Frank Atwood is the next man scheduled to be executed in Arizona, on June 8. He was sentenced to death in Pima County in 1987 for the murder of an 8-year-old girl, Vicki Lynne Hoskinson.
Because Atwood’s crimes occurred before the gas chamber was outlawed in Arizona in 1992, he has a choice between death by lethal gas or lethal injection.
His attorneys argue both methods would amount to cruel and unusual punishment. They say the lethal injection would cause Atwood a “tortuous” amount of pain because he suffers from a spinal condition, and would likely have to be restrained while laying down to a gurney for more than 20 minutes.
A review performed by Atwood’s attorneys of 14 previous lethal injections in Arizona prior to Clarence Dixon’s found the total IV insertion time ranged from 7 minutes, all the way up to 54 minutes, with a median time of 23 minutes.
“The time that patently unqualified people spend attempting to install an IV line is just one of the steps the department takes after restraining the condemned to their execution table,” Atwood attorney Joseph Perkovich said. “All told, these people have spent upwards of an hour strapped to the gurney before the lethal injection itself even begins.”
Perkovich said Atwood is disabled and frail and has spent his past years in a wheelchair, and it would be difficult to access his femoral vein if the primary attempts by the IV team are not successful in his arms.
Atwood has until May 19 to choose the method of execution. If he does not specify, the default method the state will use is lethal injection.
Dixon’s attorneys say the IV insertion process took 40 minutes
While media witnesses said it appeared to take around 25 minutes to insert IVs into Dixon’s body, notes from Dixon’s legal team shared exclusively with The Arizona Republic put the time at 40 minutes.
That belief is based on the legal team’s observations of execution team members beginning to look for a vein to insert the first IV at 9:33 AM, and not finishing with the IV insertion process until 10:13 AM.
“9:33A – medical staff member starts looking at left upper arm in apparent attempt to locate a vein after placing tourniquet on upper arm,” Dixon’s attorneys observed. “9:36A – medical staff member’s hands appear to be shaking.”
The notes indicate Dixon grimaced, said “ow” and moved his feet around while medical staff attempted to insert an IV into his veins, causing correctional staff to have to hold him down.
Both Dixon’s legal team and media witnesses said they saw the execution team give up on inserting an IV into one of Dixon’s arms, and instead make an incision to insert an IV into his groin.
Associated Press reporter Paul Davenport said he saw the team wiping up “a fair amount of blood” after making this incision.
The legal teams’ notes indicate Dixon spoke of the ironic nature of the execution team trying to carry out his death in a sterile manner.
“How bizarre is that? How twisted is that?” Dixon questioned, calling the execution team members “ghouls one and all.”
While it appeared execution team members administered a local anesthetic to his groin area, Dixon’s attorneys and media witnesses at the execution said they saw him repeatedly grimacing during the process.
“10:00A – Clarence makes face of pain – continues to grimace in pain – big grimace from Clarence in obvious pain,” the legal team documented in their notes.
Assistant federal public defender Amanda Bass said records provided to them by the Department of Corrections did not provide any insight as to the level of training or qualifications held by the execution team members who failed to properly insert IVs in both of Dixon’s arms.
“Since Arizona keeps secret the qualifications of its executioners, we don’t know whether the failure to set two peripheral lines in Mr. Dixon’s arms was due to incompetence, which resulted in the unnecessarily painful and invasive setting of a femoral line,” Bass said.
Where Arizona stands with executions
With the execution of Clarence Dixon, Arizona resumed to the death penalty this month for the first time since 2014, when a botched lethal injection process took nearly two hours to kill Joseph Wood.
Wood’s problematic execution drew scrutiny of the two-drug combination used at the time in Arizona, and prompted injunctions from the courts that stopped the process entirely.
Arizona announced it would return to executions in 2021 after settling lawsuits related to the Wood execution and announcing it had acquired pentobarbital, a barbiturate used by the federal government in a series of lethal injections in 2020.
State law prohibits the disclosure of any details about the way the state carries out the death penalty, and attorneys for death row prisoners have had little success prying loose even the most basic information about the drugs, like where they were acquired, or how they are turned into an injectable form by a pharmacist.
Legal fights leading up to the recent execution of Dixon produced limited details, including some information about when the drugs were prepared and their potency.
After a series of legal challenges, the state agreed to produce a new batch of the compounded pentobarbital just two days before Dixon’s execution.
What protocols require of the execution team
The Arizona Department of Corrections execution protocols define an “Intravenous Team” as the people responsible for administering the IVs during the execution process: “The IV Team will consist of any two or more of the following: physician(s), physician assistant(s), nurse(s), emergency medical technician(s) (EMTs), paramedic(s), military corpsman or other certified or licensed personnel including those trained in the United States Military. All team members shall be currently certified or licensed within the United States to place IV lines.”
The Department did not respond to questions about whether the members of the IV team in Dixon’s execution had any kind of certifications or licensure, or whether such licensure exists in Arizona.
The leader of the IV team is also responsible for ensuring the lines for the procedure that run from the syringes to the catheter, preparing syringes and supervising “the administration of the chemicals.”
The execution protocols specifically reference qualifications of the IV team for the use of a prisoner’s femoral vein to administer the drugs, as was done with Dixon: “A central femoral venous line shall not be used unless the person placing the line is currently qualified by experience, training, certification or licensure within the United States to place a central femoral line.” The femoral vein is a vein deep in the thigh.
According to protocols, state IV team members are required to participate in “at least one training session with multiple scenarios within one day prior to the scheduled execution.”
While current Department of Corrections protocols call for at least two members of the execution team to be certified in IV insertion, this was not always the case.
Retired corrections officer Jim Klein, who participated in 15 lethal injection executions, told the Republic he and other members of execution teams in the 1990s had absolutely no experience in administering IVs. Klein said a medical consultant taught them to practice on a prosthetic arm, before eventually practicing on one another.
Despite the training, Klein said IV insertion remained a difficult task. In one instance that took multiple attempts, Klein said a prisoner quipped “What are you trying to do Klein, lethally inject me or stab me to death?”
Dixon made similar remarks during his execution, according to witnesses. He asked members of the execution team if they were in fact doctors, but witnesses could not hear the response. Whatever was said in return to Dixon, he asked the execution team members if what they were doing was in violation of their Hippocratic oath, according to media and attorney witnesses.
“I thought you took a Hippocratic oath,” Dixon’s attorneys recorded him saying. “But money is better than that, right?”
Klein said this is the very essence of problems with administering lethal injections. While it is a complex medical task, he said the Department was not able to find medical professionals to perform it because it would go against their oath to “do no harm.”
The Arizona Department of Corrections did not return requests for clarification asking if the people who inserted Dixon’s IVs were medical professionals, or had any medical training. Witnesses described them as two men wearing medical scrubs, while correctional officers in the execution room were wearing all black, and had masks and sunglasses covering their faces.
IV insertion difficult even for trained medical professionals
Rebecca Aguirre-Guerra is a registered nurse who practices at a local valley hospital. She says she first learned how to do IV insertions during clinicals in nursing school. They were first taught in simulation labs where they practiced with prosthetic arms several times a week for a month, she said, then they would move on to conduct the procedure on real patients during clinical rotations.
While she says she was a quick study, Aguirre-Guerra says inserting an IV is a very delicate process, which can be difficult even for trained medical professionals.
“Several of my classmates had difficulty no matter how often they were trying,” Aguirre-Guerra said. “Not everybody is good at it. You have some individuals that are superb, and can always get it on the first shot, then there's those that try three times, and they still can't get it.”
Aguirre-Guerra said in the hospital setting, there are even special IV teams composed of people with extra training and knack for needle sticks, who can be called in to assist in difficult cases, such as frail, elderly patients or someone with veins that are difficult to locate.
“If a patient is severely dehydrated, it can make it very difficult to find veins,” Aguirre-Guerra said. “I know I myself am a hard stick because I have what we call rolling veins. So that can make it very difficult to start IVs as well.”
She said at her hospital, there is a designated team that can be called in to perform an insertion in a femoral vein if the IV’s cannot be put into a patient’s arms. But in her 11 years as a nurse, Aguirre-Guerra says she has never seen a case where that procedure was necessary.
, Jimmy Jenkins, May 18, 2022
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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
