The doctor defending Louisiana’s controversial execution method

Dr. Joseph Antognini travels across the nation, being paid over $500 an hour by government officials who rely on him to vouch for their execution protocols.

This [article] is part of “Operating Capital,” an ongoing Lens discussion about Louisiana’s resumption of executions.

Earlier this month, Dr. Joseph Antognini, a California-based retired anesthesiologist, walked into the execution chamber at Louisiana State Penitentiary at Angola.

He tried on the air-tight mask that prison staff plan to use to execute Death Row prisoner Jessie Hoffman, using nitrogen hypoxia, a method that Louisiana executioners have never before used.

Antognini tested the mask. An officer flipped a switch, pumping air into the mask at 70 litres per minute. Pure nitrogen gas will be pumped into the mask at that rate when Hoffman wears it, as early as Tuesday. The nitrogen will replace the oxygen in his body; he will asphyxiate and eventually die.

Antognini breathed easily. The flow rate was good.

He shook his head. The mask didn’t fall off.

In a declaration filed after his visit to Angola, Antognini gave unqualified approval to the state’s new execution method and the equipment he had viewed.

“Louisiana’s method of execution does not cause pain itself,” he wrote, giving a thumbs-up to nitrogen hypoxia in a way that is on-brand for the man that capital-punishment opponents sometimes refer to as “Dr. Death.”

Beyond the pejorative nickname, advocates say that Antognini is basically a government hired hand who is enriching himself through taxpayer dollars while ignoring medical science and violating his Hippocratic oath.

It now appears likely Hoffman’s execution will go forward as planned on Tuesday, March 18. But that didn’t happen without a legal fight.

Hoffman’s execution is set for Tuesday after the Fifth Circuit Court of Appeals overturned a federal judge’s decision to block it earlier this month.

Last week, after hearing testimony from Antognini and other witnesses about nitrogen hypoxia, Baton Rouge federal judge Shelly Dick blocked Hoffman from being executed as scheduled, until a full hearing could be held about the execution methods. Hoffman had “clearly shown,” she wrote in her decision, “that he is substantially likely to prove that nitrogen hypoxia poses a substantial risk of conscious terror and psychological pain.”

But over the weekend, the Fifth Circuit Court of Appeals overturned Dick’s ruling,

Lawyers for Hoffman had argued – and still maintain – that nitrogen hypoxia should be considered cruel and unusual punishment, putting it off-limits to Louisiana as a method of execution. And in Louisiana and other states, where advocates have filed suit to stop the use of an execution protocol like nitrogen hypoxia, Antognini is often the state’s chief legal witness supporting its use.

Traveling the nation to vouch for execution protocols

Here in Louisiana, Antognini was hired by a team of attorneys representing the state, including Attorney General Liz Murrill’s office. After a 15-year hiatus in executions in Louisiana, tied mostly to difficulties accessing the drugs used in lethal injection, this year Louisiana’s legal team is supporting Gov. Jeff Landry’s push to restart executions.

Across the nation, many states have similar needs, as more governors move toward actively executing those on their Death Rows. Over the past decade, Antognini has traveled widely, vouching for the safety of execution protocols, both lethal injection and nitrogen hypoxia. He’s testified for the states of South Dakota, Ohio, South Carolina, Arkansas, Missouri, Georgia and Alabama and for the federal government in 2020, during President Donald Trump’s first term.

Antognini did not respond to an emailed request for an interview with The Lens. Phone calls to his office went unanswered.

In nearly a decade, Antognini has never declined to serve as an expert witness because of the method of execution a government was planning to use, according to a court deposition.

For instance, Antognini has never personally observed an execution by nitrogen hypoxia. But he spent time earlier this month in Louisiana, because he’s become one of the nation’s most relied-upon witnesses on the topic. States, largely red states, bring him into court cases citing his medical qualifications.

Yet, despite his expert fee of at least $575 an hour – with $675 an hour for deposition testimony and $7,000 a day for courtroom appearances – Antognini is not known for independent inquiry, critics say.

He has made about $350,000 serving as an expert witness in execution cases in the last nine years, he estimated in a recent deposition. That includes $50,000 to $100,000 testifying about nitrogen hypoxia.

Even veterinarians have stopped using nitrogen to put down pets because it’s viewed as cruelty to animals

One of the primary arguments against nitrogen hypoxia is the convulsions triggered by the process. People executed through nitrogen hypoxia can shake and convulse vigorously for several minutes; some say the convulsions indicate prolonged consciousness in the person being put to death. Critics say that even veterinarians have stopped using nitrogen to put down pets because it’s viewed as cruelty to animals.

In Alabama, the only state to use this method to date, witnesses to each of the state’s four nitrogen-hypoxia executions have cited the violent movements of the condemned men as evidence of severe psychological distress and suffering. It amounts to torture, they contend.

Yet in a statement consistent with his reputation, Antognini sees nitrogen-hypoxia convulsions as nothing to worry about, as long as the face mask is secure.

Initial convulsions should not be seen as painful, he said. “Some of these [movements] could have occurred because of the conscious attempt by the inmate to dislodge the mask, before the nitrogen gas was administered,” Antognini wrote in a court declaration after his visit to Angola.

Similarly, later convulsions should not be seen as painful, he emphasized. “Other movements after the onset of unconsciousness are likely due to involuntary movements associated with hypoxia in the central nervous system.”

‘Untested scientific hypotheses’

Last year, the Louisiana legislature added nitrogen hypoxia as one of the state’s legal methods of execution. Once the law took effect in July, the state secretary of the Department of Corrections – which implements executions in response to parish-initiated execution warrants – could choose to use hypoxia or the state’s other previously approved methods, including lethal injection and electrocution.

On February 20, a judge in St. Tammany Parish signed a death warrant for Jessie Hoffman, who was convicted of the 1996 murder of Mary “Molly” Elliott and has been on Death Row for 26 years. His execution was then scheduled for March 18.

On February 25, lawyers for Hoffman filed a challenge to the impending execution, arguing that nitrogen hypoxia is “cruel, unreliable and that will inflict excruciating suffering on Mr. Hoffman.” They have filed a clemency petition, asking that his sentence be changed to life-without-parole.

But if the execution moves forward, his lawyers contend, Hoffman should face either a firing squad or be executed through a combination of drugs used for medical-aid-in-dying. (To successfully challenge a state’s execution protocol as cruel and unusual punishment, plaintiffs must identify a “feasible, readily implemented” alternative procedure that would “significantly reduce a substantial risk of severe pain,” the U.S. Supreme Court has held.)

 “Terror response”

To make their case, Hoffman’s attorneys also needed an expert witness. They enlisted Dr. Philip Bickler, an anesthesiologist who has been the director of the Hypoxia Research Laboratory at University of California, San Francisco, since the early 1990’s. Bickler has conducted more than 5,000 studies on the effects of oxygen deprivation in humans.

At an evidentiary hearing last week, Bickler testified that based on his research and on reports of nitrogen-hypoxia executions in Alabama, the execution method elicits a “terror response” and that it amounts to “forced asphyxiation, gassing a subject to death, exposing him to a lack of oxygen such that both extreme discomfort, distress, pain, and terror would be felt all the way up to the point of losing consciousness.”

Under certain circumstances a person breathing nitrogen may lose consciousness in under a minute, Bickler testified. But the conditions of an execution — particularly that a person would likely attempt to hold their breath to avoid imminent death — make it probable that the individual will be conscious from anywhere between three and five minutes, he said, noting that Hoffman’s long history of Post Traumatic Stress Disorder and claustrophobia would likely increase his suffering.

When Antognini took the stand for the state, he argued that someone is likely to lose consciousness in under a minute once they “inhale 90 to 100% nitrogen gas.” He acknowledged that the need to breathe, while knowing the next breath might kill you, could cause “severe emotional suffering.” But compared with the other methods, the terror was not greater with hypoxia, implied Antognini, who said. “It’s going to be present either way, I would think.”

Antognini, a board-certified anesthesiologist who no longer practices, was a professor for 19 years at the University of California Davis, where he serves as professor emeritus, and directed perioperative services for five years at UC Davis Medical Center. Today, he works part-time as the chief scientific officer at a start-up pharmaceutical company called Expanaesthetics. While his job history is impressive, his lack of scholarship and expertise in hypoxia stood out in his Louisiana testimony. Or so the judge wrote.

“Dr. Antognini has never clinically studied the effects of hypoxia on humans,” Dick wrote in her opinion blocking Hoffman’s execution. “He has not published nor presented any studies regarding the effects of nitrogen hypoxia. Professionally, the only study of human hypoxia Dr. Antognini has done is in connection to providing opinions to Alabama and Louisiana in support of nitrogen hypoxia execution.”

Antognini’s opinions were “untested scientific hypotheses,” Dick wrote, and the studies he relied on were “either irrelevant or unpersuasive.”

Bickler’s knowledge and arguments were far more compelling, Dick found. “The Court is convinced by Dr. Bickler’s testimony and by common sense that the deprivation of oxygen to the lungs causes a primal urge to breathe and feelings of intense terror when inhalation does not deliver oxygen to the lungs,” Dick wrote. “The experts agree and the Court finds that this causes severe psychological pain.”

Other judges have given Antognini’s opinions more weight.

Just six weeks ago, in Alabama, after Death Row prisoner Demetrius Frazier challenged his scheduled nitrogen-hypoxia execution on the same grounds – that it was cruel and unusual punishment – the state hired Antognini to testify.

The presiding judge ruled against Frazier, citing the state’s chief witness. “Faced with competing accounts, the Court assigns greater weight to Dr. Antognini’s expert opinion that an inmate loses consciousness closer to thirty to forty seconds after nitrogen gas is introduced,” the judge wrote, as she refused to block the procedure.

Frazier was executed on February 6 of this year.

‘He’s doing it to make a lot of money’

Beyond the science of executions, Antognini, as an anesthesiologist, is also a medical doctor held to a code of professional ethics that are best summarized under the medical motto, “Do no harm.”

As an organization, the American Medical Association has long opposed physician involvement in capital punishment. “An individual’s opinion on capital punishment is the personal moral decision of the individual,” the statement reads. “(But) a physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution.”

Debates about doctors aiding in prosecutions soared as lethal injection became common as an execution method, replacing the electric chair, which did not require anyone who looked like a physician to pull the lever. Still, many state protocols require a physician to participate in its executions. Some have argued that this role would be a “non-clinical” transaction, unbound by ethics, while critics say that as long as doctors are using knowledge and techniques attributed to medicine, they must maintain the integrity of the profession.

The AMA statement defines participation as any action that “would directly cause the death of the condemned,” “would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned,” or “could automatically cause an execution to be carried out on a condemned prisoner.”

In 2014, the American Board of Anesthesiology made its own statement, specific to its profession. “Patients should never confuse the death chamber with the operating room, lethal doses of execution drugs with anesthetic drugs, or the executioner with the anesthesiologist,” wrote board secretary Dr. J. Jeffrey Andrews. “Physicians should not be expected to act in ways that violate the ethics of medical practice, even if these acts are legal. Anesthesiologists are healers, not executioners.”

To some in the medical field, Antognini’s willingness to greenlight government execution protocol bumps up against that prohibition.

In a case challenging the federal execution of a man in 2020, toward the end of the first Trump administration, Dr. Michael Stephens, a pulmonary physician at the University of Pennsylvania in Philadelphia, testified opposite Antognini, whom he described as a “hired hand.”

“I mean, he makes a lot of money off it, right?” Stephens said. “He’s doing it to make a lot of money.”

Antognini’s behavior may not violate the letter of the AMA ethics code, but it violates the spirit behind those ethics, Stephens said. “With his track record, that is essentially what he is doing,” Stephens said. “He is endorsing the state’s and the government’s right to execute its citizens.”

Throughout his work, Antognini is careful not to delve into the moral or ethical implications of his opinions.

“I never address whether a protocol is humane or not,” Antognini testified at the evidentiary hearing. “I don’t think that’s my role as an expert witness. With all due respect, I think that’s for the court to decide, not for me.”

Source: Baton Rouge Public Radio, Nick Chrastil, The Lens, March 17, 2025

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

— Oscar Wilde