Uncomfortably Numb

Oklahoma wasted little time in adopting Deutsch's recommendation: a large dose of sodium pentothal followed by a large dose of Pavulon. When the state enacted the nation's first lethal-injection statute on May 11, 1977, a third drug had been added: potassium chloride. Texas followed suit with its own lethal-injection statute the next day, and by 1981 five states had similar protocols on the books. Missouri adopted its first lethal-injection protocol, signed into law by then-Governor John Ashcroft, in 1988. At present, the method is used by all but one of the 38 states that execute inmates. (Nebraska uses the electric chair.)

The American Medical Association has publicly condemned physician involvement in lethal injection. Deutsch's participation notwithstanding, it is unlikely that physicians have played an active role in crafting lethal-injection protocols. Instead, death-penalty experts say, many states settled on lethal-injection protocols by consulting with other states, or by simply copying. "Correctional officers certainly traveled from one state to another as the issue came up," says Richard Dieter, executive director of the Death Penalty Information Center, a Washington, D.C.-based nonprofit critical of capital punishment. "Prisons invited people down to Texas to watch, and of course Texas was regularly carrying these things out, so you could probably witness one."

Today, according to a study published in the Ohio State Law Journal, 27 of the 37 states that use lethal injection employ Oklahoma's original combination. "Deutsch's recommendations of specific drugs [are] incorporated in all of the latest lethal injection protocols," writes Deborah Denno, a Fordham University law professor who authored the 2002 study of how states adopt and alter execution methods. "It is not clear how or why this chemical combination has persisted."

Denno is quick to add that in many states, the specifics remain a mystery. Many states refuse to disclose their protocols or how they arrived at them. According to her study, nineteen states make their protocols publicly available, twelve states (including Missouri) keep their protocols partially private and another five states keep them completely confidential.

"Most of these protocols provide an enormous amount of detail about how to get the prisoner to the execution room: what time he leaves the cell, things like that. But as soon as he leaves that cell, there's nothing -- there's nothing available," says Denno, a self-described opponent of the death penalty who specializes in the legislative history of capital punishment. "They don't specify what drugs they are going to use."

Citing security concerns, officials from the Missouri Department of Corrections declined interview requests for this story. The department has also declined several requests to make its lethal-injection protocols public. In fact, Missouri's lethal-injection statute doesn't require a protocol at all. But various court documents, as well as interviews conducted for this story, indicate that soon after adopting lethal injection as its means of execution, Missouri became the first of several states to purchase a so-called lethal injection machine manufactured by Massachusetts-based Fred A. Leuchter Associates, Inc.

Leuchter's machine specified Oklahoma's sequence of sodium pentothal, Pavulon and potassium chloride. Leuchter, who had no pharmacological training, says he gauged the chemical quantities he called for by extrapolating from lethal dosages for farm animals. "They did it with pigs and rabbits. I had to increase the body weight to get to a human being," Leuchter says today. "The only thing I didn't do was they wanted me to execute a pig. I refused to execute a pig. I wound up executing a watermelon for them."

Soon after Missouri purchased its machine from Leuchter, the inventor's reputation began to crumble. On July 20, 1990, Alabama assistant attorney general Ed Carnes addressed a letter to all states with capital-punishment statutes on the books. "The purpose of the memo was to suggest that, because he has a degree in history rather than engineering, Fred Leuchter [was] not qualified as an expert in execution technology," writes Stephen Trombley in The Execution Protocol: Inside America's Capital Punishment Industry.

Leuchter, who says he does indeed hold an engineering degree, was also the subject of Mr. Death: The Rise and Fall of Fred A. Leuchter, Jr. , a 1999 feature by documentary filmmaker Errol Morris. The film traces Leuchter's involvement with execution technologies, including his eventual fall from grace when he published the infamous "Leuchter Report," a monograph that denies the existence of gas chambers at Auschwitz.

Missouri corrections spokesman John Fougere says the state stopped using Leuchter's machine "in the early '90s" and now employs prison workers to manually administer the chemicals. The mix, Fougere confirms, consists of sodium pentothal, Pavulon and potassium chloride, injected in that order.

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"It's a surprising and bizarre choice of drugs," says Columbia University Medical Center anesthesiologist Mark Heath. "The goals of the procedure are to render the inmate dead and to do so in a humane fashion. These drugs are poorly selected to achieve these goals -- particular the latter goal."