Autopsy shows that the prisoner’s lungs are filled with fluid at run timeExBulletin

AILSA CHANG, Host:

Two federal prisoners await execution in a high-security prison in Terre Haute, Indiana. One tomorrow and the other Thursday. While they wait, their lawyers are asking them to intervene in court, because the drugs used to kill prisoners cause their lungs to fill their lungs with liquid when they die, and their Because in the last moment they can experience the feeling of drowning.

Mary Ease Kelly, Host:

Those fears are not unfounded. And a little warning to the listener-what you’re about to hear may be upset. In the spring of 2017, Arkansas prisoners were sentenced to death and suffocated.

Chan: In Ohio the following year, a prisoner struggled for the air against detention.

Kelly: And a few months later, in Tennessee, prisoners again gasped and cramped for air. All of these prisoners were later found to be filled with fluid in their lungs.

Chan: I can’t ask them if they’ve reached cruel and extraordinary punishment and how painful their execution was. But what we can do is look inside their bodies. For the past two years, the ALL THINGS CONSIDIDEED team has been investigating the autopsy of prisoners killed by lethal injections. We have obtained the largest collection of these autopsies assembled in the United States so far. The collection spans decades of executions in multiple states, and findings reveal far more peace than the death promised when adopting lethal injections decades ago. Not evidence of death. We start this story in Atlanta. So in 2018 I went to see a doctor who made a phenomenal discovery with producer Noah Caldwell.

Hi, Joel.

JOEL ZIVOT: Hello. Nice to meet you.

Chan: Joel Zivot works 80 hours a week at Emory University Hospital. He is an anesthesiologist and is checking in patients at the ICU.

ZIVOT: So his temperature is like a low grade. And did he get a CIP person (ph)? Did he have to take it?

CHANG: A few years ago, federal defenders in Georgia hired Zivot to review some autopsy of prisoners performed by lethal injections.

ZIVOT: What I was asked to address was the blood levels of certain types of drugs.

CHANG: But something else caught his eye.

ZIVOT: I realized something was wrong.

Chan: What did you see during the autopsy?

ZIVOT: So I started seeing patterns of organ failure. Instead of what I thought was a momentary death, an untouched discovery, I began to see more consistent photographs of later deaths, that is, deaths associated with suffering.

Chan: Painful death. At post-autopsy autopsy, Zybot surprised him with an unusually heavy lung, a swollen lung. It is not a common finding at autopsy. This happens in cases such as congestive heart failure and sepsis, but neither happens here. He was looking for a second opinion, so he contacted a colleague named Emory, a pathologist named Mark Edgar.

ZIVOT: I said, I just want you to look at these documents and tell me what you think you are looking at here. Because I think I’m seeing something surprising to me here.

Chan: Jibot didn’t deliberately tell Edgar that he was surprised at the autopsy. But Edgar-he did exactly what Jibot did-the lungs were filled with fluid. He noticed …

Mark Edar: Foam-like liquid in the nose …

CHANG: The same words came out more and more.

EDGAR: … foamy material in the main bronchus …

Chan: Words full of bubbles.

EDGAR: … upper and lower respiratory tract bubbles …

Chan: What they were seeing was a serious condition called pulmonary edema. The presence of floss was a nasty clue. That meant that the prisoners were still alive and trying to breathe because their lungs were filled with liquid. Zivot and Edgar only got dozens of autopsies from other states, was this a fluke? And similar words like foam and water continued to appear to describe the lungs.

ZIVOT: It was a surprising discovery as there were some physical documents that could answer questions that couldn’t be answered otherwise. So what exactly is the experience of a dying prisoner?

CHANG: Zivot has submitted these findings to federal courts in several states. This is evidence that is currently at the forefront of legal challenges for lethal injections. For the past two years, the NPR team has done their own research. The range of data has been greatly expanded. At the request of the Information Disclosure Law, more than 300 inmates have been autopsied. They deal with the death penalty in nine states from 1990 to 2019.

And these autopsies show that pulmonary edema occurred 84% of the time when prisoners’ lungs were examined after their execution. It was consistent throughout the state. Medical professionals are very likely that these findings will be problematic because these detainees will experience a sensation of drowning or choking before they die, and many detainees will be properly anesthetized. It’s awkward because it means it wasn’t.

Talk to producer Noah Caldwell about all of this. He has been pondering these autopsies for the past year and a half. And he is with me now.

Hey, Noah.

Noah Caldwell, by-line: Hello, Irusa.

Chan: All right. You are investigating the science behind these discoveries of pulmonary edema, or lung fluid.

Caldwell: Yes, what does that mean for the prisoner’s experience?

Chan: Yes. So tell us about what you find.

Caldwell: Yes. To use as an example, here is an autopsy in front of you. A man named Robert Van Hook. And he was executed in Ohio in July 2018. Witnesses say their chest began to swell during the execution and they were out of breath loud enough to hear it in the next room. And during the autopsy, they found blood bubbles in his airways.

Chan: So his lungs were filled with liquid.

Caldwell: That’s right. Now let’s see how this is done. Most deadly injections use three drugs one after another. Then focus on the first drug. This is a drug that is supposed to anesthetize prisoners. And in the case of Robert Van Hook, it was a common drug used in dozens of recent executions called midazolam.

Chan: Midazolam.

Caldwell: The drug is safely used daily in hospitals. It is often used to calm people before surgery. However, the way the drug is injected during execution explains why prisoners develop pulmonary edema so often. And I found the best person to explain this.

PHILIPPE CAMUS: Yeah, it’s very interesting. The lungs are special.

Caldwell: This is Philip Camus. He is a doctor in Dijon, France, and has spent his entire career researching how various drugs can damage the lungs. And he usually administers such drugs at low doses very slowly in hospitals … because

CAMUS: Doctors and Nurses-They know that there are accidents related to injections being too fast.

Caldwell: But when it comes to fatal injections, the dose is given quickly and given in large doses. For example, Robert Van Hook was given 500 milligrams of midazolam. Compare this to the 1-2 milligrams you got at the hospital. And when that happens, you get a huge, focused ball of medicine that runs through your bloodstream. It is called the front desk.

Camus: Look at the weather. It’s sunny. And then comes the rain, what meteorologists call fronts.

Caldwell: The front goes to the heart and then straight to the lungs.

Chan: Yes. So what happens?

Caldwell: Well, the physiology here is complicated. But for simplicity, the structure of the lungs is very delicate and is damaged by its huge front of the drug. Therefore, the fluid normally flows into a dry space. These are the spaces that need to be dry to breathe. So if you are conscious at that time …

JEFFREY SIPPEL: A feeling of drowning, suffocation, panic, and imminent ruin.

Caldwell: This is Jeffrey Shippel. He is a pulmonologist at the University of Colorado. He confirmed what the Atlanta doctor had told us-if the prisoner was simply napping, we wouldn’t see pulmonary edema.

SIPPEL: Do you expect pulmonary edema in the process of death? And it’s not. This is not the way everyone would imagine a fatal injection to occur.

Caldwell: The last two points-First, it’s not just midazolam. Other drugs used by the state also cause pulmonary edema. And second, because these drugs are given first, they continue until the lungs are filled with fluid just before the start of the death penalty and the prisoner dies. Sometimes it’s 3 minutes. In the case of Robert Van Hook, that was 15 minutes. A single execution a few years ago lasted nearly two hours.

Chan: Wow. OK. If that is the reason why pulmonary edema occurs in many executions, the next question we wanted to ask is how much the prisoner feels the choking effect that his lungs are filled with fluid. Was it possible? Noah will be with me for this.

Caldwell: Yeah. This is a major issue currently being discussed by courts across the country. And the state claims that prisoners are completely anesthetized.

CHANG: But doctors testify that the first drug is unreliable, especially when talking about midazolam. David Luberski is one of the leading anesthesiologists in the country and he runs the University of California, Davis Health.

DAVID LUBARSKY: The ability of the anesthetic midazolam to create an anesthetic state is definitely zero.

Chan: We should note that he testified in the death penalty on behalf of the prisoner. He says midazolam can put you to sleep, but it doesn’t block the pain, which means that prisoners may still be awake with the pain of pulmonary edema, so many prisoners are in the death penalty chamber. Pant the air.

LUBARSKY: This is not a general anesthetic. Its use as the only anesthetic in a deadly injection protocol would be a malpractice for medical use.

Caldwell: Currently, some states use a general anesthetic called pentobarbital, but that drug also has problems. In a 2005 study, Le Barski and some other doctors examined the autopsy of prisoners executed with this type of drug. Almost all of them show blood levels of the drug lower than those required for surgery due to the short-acting action of the drug, and even high doses are rapidly depleted. And the autopsy we obtained shows similarly low levels.

LUBARSKY: Many prisoners are aware of the fact that during their executions they were sensory based on the level of drugs contained in their bodies.

Caldwell: Feeling, that is, being able to feel everything. Currently, there are doctors who oppose Le Barski’s 2005 study. They say that level is unreliable because the amount of drug in your blood can change dramatically after death.

Chan: Yes. In summary, prisoners are supposed to get medicine to prevent them from feeling pain, but one medicine used by some states is not an anesthetic. And the effectiveness of another drug is being discussed.

Caldwell: This goes back to the first question I asked. Did lethal injections fulfill their promise as a more peaceful and humane execution method than before?

ZIVOT: It doesn’t really do what the state claims.

Chan: This is Joel Zibot, an Atlanta doctor who first found evidence of pulmonary edema at an autopsy of a prisoner. And for him, lethal injections mimic medical practice, but he says it’s all just a play.

ZIVOT: This is a powerful imitation because it uses the term. Uses chemicals. And people believe that the safety provided by the drug has now been transferred to the execution room. It is not.

Chan: Tomorrow we will continue our investigation to see how all of this will be deployed in court. Courts are having a hard time understanding the difference between punishment and cruel and extraordinary punishment. We meet people on both sides of this disparity, including a man who has been waiting for 36 years to see the execution of his wife’s murderer.

Unidentified Person: Only a bleeding mind and half-hearted knowledge are relevant to this discussion. In the graveyard, there are cruel and extraordinary punishments.

CHANG: I’m Ailsa Chang.

Caldwell: I’m Noah Caldwell.

(Olaf lure sound bite “Epsilon”)

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