The presence of frothy fluid in his lungs, revealed in the autopsy report, is a symptom of pulmonary edema—a condition where fluid fills the lungs. His lungs were swollen to twice the expected normal weight. The presence of froth suggests that Bowman’s heart was still beating and he was still breathing, possibly even conscious, following the injection of pentobarbital, according to one doctor. The drug, which is roughly as caustic as household cleaners, may have caused his last sensation to feel like drowning while a burning feeling spread through his veins.
“That again is yet another example of pulmonary edema caused by pentobarbital,” said Dr. Joel Zivot, a professor of anesthesiology and surgery at Emory University. He stated there was “no way” the fluid was present before the execution. “It’s not possible; he would have been very, very uncomfortable and symptomatic.”
The nine-page autopsy report, prepared by a private pathology group, describes Bowman’s cause of death as “acute pentobarbital toxicity due to judicial execution.” The autopsy began at 6:04 p.m. on Jan. 4. A media witness described Bowman taking several “deep, loud breaths, puffing out his lips and cheeks with each one.” His breathing then became shallower and quieter before his chest appeared to stop moving at 6:06 p.m. A doctor declared him dead 20 minutes later.
Bowman received 10 grams of pentobarbital, twice the dose required by either the public federal lethal injection protocol or an affidavit submitted by South Carolina Department of Corrections Director Bryan Stirling. South Carolina is one of 15 states, along with the federal government, that use only pentobarbital in lethal injections.
State law requires that inmates sentenced to death choose between lethal injection, a firing squad, or the electric chair. If they do not make a choice, the default method is electrocution. Despite concerns raised by their legal teams over the lack of public information about the pentobarbital execution process, all but one of the four people executed since September have opted for lethal injection.
Three years ago, South Carolina’s legislature passed a shield law that withholds nearly all information about lethal injections. Pentobarbital, a barbiturate, is used medically to treat insomnia, anxiety, and seizures, as well as an anesthetic. Many states turned to pentobarbital after losing access to the chemicals used in the traditional three-drug execution cocktail due to international boycotts and drug manufacturers halting sales to execution-performing states.
In January, the Department of Justice under former Attorney General Merrick Garland announced that the federal Bureau of Prisons should suspend its use of pentobarbital. The main concern, outlined in a memo, was the unnecessary pain and suffering caused by “flash pulmonary edema,” where the lungs rapidly fill with fluid. Faced with uncertainty over whether pentobarbital caused “unnecessary pain and suffering,” the memo recommended halting its use in federal executions.
While former President Donald Trump’s Attorney General, Pam Bondi, has said that executions should resume, she stated that the use of pentobarbital should be evaluated.
What Else Does the Autopsy Report Reveal?
His lungs were significantly engorged, weighing a combined 1,930 grams. Lung weight varies among individuals, especially in those who are obese, but Bowman’s lungs weighed more than twice the average for an overweight man, which is around 800 grams. Dr. Zivot explained that such heavy lungs indicate they were full of liquid. “The spongy lung tissue holds liquid like a sponge,” he said.
In court filings, lawyers for South Carolina cited a declaration from Dr. Joseph Antognini, an anesthesiology professor and paid expert witness, who dismissed the risk of edema. Antognini argued that pentobarbital would cause unconsciousness “well before any lung congestion and pulmonary edema forms.” He suggested that any froth found in the lungs was likely due to gases being released after death or agitation as the body was moved.
The autopsy report also revealed lesser-known aspects of the death penalty and life on death row. Bowman, weighing 404 pounds, suffered from coronary artery disease, thyroid disease, Type 2 diabetes, and hyperthyroidism. He had also received 2 milligrams of lorazepam, an anti-anxiety medication, before his execution.
“We offer anti-anxiety medication to inmates facing execution. I can’t comment on the specifics of any inmate’s medical history or treatment,” said Chrysti Shain, Director of Communications at the South Carolina Department of Corrections.
“They’re trying to sedate him,” Zivot said. “Two milligrams of lorazepam is not going to kill anybody, but it’s going to make them calm. You’re blending or blurring the lines of medicine and execution.”
The toxicology report also indicated the presence of cannabinoids in Bowman’s system, suggesting that he had access to cannabis products despite the department’s well-publicized drug interdiction programs. Shain said she did not have information on how he obtained them.
Why Did Bowman Choose Lethal Injection?
Attorneys for Bowman and other death row inmates, including Brad Sigmon, who was executed by firing squad on March 7, have argued that there is insufficient information about South Carolina’s lethal injection process to ensure that it does not cause needless suffering. This lack of transparency, they contend, prevents inmates from making an informed decision about their method of execution.
While Bowman’s attorneys declined to comment on the autopsy report, prior to his execution, his lawyer Lindsey Vann stated that Bowman had “significant concerns about the quality of the lethal injection drugs used in South Carolina executions because the Department of Corrections continues to refuse to provide any basic information about the drugs, including the expiration date and storage procedures.”
In 2023, South Carolina Gov. Henry McMaster signed into law a near-total secrecy measure, making it illegal to disclose most information related to the sourcing of lethal injection drugs. With no available information, Bowman was forced “to make the barbaric choice” of selecting lethal injection over electrocution.
Source: thestate.com, Ted Clifford, March 14, 2025
"One is absolutely sickened, not by the crimes that the wicked have committed,
but by the punishments that the good have inflicted."
but by the punishments that the good have inflicted."
— Oscar Wilde
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