Attack on Texas' lethal injections is bogus

by State Sen. Kyle Janek (Republican, Houston), an anesthesiologist

"These hardened criminals never again will murder, rape or deal drugs. As governor, I made sure they received the ultimate punishment - death - and Texas is a safer place for it." -- Former Gov. Mark White

For the reason succinctly stated above, the vast majority of Texans support the death penalty.

In fact, the most recent survey on the subject - a Scripps Howard Texas poll conducted last year - found that 76 % of Texans support capital punishment. With one notable dip to 42 % in 1966, such a high level of public support generally has held true over the last 50 years.

Having no hope of overturning capital punishment itself at the ballot box or through the court system, a few vocal death penalty opponents, including inmates, have rolled out a new strategy to change how it is carried out. In what amounts to practicing medicine without a license, those critics have started to attack the inclusion of pancuronium bromide as one of the medications used in the lethal injection process. They claim its use is "cruel and unusual."

Is pancuronium bromide some new, untested drug whose sole purpose is to torture? Is it perhaps an exotic street drug that should be outlawed? Well, actually ... no.

Pancuronium bromide is a federally approved medication used routinely in hundreds of thousands of medical procedures in this country every year. I know that because, as a licensed, practicing anesthesiologist for the last 20 years, I have given pancuronium bromide and similar drugs to thousands of patients in the operating room, albeit with different results.

As any other anesthesiologist will tell you, this argument involving pancuronium bromide is bogus. But for the sake of argument, let's look at the science.

The Texas Department of Criminal Justice uses 3 drugs in its administration of the death penalty: sodium pentothal, pancuronium bromide and potassium chloride.

Sodium pentothal is a barbiturate that until about 10 years ago was the most widely used medication for inducing general anesthesia. (It has since been displaced somewhat by newer drugs that cause fewer side effects upon awakening. For obvious reasons, that isn't a concern for death penalty cases.)

It is important to understand that sodium pentothal is given to an inmate 1st to render him completely unconscious and insensible to pain. For example, a normal surgical dose for a man weighing 220 pounds would be about 300 milligrams. Yet for lethal injection, the inmate receives 3 grams - or 10 times the normal amount based on body weight.

I can attest with all medical certainty that anyone receiving that massive dose will be under anesthesia.

The 2nd of the three drugs given in a lethal injection is pancuronium bromide - the subject of so much recent scrutiny.

Pancuronium bromide and its newer cousins are members of a class called neuromuscular blockers. Simply put, those drugs paralyze the body's skeletal muscles. In a lethal injection, the effect of the drug is to relax the chest wall muscles and the diaphragm in the now unconscious inmate.

Now, as has been noted elsewhere, the American Veterinary Medical Association has adopted guidelines for euthanasia that preclude the use of this drug - when it is the only medication given. In other words, it shouldn't be used in animals that are awake.

Some critics recently opined against using pancuronium bromide as part of lethal injection, noting that the state bans its use in animal shelters "because of its potential to shield pain and suffering."

Actually, state law makes no mention of the drug. Rather, it specifically names pentobarbital and compressed carbon monoxide as the drugs that must be used. That was to address some abuses brought forth by animal rights groups that had nothing to do with pancuronium bromide.

The last chemical in the three-drug lethal injection formula is potassium chloride, whose immediate effect in the dose given is to stop the heart and hasten death. In large doses given rapidly to a patient who is awake, the medication would cause pain in the arm due to irritation of the veins through which it courses. But for the sake of emphasis, we aren't talking here about a patient who is awake or even remotely conscious at this point.

The current argument against executions seems to hinge on the supposition that the second and 3rd drugs in this regimen would be cruel to someone who could feel them - and, to be candid, that assertion is true, since the pancuronium would cause a patient to be paralyzed and unable to respond to the pain of the potassium injection.

Yet for that argument to be valid in any way, you must ignore the 1st drug in the process - sodium pentothal - that (1) renders the inmate to be completely unconscious, (2) has been used for decades to induce anesthesia in surgical patients and (3) is given in doses far exceeding what is needed to keep the inmate from being aware or feeling anything.

Regardless of one's feelings about the death penalty as a moral punishment, as a deterrent or whether it is meted out fairly - this latest objection has neither logic nor science to support it. If it did, it would follow that anesthesiologists and nurse anesthetists in this country have been treating patients "unconstitutionally" for decades.

Some years ago, a similar - and unsuccessful - protest was raised that the drugs given for lethal injection hadn't been approved by the Food and Drug Administration as being "safe and effective." Such logic is every bit as tortured as the current flap over pancuronium bromide.

--This article originally appeared in the Houston Chronicle.  It is reproduced here with the permission of the author.