Anesthesiologist Testifies As Arkansas Lethal Injection Drug Trial Ends Week 1

Apr 26, 2019

The federal courthouse in Little Rock Friday where the federal trial is being held in a lawsuit by 18 Arkansas death row inmates challenging the use of the sedative midazolam.
Credit Michael Hibblen / KUAR News

An anesthesiologist testified Friday in the lawsuit brought by a group of Arkansas death row inmates that two of the prisoners who were put to death in 2017 likely suffered "excruciating" pain because of the first drug used in the state’s lethal injection process. Dr. Gail Van Norman from Seattle said that’s because midazolam has no significant clinical anesthetic effects.

An attorney for the state countered that Van Norman has not done any scientific research on midazolam and, in particular, the dosage used by the state before injecting subsequent drugs that paralyze the muscles and stop the heart. Van Norman also acknowledged she is personally opposed to the death penalty and would never consult with a state on how to proceed with an execution.

Van Norman specializes in preparing patients for potentially painful procedures like surgery. She said part of that involves making sure patients are not aware of what is happening, don’t feel the pain and don’t remember the event.

The doctor has been sitting in the federal courtroom during testimony this week as witnesses to executions involving midazolam have described what they saw. She said it was a medical certainty that the inmates experienced pain and suffering.

"We don’t just use midazolam for anesthetics ever. It’s not an anesthetic agent. We give multiple drugs and usually among the mix is a narcotic medication that is specifically geared to block pain reception," Van Norman said while answering questions from public defender John C. Williams.

She testified that consciousness checks done by staff inside the death chamber, including pinching inmates, rubbing their eyes or calling their names are not sufficient to determine whether an inmate has been effectively knocked out and is ready for the subsequent drugs. Van Norman said better ways to check consciousness include the Isolated Forearm Technique, which is often used in surgeries. That involves a tourniquet tied to a patient’s upper arm and the administration of muscle relaxants, which allows someone to move their arm to indicate awareness or pain.

Inmate Kenneth Williams lurched repeatedly against restraints in the gurney and groaned during his execution, while Marcel Williams moved the pupil of an eye when he was put to death. Van Norman said the actions were likely indications that prisoners were aware of what was happening. She also testified that she believed both inmates experienced “excruciating” feelings of suffocation, followed by the pain of the potassium chloride being injected, which stops the heart.

The fact that the reactions of prisoners were not more dramatic isn’t a sign that the midazolam is helping alleviate pain, Van Norman said.

"The midazolam itself is incapable of producing analgesia for such strong stimuli, but it is capable of blocking or potentially reducing responses, and the movements are being masked in any case by the introduction of the paralytic agents. The prisoners are unable to move in response to indicate that they are suffering. So if there were no movements, that would still make perfect sense."

Under cross-examination by Assistant Attorney General Jennifer Merritt, Van Norman said she has never used 500 milligrams of midazolam, which is the dosage used by the state in lethal injections. The doctor also said that no one knows what the ceiling effect of midazolam is, referencing the point at which administering additional doses of the drug will have no further benefit for the patient.

"There is very strong scientific consensus that a ceiling effect exists, but no one has stated what that dose would be," Van Norman said.

The trial is expected to continue through next week, with attorneys for the state to eventually begin calling witnesses of their own. The trial is significant for other states that also use midazolam in their lethal injection procedures.