51˶

Lethal Injection: 'Burning as They Die'

— How death penalty drugs go unregulated

MedpageToday

A Houston-based pharmacy called may be the source of pentobarbital used in Texas lethal injection executions. Greenpark Compounding has a storied history and has been the subject of a number of complaints as a result of improper drug manufacturing leading to patient harm. Compounding pharmacies have been in the spotlight before for bad manufacturing, most notoriously in the case of (NECC). In 2012, NECC manufactured an injectable steroid that was later shown to be contaminated with a fungus. This compounded steroid was used widely to treat patients and as a direct result, 64 people died, and 793 patients became sick. Charges arising from this case included racketeering, racketeering conspiracy, mail fraud, and false labeling. The pharmacist in charge of NECC was later sentenced to 8 years in prison.

Lethal injection has the look and feel of a medical act. This is no accident. Lethal injection involves protocols, medical equipment, pharmaceuticals, and people in white coats. The state wishes the public to believe lethal injection, therefore, is subject to the same safety oversights as medical procedures and by association, be regarded as a serious and sober activity. This is a false claim. Lethal injection is not subject to anything within medical or pharmaceutical regulation. As such, any attempt to cite medical or pharmaceutical regulatory oversight in any aspect of lethal injection, including drug manufacturing, is a forgery of the truth. No pharmaceutical contains "lethal injection" as an FDA-labeled indication. In the case of Texas Corrections, pentobarbital is intended to be used as poison, not as medicine. The question as to the proper assembly of a poison might be better asked of the Evil Queen in "Snow White" than a pharmacy regulatory manufacturing authority. Greenpark Compounding may have substandard practices with respect to some of its pharmaceutical production but as a maker of poison for execution, it appears to have an unblemished record of success.

In several lethal injection executions in Texas, inmates have been heard to declare a . The 8th amendment of the U.S. Constitution unambiguously proscribes cruelty in the setting of punishment. Previous courts have claimed there is such a thing as the and lethal injection does not need to be pain-free to be a constitutionally valid form of punishment. In the medical field, no such notion of the normal pain of dying exists and doctors do not seek treatment for the dying up until the point of when the normal dying pain apparently occurs. Doctors seek to relieve all pain that might be associated with dying and anything less than this is considered a treatment failure.

Properly assembled pentobarbital is a drug known to be of a caustic nature. Texas Corrections injects a large quantity of this chemical into individuals with the intention of killing them. Properly assembled, or tainted, this chemical will likely burn on injection. This burning is not trivial, and the burning occurs inside of the body as well as in the vein that first encounters the pentobarbital. Autopsies of executed inmates show internal organ damage. It would be false to claim that pentobarbital kills by inducing sleep and the body remains pristine. At autopsy, the evidence under the skin of the deceased tells a markedly different story. Greenpark Pharmaceuticals may be below pharmaceutical industry manufacturing standards but as makers of poison, they are more than up to the task. To criticize Greenpark Pharmaceuticals here would be akin to discover that the bullets used in a firing squad execution turned out not to be polished.

is fellowship director in critical care medicine at Emory University School of Medicine in Atlanta. His clinical expertise and research interest include care of critically ill patients in the OR and ICU, education and scholarly work in bioethics, the anthropology of conflict resolution, pharmaco-economics, and a variety of topics related to anesthesiology/critical care monitoring and practice.