the findings, saying the method works if done properly.

"If the protocol is set up and carried out properly, death will result," he said. "It has to be done competently."

In an editorial accompanying the paper, the editors of the journal said they were not publishing the study in the hopes of prompting improvements to the protocol. Instead, they are hoping it will fuel a campaign to abolish executions.

"As a moral society, the U.S. should take a leading role in the abandonment of executions worldwide," they wrote.