Anesthesiologists unwilling to assist in Missouri executions

ST. LOUIS -- Two days after a federal judge ordered Missouri to revamp its execution procedures, the state's corrections chief says it is finding it "very challenging" to land one key component -- a board-certified anesthesiologist to assist in lethal injections.

Corrections Department director Larry Crawford said Wednesday his office has put out feelers, but is meeting with resistance from anesthesiologists wary of crossing an ethical line that could cost them their practice.

He's even solicited help from 37 other states that, like Missouri, use a series of three intravenously injected drugs to execute condemned prisoners strapped to a gurney.

"We will cast our net as wide as we need to to see if we can comply," Crawford said. "We haven't been successful yet, and it doesn't look promising that we can find anyone willing to do it."

The Death Penalty Information Center says no other state has been required to employ such involvement by an anesthesiologist in carrying out an execution.

"This is a new wrinkle on all of this," said Richard Dieter, executive director of the nonprofit research organization.

"This requirement is a new and problematic area. ... It's one thing to say a doctor should be present. It's another to say you shall be present. It isn't being done anywhere else."

Dieter said a federal judge's order Monday is the first high-level, definitive ruling of what has to be changed in a state's lethal injection protocol.

Ruling in the case of death row inmate Michael Taylor of Kansas City, U.S. District Judge Fernando Gaitan Jr. ordered the state corrections department to make sweeping changes to its execution protocol by July 15. He halted executions until he was satisfied that Missouri's procedures posed no risk of unnecessary pain and suffering.

In his ruling, Gaitan expressed grave concerns that a surgeon, a self-described dyslexic identified only as "John Doe 1," had much discretion and worked under no written protocol in mixing the lethal drugs and overseeing the executions, despite his lack of training in anesthesiology.

Moreover, the surgeon admitted using less than half the expected dose of the first drug, which is supposed to render the inmate unconscious.

Two other drugs given in quick succession are aimed at paralyzing the inmate, then stopping his heart.

Taylor's attorneys argued that inmates could be left paralyzed and unable to say they were still conscious and feeling the third, heart-stopping drug, which causes excruciating pain.

The same argument from inmates is being tested throughout the U.S.

Gaitan's ruling makes the anesthesiologist's role central in executions.

The specialist would mix the drugs, and administer them or observe those who do. He or she would determine and monitor the inmate's level of consciousness, with the help of monitoring equipment or presence in the execution room.

The anesthesiologist also would serve as a consultant in drafting the state's protocol, contingency plan and auditing process.

But the medical profession is decidedly uncomfortable with the role.

In February, a federal judge recommended that California employ two anesthesiologists to ensure that a condemned prisoner was fully unconscious at his execution. They initially agreed, then backed out, citing ethical concerns.

Also in February, the American Society of Anesthesiologists issued a statement saying it supports the American Medical Association's position that doctors should not directly or indirectly participate in executions.

"Physicians are healers, not executioners," the ASA statement said in part.

Dr. Orin Guidry, president of the ASA, said the practice of anesthesiologists assisting in executions is "really misguided" and "inappropriate." He said the mere image would lead patients undergoing surgery to wonder if their anesthesiologist is acting in their best interest.

He said some anesthesiologists may feel a compassionate duty to ensure an inmate's painless death, but state demands on these doctors are getting progressively more specific.

"Medicine didn't create this box the legal system has gotten itself into and it's not up to medicine to solve their problem," he said.

A North Carolina man was executed in April wearing a brain function monitor to measure his level of consciousness. Both Guidry and the manufacturer said the monitor wasn't designed for executions. It's not clear whether the medical person who monitored it was an anesthesiologist.

The Missouri attorney general's office has four pending execution requests before the Missouri Supreme Court, which has not scheduled them.

"The court's order does not say that the method of lethal injection used in Missouri is a constitutional problem, but rather the problem is with how it is currently implemented," attorney general's office spokesman Scott Holste said.

The 8th U.S. Circuit Court of Appeals will review Gaitan's ruling.

"We're under fire now," Crawford said.

Will the state have to cease executions if it can't find an anesthesiologist?

"That's a logical conclusion, but I'm not ready to say that's what's going to happen," Crawford said. "All eyes are on Missouri."

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On the Net:

Missouri Department of Corrections: http://www.doc.missouri.gov/

American Medical Association: http://www.ama-assn.org/

American Society of Anesthesiologists: http://www.asahq.org/

The Death Penalty Information Center: http://www.deathpenaltyinfo.org/