Post by thinkinkmesa on Aug 15, 2008 15:25:34 GMT -5
The Executioners
*
By ERIC LYTTLE
Published: Thursday, August 14, 2008 7:31 AM EDT
On Oct. 14, the state of Ohio is scheduled to execute Death Row
inmate Richard Cooey by injecting a lethal three-drug combination
through several feet of tubing into a hollow IV needle inserted
directly into his vein. The state mandates that the killing be done
“quickly and painlessly.”
There’s one problem, though. The medical professionals best suited to
carry out the process want no part of it.
There’s a confounding contradiction in the Ohio Revised Code.
On the one hand, the state courts and legislature support the death
penalty as an apparent public good, a deterrent to society’s most
heinous crimes. Courts at both the state and federal levels have
consistently ruled in favor of capital punishment in Ohio and the 37
other states that allow the death penalty.
What’s more, Ohio has deemed lethal injection the only humane way to
kill a Death Row inmate since 2001, when Gov. Bob Taft signed House
Bill 362, eliminating the electric chair as a form of punishment.
Section 2949.22 of the Ohio Revised Code states, “a death sentence
shall be executed by causing the application to the person, upon whom
the sentence was imposed, of a lethal injection of a drug or
combination of drugs of sufficient dosage to quickly and painlessly
cause death.”
In Ohio, that lethal combination of drugs includes two 40 cc syringes
of sodium thiopental, an anesthetic that is intended to render the
victim unconscious, followed by two 25 cc syringes of pancuronium
bromide, which paralyzes the condemned person, preventing him from
breathing, moving, communicating or even making a facial expression.
The third drug administered is a 50 cc syringe full of potassium
chloride, which stops the heart.
The process is, for all intents and purposes, a medical procedure,
and state law dictates that only certain qualified and licensed
members of society can receive, prepare and deliver the controlled
substances. The Ohio Department of Rehabilitation and Correction
execution protocol states, “Medical personnel, first and foremost,
must be qualified under Ohio law to be able to prepare and administer
intravenous drugs and/or be qualified to start an IV.”
The drugs, the syringes, the IV lines all are identical to those used
in hospitals daily.
Yet strangely, another part of the Ohio Revised Code makes it all but
illegal for any member of the medical profession to take part in the
state’s execution procedure.
Section 4731.22 permits the state medical board to “limit, revoke, or
suspend an individual’s certificate to practice, refuse to register
an individual, refuse to reinstate a certificate, or reprimand or
place on probation” a licensed medical professional for a number of
infractions, including a “violation of any provision of a code of
ethics of the American medical association, the American osteopathic
association, the American podiatric medical association, or any other
national professional organizations that the board specifies by rule.”
And, almost without exception, every medical association in the
country specifically decries its members’ participation in state-
sponsored executions as a direct violation of the profession’s
guiding “first do no harm” principle of the Hippocratic Oath.
The largest of these, the American Medical Association, resolves, “A
physician, as a member of a profession dedicated to preserving life
when there is hope of doing so, should not be a participant in a
legally authorized execution.” It further defines participation as
“prescribing or administering” drugs used in an execution,
“monitoring vital signs,” “attending or observing an execution” or
“rendering technical advice regarding execution.”
Most others have followed suit, including the American Nurses
Association, the American Public Health Association, the American
Society of Anesthesiologist and the American Osteopathic Association.
Curiously, even the Society of Correctional Physicians, which
represents physicians who provide health care to prisoners, states in
its code of ethics that “the correctional health professional shall…
not be involved in any aspect of execution of the death penalty.”
But laws are little more than black words on white pages unless
they’re enforced and, to date, no member of the medical profession
has ever been subject to discipline by the Ohio Medical Board for
participating in a state-sponsored execution. In fact, the Ohio
Medical Board has seemingly taken a head-in-the- sand approach to the
issue.
“We don’t have an opinion on state-sponsored execution,” said Joan
Wehrle, the board’s executive staff coordinator. “The topic just
hasn’t come up for discussion before the board.”
In practice, however, the apparent legal paradox has made life tough
for the Ohio Department of Rehabilitation and Correction.
The ODRC’s execution team consists of 12 to 15 members, of which
“three to four” make up the team’s medical staff, according to
department spokesperson Andrea Carson. None of those three to four
are physicians or nurses; instead, they’re certified Emergency
Medical Technicians, Carson said, and all are ODRC employees.
The National Association of Emergency Medical Technicians, by the
way, has an ethics code as well, which states: “(NAEMT) is strongly
opposed to participation in capital punishment by an EMT, Paramedic
or other emergency medical professional. Participation in executions
is viewed as contrary to the fundamental goals and ethical
obligations of emergency medical services.
With all the legal and ethical paradoxes they face, it should come as
no surprise that the identities of the ODRC execution-team members
are closely guarded.
“These folks, in my opinion, perform one of the most difficult tasks
of any public servant,” said Greg Trout, chief legal adviser for the
DRC. “Capital punishment is part of the law of the state of Ohio, and
the Ohio Department of Rehabilitation and Correction is charged with
carrying that out. At some point or other, these volunteers became
aware of the need to fulfill our legal obligation, and they do so to
demonstrate a measure of compassion and dignity with respect to the
man who is about to lose his life, as well as to the witnesses and
the families of the victims.”
Maintaining their anonymity, Trout said, is a necessary part of being
able to carry out the process effectively.
“The concern is that if we turned the spotlight on them, the negative
publicity that could come to them could impact the role they take,”
Trout said.
“Their anonymity extends even throughout the institution. The inmates
and some employees at Lucasville don’t know who they are. In one
case, the spouse does not even know this individual is a member of
the team.”
The medical preparations, including inserting the IV lines into the
inmate as well as delivering the series of lethal injections, take
place in a room adjacent to the death chamber, outside the view of
the witnesses.
Though no MDs, DOs or registered nurses take part in Ohio’s execution
process, Trout suggested their presence would be welcome, even as he
defended the execution team’s current makeup.
“We use people who are qualified to prepare and administer
intravenous drugs,” Trout said, “and we feel comfortable with the
competence of our team members. But we’re always looking for ways to
improve and learn. And if, at some point, we came across a physician
who was willing to participate and is not suspected of having an
agenda that is at odds with what we’re trying to accomplish, we’d
certainly consider them. But they’re not exactly filling out
applications and sending in resumés.”
The obvious concern is that the state is relegated to using EMTs,
whose medical training and expertise fall decidedly below that of
physicians and nurses, to oversee a most stressful and difficult
procedure, wrought with controversy and possible pitfalls. In
addition to the intensity of the moment—involving the death of a
fellow human being—Death Row inmates present a number of unique
difficulties as well, such as longtime IV drug use, or obesity from
years of inactivity in a cell, both of which make vascular access
more problematic. And most aren’t cooperative patients.
Twice in the past two years, that medley of circumstance has
conspired to cause problems in the execution process in Ohio.
In May 2006, medical technicians struggled to find a usable vein to
execute convicted killer Joseph Clark. Then, once the IV was inserted
and the drugs began to be administered, it quickly became apparent
something was wrong. Clark lifted his head and said, “It don’t work,”
five times, according to witnesses, before prison officials
temporarily halted the execution and closed the curtain. Apparently,
the chosen vein had collapsed, and the drugs were being injected into
his skin.
Medical staff struggled for more than 30 minutes behind the curtain
to find another vein, and witnesses reported hearing “moaning, crying
out and guttural noises” in the interval. Reports say Clark even
requested that the poison be administered orally rather than continue
suffering as staff searched for other IV locations. Eventually, the
curtain was reopened—with Clark unconscious—and the execution was
completed.
Then, in May 2007, prison EMTs took more than 70 minutes to find a
usable vein in Christopher Newton, whose obesity complicated matters.
Newton, who reportedly laughed through the struggle, was even given a
bathroom break during the search for a vein. The process, which
typically should take little more than 15 minutes, took nearly two
hours from start to finish.
Both cases arguably stretched Ohio’s legal definition of “quickly and
painlessly.”
And now, attorneys for Richard Cooey—scheduled to become Ohio’s 27th
person to be executed in Ohio since Wilford Berry, “The Volunteer,”
was killed in 1999—have fired a warning shot across the state’s bow
that this, too, may be a problematic case. Cooey, through the Ohio
Public Defender’s office, filed suit against the state Aug. 4,
stating that, with his particular medical circumstances, being
executed under Ohio’s current protocol would violate his rights to
humane treatment.
Cooey, convicted in 1986 of raping and murdering two University of
Akron coeds, claims his “morbid obesity” (he’s 5 feet, 7 inches tall
and weighs 267 pounds) increases the risk that IV access will be
problematic. In addition, the suit claims Cooey has been receiving
the drug Topamax for migraines for years, which, in the opinion of a
sworn medical expert, may cause a resistance to the barbiturate that
is the first drug administered in the lethal injection process.
“One of the pieces,” said Cooey’s lead attorney, Kelly Schneider,
“is questioning whether the people who administer the protocol are
trained, experienced and qualified to warrant them proficient to deal
with this situation.”
“We’re not arguing that he’s too fat to be executed,” Schneider said.
“We’re saying there need to changes to the current protocol. We’re
trying to avoid what’s happened to Joe Clark and Christopher Newton.”
The case is pending. Cooey’s clemency hearing is scheduled for Aug. 25.
www.theotherpaper.com/articles/2008/08/14/cover_story/doc48a353021f25b556052407.txt
*
By ERIC LYTTLE
Published: Thursday, August 14, 2008 7:31 AM EDT
On Oct. 14, the state of Ohio is scheduled to execute Death Row
inmate Richard Cooey by injecting a lethal three-drug combination
through several feet of tubing into a hollow IV needle inserted
directly into his vein. The state mandates that the killing be done
“quickly and painlessly.”
There’s one problem, though. The medical professionals best suited to
carry out the process want no part of it.
There’s a confounding contradiction in the Ohio Revised Code.
On the one hand, the state courts and legislature support the death
penalty as an apparent public good, a deterrent to society’s most
heinous crimes. Courts at both the state and federal levels have
consistently ruled in favor of capital punishment in Ohio and the 37
other states that allow the death penalty.
What’s more, Ohio has deemed lethal injection the only humane way to
kill a Death Row inmate since 2001, when Gov. Bob Taft signed House
Bill 362, eliminating the electric chair as a form of punishment.
Section 2949.22 of the Ohio Revised Code states, “a death sentence
shall be executed by causing the application to the person, upon whom
the sentence was imposed, of a lethal injection of a drug or
combination of drugs of sufficient dosage to quickly and painlessly
cause death.”
In Ohio, that lethal combination of drugs includes two 40 cc syringes
of sodium thiopental, an anesthetic that is intended to render the
victim unconscious, followed by two 25 cc syringes of pancuronium
bromide, which paralyzes the condemned person, preventing him from
breathing, moving, communicating or even making a facial expression.
The third drug administered is a 50 cc syringe full of potassium
chloride, which stops the heart.
The process is, for all intents and purposes, a medical procedure,
and state law dictates that only certain qualified and licensed
members of society can receive, prepare and deliver the controlled
substances. The Ohio Department of Rehabilitation and Correction
execution protocol states, “Medical personnel, first and foremost,
must be qualified under Ohio law to be able to prepare and administer
intravenous drugs and/or be qualified to start an IV.”
The drugs, the syringes, the IV lines all are identical to those used
in hospitals daily.
Yet strangely, another part of the Ohio Revised Code makes it all but
illegal for any member of the medical profession to take part in the
state’s execution procedure.
Section 4731.22 permits the state medical board to “limit, revoke, or
suspend an individual’s certificate to practice, refuse to register
an individual, refuse to reinstate a certificate, or reprimand or
place on probation” a licensed medical professional for a number of
infractions, including a “violation of any provision of a code of
ethics of the American medical association, the American osteopathic
association, the American podiatric medical association, or any other
national professional organizations that the board specifies by rule.”
And, almost without exception, every medical association in the
country specifically decries its members’ participation in state-
sponsored executions as a direct violation of the profession’s
guiding “first do no harm” principle of the Hippocratic Oath.
The largest of these, the American Medical Association, resolves, “A
physician, as a member of a profession dedicated to preserving life
when there is hope of doing so, should not be a participant in a
legally authorized execution.” It further defines participation as
“prescribing or administering” drugs used in an execution,
“monitoring vital signs,” “attending or observing an execution” or
“rendering technical advice regarding execution.”
Most others have followed suit, including the American Nurses
Association, the American Public Health Association, the American
Society of Anesthesiologist and the American Osteopathic Association.
Curiously, even the Society of Correctional Physicians, which
represents physicians who provide health care to prisoners, states in
its code of ethics that “the correctional health professional shall…
not be involved in any aspect of execution of the death penalty.”
But laws are little more than black words on white pages unless
they’re enforced and, to date, no member of the medical profession
has ever been subject to discipline by the Ohio Medical Board for
participating in a state-sponsored execution. In fact, the Ohio
Medical Board has seemingly taken a head-in-the- sand approach to the
issue.
“We don’t have an opinion on state-sponsored execution,” said Joan
Wehrle, the board’s executive staff coordinator. “The topic just
hasn’t come up for discussion before the board.”
In practice, however, the apparent legal paradox has made life tough
for the Ohio Department of Rehabilitation and Correction.
The ODRC’s execution team consists of 12 to 15 members, of which
“three to four” make up the team’s medical staff, according to
department spokesperson Andrea Carson. None of those three to four
are physicians or nurses; instead, they’re certified Emergency
Medical Technicians, Carson said, and all are ODRC employees.
The National Association of Emergency Medical Technicians, by the
way, has an ethics code as well, which states: “(NAEMT) is strongly
opposed to participation in capital punishment by an EMT, Paramedic
or other emergency medical professional. Participation in executions
is viewed as contrary to the fundamental goals and ethical
obligations of emergency medical services.
With all the legal and ethical paradoxes they face, it should come as
no surprise that the identities of the ODRC execution-team members
are closely guarded.
“These folks, in my opinion, perform one of the most difficult tasks
of any public servant,” said Greg Trout, chief legal adviser for the
DRC. “Capital punishment is part of the law of the state of Ohio, and
the Ohio Department of Rehabilitation and Correction is charged with
carrying that out. At some point or other, these volunteers became
aware of the need to fulfill our legal obligation, and they do so to
demonstrate a measure of compassion and dignity with respect to the
man who is about to lose his life, as well as to the witnesses and
the families of the victims.”
Maintaining their anonymity, Trout said, is a necessary part of being
able to carry out the process effectively.
“The concern is that if we turned the spotlight on them, the negative
publicity that could come to them could impact the role they take,”
Trout said.
“Their anonymity extends even throughout the institution. The inmates
and some employees at Lucasville don’t know who they are. In one
case, the spouse does not even know this individual is a member of
the team.”
The medical preparations, including inserting the IV lines into the
inmate as well as delivering the series of lethal injections, take
place in a room adjacent to the death chamber, outside the view of
the witnesses.
Though no MDs, DOs or registered nurses take part in Ohio’s execution
process, Trout suggested their presence would be welcome, even as he
defended the execution team’s current makeup.
“We use people who are qualified to prepare and administer
intravenous drugs,” Trout said, “and we feel comfortable with the
competence of our team members. But we’re always looking for ways to
improve and learn. And if, at some point, we came across a physician
who was willing to participate and is not suspected of having an
agenda that is at odds with what we’re trying to accomplish, we’d
certainly consider them. But they’re not exactly filling out
applications and sending in resumés.”
The obvious concern is that the state is relegated to using EMTs,
whose medical training and expertise fall decidedly below that of
physicians and nurses, to oversee a most stressful and difficult
procedure, wrought with controversy and possible pitfalls. In
addition to the intensity of the moment—involving the death of a
fellow human being—Death Row inmates present a number of unique
difficulties as well, such as longtime IV drug use, or obesity from
years of inactivity in a cell, both of which make vascular access
more problematic. And most aren’t cooperative patients.
Twice in the past two years, that medley of circumstance has
conspired to cause problems in the execution process in Ohio.
In May 2006, medical technicians struggled to find a usable vein to
execute convicted killer Joseph Clark. Then, once the IV was inserted
and the drugs began to be administered, it quickly became apparent
something was wrong. Clark lifted his head and said, “It don’t work,”
five times, according to witnesses, before prison officials
temporarily halted the execution and closed the curtain. Apparently,
the chosen vein had collapsed, and the drugs were being injected into
his skin.
Medical staff struggled for more than 30 minutes behind the curtain
to find another vein, and witnesses reported hearing “moaning, crying
out and guttural noises” in the interval. Reports say Clark even
requested that the poison be administered orally rather than continue
suffering as staff searched for other IV locations. Eventually, the
curtain was reopened—with Clark unconscious—and the execution was
completed.
Then, in May 2007, prison EMTs took more than 70 minutes to find a
usable vein in Christopher Newton, whose obesity complicated matters.
Newton, who reportedly laughed through the struggle, was even given a
bathroom break during the search for a vein. The process, which
typically should take little more than 15 minutes, took nearly two
hours from start to finish.
Both cases arguably stretched Ohio’s legal definition of “quickly and
painlessly.”
And now, attorneys for Richard Cooey—scheduled to become Ohio’s 27th
person to be executed in Ohio since Wilford Berry, “The Volunteer,”
was killed in 1999—have fired a warning shot across the state’s bow
that this, too, may be a problematic case. Cooey, through the Ohio
Public Defender’s office, filed suit against the state Aug. 4,
stating that, with his particular medical circumstances, being
executed under Ohio’s current protocol would violate his rights to
humane treatment.
Cooey, convicted in 1986 of raping and murdering two University of
Akron coeds, claims his “morbid obesity” (he’s 5 feet, 7 inches tall
and weighs 267 pounds) increases the risk that IV access will be
problematic. In addition, the suit claims Cooey has been receiving
the drug Topamax for migraines for years, which, in the opinion of a
sworn medical expert, may cause a resistance to the barbiturate that
is the first drug administered in the lethal injection process.
“One of the pieces,” said Cooey’s lead attorney, Kelly Schneider,
“is questioning whether the people who administer the protocol are
trained, experienced and qualified to warrant them proficient to deal
with this situation.”
“We’re not arguing that he’s too fat to be executed,” Schneider said.
“We’re saying there need to changes to the current protocol. We’re
trying to avoid what’s happened to Joe Clark and Christopher Newton.”
The case is pending. Cooey’s clemency hearing is scheduled for Aug. 25.
www.theotherpaper.com/articles/2008/08/14/cover_story/doc48a353021f25b556052407.txt