How will Scott Dozier die? Experts weigh in on Nevada's experimental execution cocktail

Imagine you’re lying down, and you tell yourself to take a deep breath. But you realize you can’t.

You want to jump up, wave your arms or call for help. But even your face is frozen. You’re completely paralyzed.  

You’re slowly suffocating to death, and no one seems to notice.

That’s how two medical experts described a Las Vegas inmate’s possible fate if state officials don’t administer enough drugs to render him unconscious during his voluntary execution — scheduled in less than two weeks at Ely State Prison.

That scenario would challenge the Eighth Amendment of the U.S. Constitution, which prohibits the government from imposing a cruel and unusual punishment, according to experts. 

In August, the Nevada Department of Corrections announced it would use fentanyl, diazepam and Cisatracurium in Scott Dozier’s lethal injection—a cocktail of drugs never before used in an execution.

The new cocktail has raised questions about how the drugs will be administered, the details of which would be available in the state's execution protocol. The state still hasn't released how it will use those drugs, including dosages. 

A court hearing is scheduled for Friday in Clark County about unsealing those details for the public.

Dozier, 45, was sentenced to death for the 2002 murder and dismemberment of 22-year-old Jeremiah Miller, whose torso was found in a suitcase inside a trash bin at an apartment complex near the Las Vegas Strip.

Dozier has been sitting behind bars for more than a decade and voluntarily waived his right to appeal his sentence.

The drug cocktail has sparked debate over the use of paralytic drugs in lethal injections, a topic that’s been talked about for decades since the first lethal injection execution was carried out in 1982.

The Reno Gazette-Journal reached out to Dr. Joel Zivot, an associate professor of anesthesiology and surgery at Emory University School of Medicine, and Dr. Susi Vassallo, a professor of emergency medicine at New York University of Medicine. 

Zivot, Vassallo and Denno have all served as experts and written extensively about lethal injection and its role in capital punishment. 

Here’s a look at how each of the three drugs work, what they’re used for and how they could affect Dozier if state officials don’t administer them correctly.

Fentanyl in executions: ‘It makes sense’

Fentanyl is an opiate, like heroin, but it was "cooked up in a laboratory," according to Vassallo.

It's a potent synthetic drug designed to take away symptoms of pain.

“It’s extremely short-acting and extremely powerful,” said Vassallo, who is an emergency medical physician certified by the American College of Medical Toxicology, which deals with drug overdoses.

“Depending on the amount you give, somebody can become unconscious and stop breathing,” she said. “That can be lethal.”

Fentanyl is a drug that’s used every day in modern medicine. It’s also at the center of the opioid overdose epidemic in the United States.

“So, you can see that fentanyl — if you’re trying to kill somebody — it’s a very good drug for lethal injection,” Vassallo said. “It makes sense if that’s what you’re trying to do.”

Fentanyl affects different opioid receptors in the body, which are responsible for pain relief and breathing.

Opioid receptors exist not only in the nervous system, but in organs, such as the heart, lungs, liver, gastrointestinal and reproductive tracts, according to the U.S. National Library of Medicine.

“When you inject fentanyl into a human body, that fentanyl goes and finds that receptor and provides pain relief and respiratory depression,” Vassallo said. “It slows breathing until it stops.”

At the same time, it keeps the person unconscious and unable to feel pain.

“Nevada could easily kill a human being with fentanyl,” she said. “Or they could inject an even longer acting, enormous dose of morphine or any kind of powerful opiate…”

Diazepam: The sleeping drug

State officials also plan on using diazepam as part of lethal injection cocktail. But the drug itself isn't dangerous . And it doesn’t make much sense to use it in an execution, according to both Vassallo and Zivot. 

Diazepam is used for various reasons. It can be used to temporarily treat insomnia, seizures, muscle spasms and anxiety. It can also be used as a light muscle relaxant or as a sedative for minor surgery or non-invasive procedures, according to the U.S. National Library of Medicine. 

Veterinarians also use it to help alleviate anxiety in dogs and cats. But it doesn't affect consciousness.

“Diazepam is used for anxiety,” said Zivot, who’s practiced anesthesiology for 25 years. “In the past, they were used as sleep promoters.”

Basically, it’s just a Valium, Vassallo said.

“People take valium to relax,” she said.

“Valium, in general, won’t kill someone. It would have to be massive doses, very massive and given very rapidly.”

Cisatracurium: The paralyzing drug

Zivot and Vassallo agreed using Cisatracurium in Dozier’s execution could violate the Eighth Amendment of the U.S Constitution, which prohibits the government from imposing cruel and unusual punishment.

Cisatracurium is a paralytic drug, typically used on patients undergoing surgery.

Cisatracurium affects how skeletal muscles contract and relax. Even if a patient is deeply anesthetized, muscles can still contract during surgery.

“Paralyzing drugs are used safely every day in the country and around the world to facilitate surgery,” Zivot said. “It allows for muscle relaxation, so the muscles don’t create a barrier next to the organs beneath.”

It’s also helpful when placing a ventilation tube in a patient’s throat.

“There is a muscle for breathing called the diaphragm, and the diaphragm is a skeletal muscle,” Zivot said. “When a person is given Cisatracurium, the diaphragm muscle becomes paralyzed. It won’t move.”

But the drug won’t affect consciousness, awareness, pain or anxiety, which is why state officials plan to use fentanyl and diazepam.

“If I gave Cisatracurium to a person who was awake, they would become quickly aware of their inability to move and… breath,” Zivot said. “Even though our brain is sending messages to our muscles to move, the muscles themselves would not be able to respond.”

“Outwardly, we would appear calm,” he said. “The expression of our face would be relaxed.

“Inside, we would be dying. We would be suffocating, and it would be terrifying. But you can’t communicate this terror.”

Source: Reno Gazette Journal, Marcella Corona, November 3, 2017

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