1. Getting The Drugs
Most pharmaceutical companies refuse to let states use their drugs for executions. So some states have tried to import drugs – against federal laws – or resort to buying them from unregulated compounding pharmacies with poor safety records.
2. Preparing The Drugs
States have run into a host of problems as they get the drugs ready: drugs expire because of lengthy court challenges that delay executions; the wrong drugs have been used (Oklahoma, in 2015); the wrong doses have been used in multiple cases.
3. Placing The IV
Since most doctors won’t participate in executions, IVs are often placed by nonmedical prison personnel or nurses with little experience. This can lead to serious issues affecting the execution: the inability to find a vein, since inmates disproportionately have collapsed veins due to drug use or poor health; mistakenly inserting the IV into tissue, which won’t deliver the drugs’ effect; IVs slipping out partway through the execution.
4. The Lungs
Massive intravenous doses of drugs can injure the delicate wall between capillaries and air sacs in the lungs, allowing them to fill up with fluid. This is called pulmonary edema, and an NPR analysis of more than 200 autopsies found that it developed in more than 84% of those executions.
5. Conscious Or Not?
Midazolam, a drug used in dozens of executions in recent years, wasn’t developed to induce anesthesia, and doctors have raised serious concerns about its ability to render inmates unconscious. Many inmates have exhibited signs of consciousness after receiving midazolam, by gasping, lurching, writhing and yelling.