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Missouri Used Midazolam In Its Most Recent Execution

via Wikimedia Commons

Missouri used a considerable amount of sedatives on the last inmate it executed before it injected its lethal drug, records obtained by St. Louis Public Radio show. Chemical logs show the state used the controversial drug midazolam for the first time since its use was revealed months ago.

Midazolam is a drug widely used in low doses by anesthesiologists before some procedures, but its use in executions has drawn controversy and raised unanswered questions. A typical dose of midazolam in a medical setting is between 0.5 and 2 milligrams, but little is known about what happens when that amount is increased exponentially.

The execution team gave Paul Goodwin 20 milligrams of valium and 4 milligrams of midazolam in the hours and minutes before he died. Goodwin was put to death in December for sexually assaulting a widow and then killing her with a hammer in St. Louis County in 1998.
Midazolam has been used in executions in Oklahoma, Ohio and Arizona. The three botched executions in those states all had the use of midazolam in common.  A St. Louis Public Radio investigation in September revealed Missouri was covertly using the drug before execution warrants were valid, and before members of the press were present to provide oversight if things go wrong.
Following that story, Missouri officials said the use of midazolam would be optional, causing a couple of federal judges to remark that the change "appears to be an acknowledgement that mandated injection of dangerous levels of midazolam shortly before the execution likely violates the inmate's constitutional rights."

In the case against Missouri's secret midazolam use, four U.S. Supreme Court justices said the execution should be halted -- one short of what's needed to stop an execution.

Goodwin took 20 milligrams of valium three and a half hours before he was executed, according to the Department of Corrections. The state also says he was injected with 4 milligrams of midazolam about 25 minutes before he was executed, when the blinds would have been closed to state and press witnesses.

The chemical log for Goodwin's execution. Versed is another name for midazolam.

The Department of Corrections says Goodwin requested the drugs and that they are used to calm the inmate.

"I wasn't aware he was given either of those," Jennifer Herndon, Goodwin's attorney said, but added that it doesn't mean Goodwin didn't request the sedatives. Goodwin's IQ was in the low 70s, and that affected their ability to converse with each other.

Attorneys representing death row inmates have taken issue with Missouri's midazolam usage, and argue that its use could render the inmates unconscious (or kill them before the execution warrant is valid) and that it deprives them of their ability to make a final statement.

Dr. Mark Heath, an expert in anesthesiology in New York, said in an affidavit that 3 milligrams of midazolam would put a typical male in a "substantially intoxicated state." Heath has testified as an expert against several states' lethal injection protocols.

"I rarely administer doses above 2-3 mg IV for purposes of pre-anesthetic sedation," Heath said. "For the great majority of my patients, ranging above this dose would court the risk of over-sedation and respiratory depression."

Heath added that using midazolam in conjunction with valium, as was the case here, would compound the effect. But he also pointed out that the potency would be affected by many factors, including the inmate's size and drug history.

An Associated Press reporter that witnessed the execution said Goodwin did not appear to be asleep when the blinds were opened in the chamber, although he made no final statement. The reporter said Goodwin turned to look over to his witnesses.

Midazolam was recently used as an execution drug this month by Oklahoma, over the objections of some Supreme Court justices.

"I find the... conclusion that midazolam will in fact work as intended difficult to accept given recent experience with the use of this drug," Justice Sonia Sotomayor wrote before Oklahoma used 500 milligrams of the drug. "A number of scientific studies support the conclusion that midazolam does, in fact, have a ceiling effect, and in part for that reason has not been approved for use as an anesthetic by the FDA."

A ceiling effect would mean that at a certain point, regardless of the increasing dosage, the drug has no more effect and wouldn't be able to keep someone unconscious.

Three other justices agreed with her, asking for the execution to be stayed. But until another justice joins, little is likely to change in states' lethal injection procedures.

Follow Chris McDaniel on Twitter@csmcdaniel