"One is absolutely sickened, not by the crimes that the wicked have committed, but by the punishments that the good have inflicted." - Oscar Wilde

Thursday, May 14, 2015

Cruel and Unusual

A diagram from an autopsy performed on Lockett. Pathologists found nothing to explain why the doctor and the paramedic had had so much trouble placing an IV. (Oklahoma Department of Public Safety / AP)
A diagram from an autopsy performed on Lockett. Pathologists
found nothing to explain why the doctor and the paramedic had
had so much trouble placing an IV.
(Oklahoma Department of Public Safety / AP)
The botched execution of Clayton Lockett—and how capital punishment became so surreal

On the morning of his execution, Clayton Lockett hid under the covers.

Before a team of correctional officers came to get him at 5:06 a.m., he fashioned a noose out of his sheets. He pulled the blade out of a safety razor and made half-inch-long cuts on his arms. He swallowed a handful of pills that he’d been hoarding. And on April 29, 2014, when the team of officers knocked on the door of his cell in the Oklahoma State Penitentiary in McAlester, Oklahoma, Clayton Lockett—a 38-year-old convicted murderer—pulled a blanket over his head and refused to get up.

The officers left and asked for permission to tase him. While they were gone, Lockett tried to jam the door. They came back, forced their way in, tased him, and dragged him out.

Eleven hours later, at about 5:20 p.m., after a medical examination, X‑rays, eight hours in a holding cell, and a shower, Lockett was brought by a five-member strap-down team into the death chamber. It was a small, clinical-looking room with white walls and a polished floor that reflected the lights overhead. A gurney stood in the center of the room; above it hung a microphone for Lockett’s final words.

One of the walls in the chamber had a pair of baseball-size holes through which IV lines could pass into the chemical room, a small space where three executioners would administer the drugs that would kill him. The executioners had been driven to the prison earlier in the day, and had put on hoods as they approached. They would remain out of sight until after Lockett was dead.

In the execution chamber, Lockett was belted to the gurney. To his left, beige blinds covered the windows to the viewing area. Soon, shadows would be visible as the seats on the other side filled up. There was so much media interest in his execution that the prison had had to draw names to decide which reporters could attend.

A clock on the wall read 5:26. The execution was scheduled to begin at 6 p.m. Lockett could expect to be dead within about 45 minutes.

At 5:27 p.m., a paramedic approached the gurney. Like the three executioners, she would remain anonymous. Before the blinds opened, she would retreat into the chemical room while a doctor and the prison’s warden stayed with Lockett in the death chamber. But first she had a job to do: prepare the drugs and medical equipment, and get an IV into Lockett. (Those who participated in the execution either did not respond to requests for interviews or could not be reached. Court records provide a detailed account of what happened.)

The paramedic later told investigators that she’d felt incredible pressure since she’d walked into the room an hour earlier. She’d never participated in an execution that used midazolam. She’d never participated in two executions in one night—not many people in the world had. And she knew the media were watching.

Oklahoma's death chamber. (AP)
Oklahoma's death chamber. (AP)
To make matters worse, the equipment was all wrong: the saline was packed in bags instead of syringes, the drugs were in syringes that looked smaller than she was used to, and the tubing for the IV was the wrong kind. But she tried to focus on doing her job and getting everything set up on time. She would be paid $600 for the two executions.

The paramedic stuck a needle into a vein in Lockett’s left arm. A few drops of blood moved up the catheter—“flashback.” A good sign. It meant the needle was in the vein. But she’d forgotten tape to hold the IV in place. She asked someone to bring it to her, but the IV slipped out before she could secure it. Lockett’s arm started to bleed, so she put pressure on it and tried again. This time, she didn’t get flashback. Then she tried a brachial vein, near Lockett’s biceps. No luck there.

By now, she’d tried to place an IV three times. She’d been taught that if you can’t find a vein after the third attempt, you ask someone else to step in. So she asked the doctor to help.

The doctor, Johnny Zellmer, was a last-minute substitute. (Zellmer, whose name was revealed in a lawsuit following the execution and in multiple press reports, has not denied his involvement. He did not respond to requests for comment.) He was a local family-medicine and emergency-room physician who’d participated in just one previous execution. Zellmer had arguably violated his profession’s oath to “never do harm” the moment he stepped into the death chamber. Indeed, the American Medical Association’s code of ethics states that physicians should not participate in executions, even in a supervisory capacity. But Zellmer thought his job would be limited to checking the offender for consciousness and pronouncing the time of death. He wasn’t expecting to actually do anything to Lockett.

The paramedic’s request for help put him in the position of no longer just observing the execution but actively facilitating it. She was clearly struggling, though. He scanned Lockett’s body and didn’t see any good veins. Then Lockett turned his head, and the paramedic saw a vein in his neck pop up. She pointed it out to Zellmer. “Get me a needle for the jugular,” he said.

This was an odd choice. IVs in the neck are painful, and also hard to place. On the arms and legs, you can use a tourniquet to bring the veins up. You cannot do that on the neck, because a tourniquet on the neck is effectively a noose, and while this was an execution, it was not a hanging.

As Zellmer tried to get the needle into the jugular, the paramedic stuck Lockett three more times on his right arm, failing each time.

Zellmer got the needle into Lockett’s neck and saw flashback, but then saw blood spread under the skin—he thought the needle might have gone all the way through the vein. Zellmer decided to try a subclavian line, in a vein running beneath Lockett’s collarbone. The paramedic brought him a central-venous catheterization kit, and Zellmer numbed Lockett’s chest with lidocaine. The paramedic tried two different veins on Lockett’s right foot; both attempts failed.

Clayton Lockett
Clayton Lockett
Zellmer kept trying to get the needle into Lockett’s subclavian vein. He finally saw a little flashback, then lost the vein and couldn’t get the needle back in. After repeatedly sticking Lockett’s chest, he decided to try the femoral vein, in Lockett’s groin. The paramedic went to get a longer needle.

As the warden, Anita Trammell, watched the doctor and the paramedic work on Lockett, she felt a sliver of pride for the inmate. He’d now been stuck with needles more than a dozen times. She knew he was in pain, but she thought he was taking it like a man. Trammell tried to make conversation to help calm him. She knew he had been a drug user. “What was your drug of choice?” she asked him.

“Ice.”

“I thought that was a white man’s drug,” she said, and he laughed.

The paramedic came back and said she had no needles longer than an inch and a quarter. That presented a problem. The femoral vein lies deeper in the body than other veins, so they would ideally use a needle at least twice that length. There were longer needles inside a second central-venous catheterization kit, like the one they’d just used on Lockett’s chest, but neither Zellmer nor the paramedic thought of it. Zellmer asked for an IO-infusion needle. IO stands for “intraosseous”—into the bone. It is, in effect, a power drill, used to bore a hole through bone and into the marrow, and therefore doesn’t require finding a vein.

The prison had no IO needle. Zellmer had only the absurdly short one-and-a-quarter-inch needle. “Well,” he told the paramedic, “we’ll just have to make it work.”

Lockett’s prison scrubs and underwear were cut away. Zellmer stuck the needle into Lockett’s femoral vein and saw flashback on the first try. Finally, after almost an hour, they had an IV.

Right away, the paramedic noticed a potential warning sign. Saline should have been flowing easily through the IV, but it flowed only when she propped up the line. Instead of starting over, though, she taped the IV in place. Two IVs are typically used to administer the drugs, but with the execution running way behind schedule, the doctor and the paramedic decided they would proceed with just one.

Warden Trammell asked Lockett whether he needed anything. “I was gonna see if I could get my mouth wiped off,” he said. She got a Kleenex and wiped it for him.

Finally, a sheet was draped over Lockett, covering him up to his chest. The execution could begin.


Source: The Atlantic, Jeffrey E. Stern, June 2015 Issue

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