Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-2_11-cv-00438/USCOURTS-almd-2_11-cv-00438-20/pdf.json

Nature of Suit Code: 535
Nature of Suit: Habeas Corpus - Death Penalty
Cause of Action: 42:1983 Prisoner Civil Rights

---

IN THE UNITED STATES DISTRICT COURT

FOR THE MIDDLE DISTRICT OF ALABAMA

NORTHERN DIVISION

THOMAS D. ARTHUR, )

)

Plaintiff, )

)

v. ) CASE NO. 2:11-CV-438-WKW 

) [WO]

)

JEFFERSON S. DUNN, et al., )

)

Defendants. )

MEMORANDUM OPINION AND ORDER

For more than thirty-one years, Plaintiff Tommy Arthur, an Alabama deathrow inmate, has litigated in the state and federal courts1 of Alabama, and in the 

Eleventh Circuit and the United States Supreme Court, as is his right.2 The present 

case has been in litigation since June 8, 2011. Under controlling law, Arthur’s

bottom-line task here and now is very clear and forthright: Proceeding under 42 

U.S.C. § 1983 without challenging the judgment of execution, he must provide a 

known and available alternative for what he claims is an unconstitutional execution 

 

1

 Arthur’s federal court litigation includes a habeas petition filed under 28 U.S.C. § 2254, 

a prior case filed under 42 U.S.C. § 1983, and the current § 1983 action.

2 He was tried for a 1981 murder three times and sentenced to death three times, in 1982, 

1987, and 1992. In 2007, Arthur appealed the dismissal of a previous § 1983 action to the 

Eleventh Circuit. In deciding that appeal, the Eleventh Circuit reviewed Arthur’s extensive 

litigation history and referred to that appeal as “Arthur XXI.” Arthur v. King, 500 F.3d 1335, 

1337 (11th Cir. 2007) (“Arthur XXII”). That was almost nine years ago.

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method employed by Alabama. He failed to do so in a trial held on his Eighth 

Amendment facial challenge in January 2016. (See Doc. # 359.) He has now failed 

again to provide an alternative method of execution, this time with respect to his 

alleged idiosyncratic or unique medical conditions in an as-applied challenge. This 

memorandum opinion and order will conclude this case.

This matter is before the court on Defendants’ Motion for Judgment on the 

Pleadings, and in the Alternative, Motion for Summary Judgment on Arthur’s 

Eighth Amendment as-applied claim based on his unique health concerns (Doc. 

# 364), and Arthur’s Motion for a New Trial (Doc. # 367), filed pursuant to Federal 

Rule of Civil Procedure 59(a). The motion for new trial relates to his Eighth 

Amendment facial claim that was resolved after a trial in January 2016. All motions 

have been fully briefed and are ripe for review. Defendants’ alternative Motion for 

Summary Judgment is due to be granted, and Arthur’s Motion for a New Trial is 

due to be denied. These motions will be addressed in that order.

I. BACKGROUND 

A. Factual Background and Procedural History

The factual background and procedural history have been thoroughly 

recounted in Arthur v. Thomas, 674 F.3d 1257 (11th Cir. 2012), in prior opinions 

of this court, and most recently on April 15, 2016. (Doc. # 359 at 2-6.) They need 

not be repeated here, except for a brief review which will be followed by a summary 

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of the relevant factual and legal developments that have occurred following the first 

part of the bifurcated trial conducted on January 12-13, 2016. On June 8, 2011, 

Arthur filed this action under § 1983 challenging the constitutionality of Alabama’s 

method of execution under the Eighth and Fourteenth Amendments to the United 

States Constitution after Alabama changed its three-drug, lethal injection cocktail

by substituting pentobarbital for sodium thiopental as the first drug to be injected.3 

(Docs. # 1, 12.) In 2014, Alabama again changed its three-drug cocktail, this time

to midazolam hydrochloride, rocuronium bromide, and potassium chloride, and 

Arthur amended his complaint to challenge, as violating the Eighth Amendment, 

that lethal injection protocol as well.4 (Doc. # 197.) Arthur’s Fourteenth 

Amendment equal protection claim concerned the “consciousness assessment” 

component of Alabama’s execution protocol. Following the Supreme Court’s 

ruling in Glossip v. Gross, 135 S. Ct. 2726 (2015), Arthur was given leave to file a 

Third Amended Complaint to meet the pleading requirements established by

Glossip and Baze v. Kentucky, 553 U. S. 35 (2008), for Eighth Amendment methodof-execution challenges. (Doc. # 267.)

 

3 The remaining two drugs used by Alabama at the time were pancuronium bromide and 

potassium chloride.

4

 Arthur’s challenge concerns the substitution of midazolam hydrochloride for 

pentobarbital; he does not challenge the substitution of pancuronium bromide for rocuronium 

bromide. 

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On January 12–13, 2016, the court conducted the first part of a bifurcated

bench trial (1) on Arthur’s Eighth Amendment facial claim concerning only the 

second prong of the Baze/Glossip test, i.e., the availability of an alternative method 

of execution to the current lethal injection protocol, and (2) on Arthur’s Fourteenth 

Amendment equal protection claim challenging the consciousness assessment. 

After considering all of the testimony and other evidence from the bench trial, on 

April 15, 2016, the court entered its Findings of Fact, Conclusions of Law, and 

Judgment in favor of Defendants on those claims. (Doc. # 359.) Arthur failed to 

prove an alternative to the current execution protocol in Alabama. The court found 

that neither pentobarbital nor sodium thiopental is available to ADOC as an

execution drug.5 Even if he could prove an unconstitutional risk, he could not and 

did not prove a viable, known and available method of execution; therefore, 

Arthur’s Eighth Amendment facial claim failed.

The remainder of Arthur’s Eighth Amendment claim, viewed as an asapplied claim concerning his alleged unique medical condition, was not tried and

has not been resolved. This opinion addresses the remaining issue: Arthur’s health 

concerns as expressed in his Third Amended Complaint. (Doc. # 267 at ¶¶ 5d, 18, 

89 & 100.) In a nutshell, Arthur has alleged that he has cardiovascular issues that 

 

5

 Arthur proposed single doses of pentobarbital and sodium thiopental and a firing squad 

as alternatives. A firing squad is not a legal method of execution in Alabama. 

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combine with his age and emotional makeup to create a constitutionally 

unacceptable risk of pain if he is executed under the current protocol.

B. Court-Ordered Modified Protocol Negotiations

Acknowledging the possibility that Arthur’s claim that his idiosyncratic or 

unique health issues, if proven, may require a modification of the ADOC’s 

execution protocol in order to proceed with a constitutional execution, at the 

court’s direction the parties engaged in a process to determine if they could agree 

on a modified protocol. The results of that process, which occurred after the trial 

but before the April 15 ruling, are summarized below.

On February 24, 2016, the court entered an Order establishing a format for 

the parties to engage in good faith efforts to resolve Arthur’s protocol issues related 

to his specific health conditions. (See Doc. # 351.)6 The order was very specific: 

“Arthur shall propose a modified protocol that reasonably addresses these [health] 

issues, and to which Arthur would stipulate.” (Id. at 2.) The parties ostensibly 

complied with the court’s directive and exchanged written proposals on 

 

6

 Summarizing this order, the court directed the parties to meet and confer to determine 

if they could agree on a modified protocol that would accommodate Arthur’s idiosyncratic health 

concerns. In advance of the meet-and-confer, the court directed the parties to propose a modified 

protocol to each other, starting with Arthur first proposing a modified protocol to Defendants, 

followed by Defendants’ response thereto and a proposed modified protocol to Arthur. (See Doc. 

# 351 at 2.) If, after an exchange of proposed modified protocols the parties were unable arrive 

at a modified protocol to which they could stipulate, then the parties were directed to submit their 

respective positions on a modified protocol to the court, supported by briefing and evidence for 

the court’s consideration. Id. 

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modifications to the current protocol; however, the parties were unable to reach an 

agreement on a modified protocol. Consequently, pursuant to the February 24 

Order, the parties submitted their respective protocol proposals for the court’s 

consideration. (See Docs. # 354 - 357.) Exhibits to these submissions included the 

written exchanges between the parties prior to the meet-and-confer. 

These exhibits reveal that on March 8, 2016, Arthur advised Defendants that 

he could not stipulate to a modified three-drug protocol based on Alabama’s 

current protocol using midazolam as the first drug. However, without waiving or 

modifying his position, Arthur’s letter, in relevant part, stated:

[H]is position is that a protocol designed to administer midazolam 

gradually and with due consideration for Mr. Arthur’s medical 

condition—including with medical monitoring of Mr. Arthur’s 

health by a trained professional during the protocol with the use of 

an electroencephalogram, an electrocardiogram, a bispectral index 

monitor and/or other appropriate methods—may reduce to some 

extent the likelihood of Mr. Arthur suffering the pain of a heart 

attack during administration of the protocol, although it would not 

ameliorate those risks entirely or address the other previously 

identified reasons why the use of midazolam in a three-drug 

execution protocol is violative of Mr. Arthur’s constitutional 

rights. Such a modified protocol may also require the 

administration of other medication to prevent cardiac 

complications. Counsel for Mr. Arthur are endeavoring to obtain 

further medical advice, within the confines of ethical rules,

regarding timing and monitoring requirements and will be 

prepared to discuss any further details after receipt of Defendants’ 

position on March 15, 2016 during the parties meet and confer on 

or before March 22, 2016.

(Doc. # 354-1 (emphasis added).)

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On March 15, 2016, Defendants responded to Arthur’s March 8 letter, noting 

that Arthur did not address his specific health concerns and did not propose an 

actual protocol or provide specific details on modifying the protocol. (Doc. # 354-

2.) Defendants asked Arthur to provide specific details on the following:

• Define what a gradual administration meant and explain how 

“gradually” Arthur wanted midazolam to be administered;

• Define what “due consideration” for his medical condition meant;

• State what specific trained professionals he wanted to participate 

in his execution and what specific role these professionals would 

have in addressing his alleged health concerns; and

• State what specific “other medication” he wanted to be 

administered to prevent cardiac complications.

(Id.) Defendants requested Arthur to provide this specific information prior to the 

meet-and-confer, and to explain how these modifications can be implemented. 

(Id.) Given the lack of detailed information from Arthur regarding a modified 

protocol, Defendants maintained their position: “Defendants believe that a 

properly administered 500-milligram bolus of midazolam, as called for in the 

ADOC’s execution protocol, will adequately address Arthur’s alleged health 

concerns.” (Doc. # 354-2 at 2.)

While not detailed here, the parties exchanged additional correspondence, 

but to no avail. (See Docs. # 354-3, 355-10, 355-14.) Arthur contends he complied 

with the court’s directive to propose a modified protocol to which he would agree, 

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but as discussed later in this opinion, that is not the case. From Defendants’ 

perspective, Arthur had the initial burden to propose a modified protocol, but he 

did not meet that burden in that his proposals were too vague and generalized to 

enable Defendants to stipulate or to meaningfully respond. Hence, an impasse in 

stipulating to a modified protocol ensued.

7

Based on the parties’ negotiations toward a modified protocol and the 

evidence actually produced, the court concludes that Arthur’s submissions reflect 

a lack of good faith in resolving whatever health issues apply to him with respect 

to the present execution protocol. Intense prodding by the court saw Arthur 

essentially standing mute as to the existence of a specific remedy, i.e., a proposed 

alternative method of execution, for an alleged unconstitutional risk. It surely can 

be no surprise to Arthur that § 1983 method-of-execution proceedings, like all 

lawsuits, contemplate a remedy, a resolution to which the person bringing the suit 

would stipulate, were it offered by the opposition. No such remedy, despite 

repeated invitations to Arthur, has been offered. He has produced no bona fide 

 

7 As amply demonstrated by Defendants’ submissions, Arthur’s responses to the February 

24, 2016 Order were vague and incomplete. All three “proposals” were little more than 

nonspecific suggestions replete with vaporous modifiers, as seen from the following examples:

(1) administration of midazolam “gradually [undefined] and with due consideration 

[undefined] for [his] medical condition [unproven]” (Doc. # 354-1);

(2) “medical monitoring” [unspecified] “by a trained professional” [unspecified] using 

appropriate methods [unspecified] (Doc. # 354-1); and

(3) “the administration of other medication” [unspecified as to what, how much, dosage 

or rate of administration]. (Doc. # 354-1 (brackets added).) 

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proposal a court could weigh and consider, despite having the benefit of worldrenowned medical and scientific experts,

8

and despite having litigated this case 

since 2011. 

C. Arthur’s As-Applied Eighth Amendment Claim 

In Arthur’s Complaint and First Amended Complaint, his Eighth 

Amendment challenge to the execution protocol was facial. (See Docs. # 1, 12.) 

However, in both his Second Amended Complaint and Third Amended Complaint, 

Arthur included allegations that suggested he was asserting an as-applied Eighth 

Amendment claim in addition to his facial challenge. (See Doc. # 197, ¶¶ 5d, 18, 

79, 81, 90; Doc. # 267, ¶¶ 5d, 18, 89, 100.) Thus, over the course of this protracted 

litigation, Arthur’s facial challenge has evolved into both a facial challenge and an 

as-applied challenge to the execution protocol.

While Arthur did not specifically delineate his hybrid Eighth Amendment 

claim into separate counts or plead it clearly, not following the format established 

by Federal Rules of Civil Procedure 8 and 10(b), his filings indicate that his Eighth 

Amendment claim includes not only a facial claim but also an as-applied claim. 

 

8

 Arthur recently but belatedly offered a supplemental Declaration of one of his experts, 

J. Russell Strader, Jr., M.D., F.A.C.C., which came closer to the mark of specificity. (See Doc. 

# 355-12.) Dr. Strader offered a range of prebolus dosages of midazolam together with a time 

range of administration, but failed to suggest how long to administer the prebolus protocol, how 

to determine when it has reached its intended effect, or even what would constitute the intended 

effect. 

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That the claims are not delineated as such, but rather are intertwined, has required 

significant sorting and deciphering, and the court would have acted well within its 

discretion to dismiss the as-applied claim. Cf. Gissendaner v. Comm’r, Ga. Dep’t 

of Corr., 803 F.3d 565, 567 (11th Cir.) (Gissendaner II), cert. denied sub nom. 

Gissendaner v. Bryson, 136 S. Ct. 26 (2015) (observing that the court “would have 

been well within its discretion to strike” the complaint because it violated Federal 

Rule of Civil Procedure 8(b)(2)). Notwithstanding the procedural irregularity and 

Defendants’ urging, out of an abundance of caution, the court has considered his 

as-applied claim on the merits.

Cognizant of the medical profession’s stance on lethal injection executions9, 

and immediately after publishing the April 15, 2016 ruling on the first issues tried 

in January, the court reviewed all submissions and concluded that it was 

questionable whether Arthur could produce evidence sufficient to support an asapplied Eighth Amendment claim, especially on the Baze/Glossip prong requiring 

proof of a known and available alternative method of execution. No dispositive 

motion was pending so the court sua sponte ordered Defendants to file the current 

dispositive motion and invited, but did not require, Arthur to do likewise. (See 

Doc. # 360.) 

 

9

 See American Medical Association Code of Medical Ethics, Opinion 2.06 – Capital 

Punishment.

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Of particular note, that Order very clearly required Arthur to provide 

evidence of “specific, detailed, and concrete alternatives or modifications to the 

protocol [ ] that more than marginally address his serious health risks,” and that 

“provide precise procedures, amounts, times, and frequencies of implementation 

that would avoid the court being called upon to make improper medical, scientific, 

or peneological decisions, and [ ] that do not implicate abrogation of the death 

penalty per se.” (Doc. # 360 (emphases added).) Defendants filed a dispositive 

motion, but Arthur did not. Instead, Arthur filed a motion for a new trial on his 

Eighth Amendment facial claim. 

Arthur claims that because of his unique health concerns, Alabama’s 

execution protocol as applied to him will be cruel and unusual punishment in 

violation of the Eighth Amendment. Arthur states that because there is a “high 

likelihood that [he] has clinically significant obstructive coronary disease,” (Doc. 

# 267-1 at ¶ 89), the administration of a 500-milligram dose of midazolam as the 

first drug in the three-drug protocol will likely induce “a rapid and dangerous 

reduction in blood pressure,” (Id. at ¶ 88) and “will cause him to suffer a painful 

heart attack before he loses consciousness.” (Id. at ¶ 87.) Arthur also alleges:

100. Finally, there is a high likelihood that Mr. Arthur, who, among 

other things, is in his seventies and suffers from an anxiety disorder, 

will experience a paradoxical reaction to the intravenous 

administration of midazolam, causing Mr. Arthur to remain in a 

conscious state and suffer the severe pain of the administration of 

the second and third lethal injection drugs . . . .

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(Doc. # 267-1 at ¶ 100.)

Distilled to its essence, Arthur’s as-applied claim is that his cardiovascular 

issues, combined with his age and emotional makeup, create a constitutionally 

unacceptable risk of pain that will result in a violation of the Eighth Amendment if 

he is executed under the ADOC’s current protocol. Because Arthur does not request 

specific relief on his as-applied claim, it will be presumed that Arthur proposed the 

same alternatives for relief as he proposed for his facial claim: a single-drug 

injection of either compounded pentobarbital or sodium thiopental, or a firing squad 

(the latter of which is not authorized in Alabama). However, based on his proof 

and giving Arthur the benefit of the doubt, he also is requesting modification of the 

current protocol to require midazolam to be administered gradually with medical 

monitoring as an additional alternative form of relief, (See Strader Supp. Decl. 

(Doc. # 378-2), but in contradictory fashion, Arthur’s proof from Dr. Kaye is that 

midazolam in any form of dosage cannot be used in a constitutional execution. 

In evaluating this claim, the court is guided by controlling precedent, Baze v. 

Kentucky, 553 U. S. 35 (2008) and Glossip v. Gross, 135 S. Ct. 2726 (2015), 

explained in Glossip, below:

The controlling opinion in Baze first concluded that prisoners 

cannot successfully challenge a method of execution unless they 

establish that the method presents a risk that is ‘‘‘sure or very likely 

to cause serious illness and needless suffering,’ and give rise to 

‘sufficiently imminent dangers.’’’ Id., at 50, 128 S. Ct. 1520 

(quoting Helling v. McKinney, 509 U. S. 25, 33, 34–35, 113 S. Ct. 

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2475, 125 L. Ed. 2d 22 (1993)). To prevail on such a claim, ‘‘there 

must be a ‘substantial risk of serious harm,’ an ‘objectively 

intolerable risk of harm’ that prevents prison officials from 

pleading that they were ‘subjectively blameless for purposes of the 

Eighth Amendment.’” 553 U. S., at 50, 128 S. Ct. 1520 (quoting 

Farmer v. Brennan, 511 U. S. 825, 846, and n. 9, 114 S. Ct. 1970, 

128 L. Ed. 2d 811 (1994)). The controlling opinion also stated that 

prisoners ‘‘cannot successfully challenge a State’s method of 

execution merely by showing a slightly or marginally safer 

alternative.’’ 553 U. S., at 51, 128 S. Ct. 1520. Instead, prisoners 

must identify an alternative that is ‘‘feasible, readily implemented, 

and in fact significantly reduce[s] a substantial risk of severe pain.’’ 

Id., at 52, 128 S. Ct. 1520.

The controlling opinion summarized the requirements of an 

Eighth Amendment method-of-execution claim as follows: ‘‘A 

stay of execution may not be granted on grounds such as those 

asserted here unless the condemned prisoner establishes that the 

State’s lethal injection protocol creates a demonstrated risk of 

severe pain. [And] [h]e must show that the risk is substantial when 

compared to the known and available alternatives.’’ Id., at 61, 128 

S. Ct. 1520. . . . 

The challenge in Baze failed both because the Kentucky 

inmates did not show that the risks they identified were substantial 

and imminent, id., at 56, 128 S. Ct. 1520, and because they did not 

establish the existence of a known and available alternative method 

of execution that would entail a significantly less severe risk, id., at 

57–60, 128 S. Ct. 1520.

Glossip, 135 S. Ct. at 2737. 

Additionally, in Gissendaner II, the Eleventh Circuit held that the pleading 

burden and standard of proof established in Baze and Glossip applied to both facial 

and as-applied Eighth Amendment claims challenging the method of execution. See

803 F.3d at 568–69. As pertinent here, Gissendaner II establishes that a condemned 

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inmate must both plead and prove a readily available alternative whether the inmate 

is raising an Eighth Amendment as-applied challenge or a facial challenge: 

“[T]here is no logical reason why there should be a readily available alternative 

requirement in facial challenges to lethal injection protocols but not to as-applied 

challenges to them.” Id. at 569. 

Arthur argues that there are good grounds for distinguishing Gissendaner II

and foregoing the requirement in this case of showing a readily available alternative

method of execution. As he points out, the Gissendaner II majority distinguished 

the facts in Seibert v. Allen, 506 F.3d 1047 (11th Cir. 2007), in which the 

condemned inmate obtained a preliminary injunction on an Eighth Amendment 

claim that lethal injection would cause him severe pain based upon his inoperable 

pancreatic cancer. The Eleventh Circuit noted that Gissendaner’s claim, unlike 

Seibert’s claim, did not involve an assertion that the “plaintiff’s unique medical 

condition would enhance the likelihood and severity of a painful death.” 

Gissendaner II, 803 F.3d at 565 n.1. Notwithstanding this factual distinction, 

Gissendaner II made no legal distinction in the elements of proof for facial and asapplied method-of-execution claims. It even went so far as to say that Seibert “does 

not serve as an authoritative interpretation of the requirements announced in Baze 

and Glossip because it preceded both of those decisions.” Id. And in Terrell v. 

Bryson, 807 F.3d 1276 (11th Cir. 2015), the concurring opinion confirmed 

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Gissendaner II’s reach to as-applied challenges. See id. at 1280 (Marcus, J., 

concurring) (“As we’ve said in binding precedent, ‘a readily available alternative’ 

showing is required in all challenges to lethal injection protocols.”) (citing 

Gissendaner II, 803 F.3d at 569)).10 Thus, as to his as-applied claim, Arthur has 

the burden to plead and prove a known and available alternative method of 

execution. Glossip, 135 S. Ct. at 2739.

D. Arthur’s Idiosyncratic Health Issues11

Arthur is currently 74 years old. He contends that he suffers from clinically 

significant coronary artery disease (“CAD”)

12 and that because of that condition, he 

 

10 The Eleventh Circuit’s ruling in Gissendaner II that an inmate filing an as-applied 

challenge must meet the pleading and proof standard of Baze and Glossip is consistent with the 

law in another circuit. Specifically, the Eighth Circuit has held that an inmate who filed an asapplied challenge to Missouri’s method of execution had to “identify a feasible, readily 

implemented alternative procedure that will significantly reduce a substantial risk of severe pain 

and that the State refuses to adopt.” Bucklew v. Lombardi, 783 F.3d 1120, 1128 (8th Cir. 2015) 

(emphasis in original). The Eighth Circuit recognized that there was some pre-Baze case law 

supporting the inmate’s assertion that his as-applied challenge distinguished his case from a facial 

challenge to Missouri’s lethal injection protocol. Id. at 1127. But ultimately, the court held that 

“capital punishment is constitutional. It necessarily follows that there must be a means of carrying 

it out.” Id. at 1128 (quoting Baze, 553 U.S. at 47).

11

 In Arthur’s Third Amended Complaint, he alleged that because of his age and because 

he suffers from an anxiety disorder, there is a high likelihood that he will experience a paradoxical 

reaction to midazolam, resulting in his remaining in a conscious state and suffering the pain of 

the administration of the second and third lethal injection drugs. (Doc. # 267 at 30, ¶ 100.) 

However, Arthur offered no medical evidence to support his claim that he suffered from an 

anxiety disorder. Given his failure of any proof, the court presumes that Arthur has abandoned 

that part of his claim. 

12

 As explained in greater detail infra, Dr. Strader reports that before coronary artery 

disease (CAD) is clinically significant, the cross-section of an artery needs to be at least 70% 

obstructed. (Doc. # 378-1 at 10, ¶ 2.)

 

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cannot be executed under the present protocol because a 500-mg bolus dose of 

midazolam will induce a heart attack that he will experience before the midazolam 

sedates him. Arthur offers support for this argument with the opinions of his expert, 

J. Russell Strader, Jr., M.D., F.A.C.C.13 Dr. Strader’s declaration contained two 

separate risk assessments from a clinical, not capital punishment, perspective when 

he is treating a medical patient: “First, what is the likelihood that the individual has 

clinically significant obstructive coronary disease? And second, what is the 

likelihood that the level of anesthesia required for the proposed procedure will cause 

the onset of myocardial ischemia and/or infarction?” (Doc. # 378-1 at 3, ¶ 4

(emphases in original).) Dr. Strader attempted to extrapolate his clinical 

observations of routine doses of 2–5 mg of midazolam (and a high of 20 mg, 

titrated) into a medical and scientific conclusion regarding a 500 mg dose of 

midazolam, the one used in Alabama as the first of the three-drug protocol.

Based on his review and analysis of Arthur’s medical records, Dr. Strader 

opined that there is a “significant risk” that Arthur suffers from clinically significant 

 

13

 Summarizing Dr. Strader’s background and qualifications, he is board-certified by the 

American Board of Internal Medicine in both Internal Medicine and Cardiovascular Disease, and 

he is also board-certified by the American Society of Nuclear Cardiology. He was formerly Chief 

of Cardiovascular Services at The Medical Center of Plano in Plano, Texas, and he is currently a 

cardiologist in private practice in Colorado Springs, Colorado. He sees an average of 100-125 

patients per week. In his routine clinical practice, he administers midazolam to patients for the 

purpose of achieving sedation for invasive cardiac procedures. As of November 16, 2015, he had 

performed approximately 3,500 invasive procedures using midazolam. (See Doc. # 378-1 at 3, 

¶¶ 1, 3, 5.) 

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obstructive CAD, for the reasons succinctly stated in his November 15, 2015 

Declaration:

8. In my professional medical opinion, Mr. Arthur’s abnormal 

ECGs showing evidence of a prior myocardial infarction, history of 

recurrent atrial fibrillation, age, presence of hypertension, and 

symptoms of recurrent chest pain are all independent risk factors 

for coronary heart disease and confer a significant risk of having 

clinically significant obstructive coronary artery disease of at least 

70%, and possibly greater.

(Doc. # 378-1 at 12, ¶ 8.)

In reaching his next opinion, Dr. Strader defined coronary atherosclerosis and 

reviewed its relevant aspects, reporting that a coronary artery needs to be 70% 

obstructed before it is hemodynamically significant, as detailed below:

1. Coronary atherosclerosis refers to the deposition of cholesterol 

into plaques within the walls of the coronary arteries. Over time, 

this results in the narrowing of the vessel, resulting in what is 

commonly referred to as coronary heart disease. It takes 3-10 years 

for cholesterol plaques to grow to the level of obstructing blood 

flow down the coronary arteries.

2. Cholesterol plaques typically need to obstruct at least 70% of 

the cross-sectional area of the artery before they are 

hemodynamically significant, i.e., before they provide a degree of 

obstruction sufficient to cause interruptions or reductions in blood 

flow down the coronary artery such that there is a high risk of 

induction of myocardial ischemia/infarction. At levels of 

obstruction less than 70%, there is generally enough flow such that 

alterations in blood pressure (e.g., supply), or actions such as 

exercise that increase myocardial oxygen requirements (e.g., 

demand), do not result in an inadequate oxygen supply to the 

myocardium.

(Doc. # 378-1 at 9-10, ¶¶ 1-2.)

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Based on (1) Dr. Strader’s review noted above, (2) his review of the relevant 

aspects of myocardial ischemia/infarction (Doc. # 378-1 at 10-11), (3) his opinion 

that Arthur suffers from clinically significant obstructive CAD, (4) the known 

hemodynamic effects of midazolam, (5) his experience with midazolam in clinical

practice, and (6) a wide array of medical literature in the field,14 Dr. Strader 

rendered a second opinion, as follows:

5. It is therefore highly likely that an individual with obstructive 

coronary disease who is given a large and rapid dose of midazolam 

would feel the resulting myocardial ischemia and/or infarction, 

because it takes more time for midazolam to induce sedation than 

it does for myocardial ischemia/infarction to occur.

. . . 

7. It is thus highly likely that the administration of a large dose of 

midazolam to Mr. Arthur as directed by the ADOC protocol would 

result in the very rapid induction of acute myocardial 

ischemia/infarction.

8. Given that the onset of myocardial ischemia and/or infarction is

immediate, it is highly likely that Mr. Arthur would experience the 

excruciating pain of a heart attack before the onset of midazolam’s 

sedative effect.

(Doc. # 378-1 at 13, ¶¶ 5, 7-8.) Arthur relies heavily on the expert testimony of Dr. 

Strader to establish the risk prong of Baze/Glossip and to support the alternative 

method prong.

 

14

 This supporting medical literature (consisting of excerpts from medical treatises, peerreviewed articles and clinical studies) is attached to Dr. Strader’s deposition. (See generally Doc. 

# 364-4.)

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While Dr. Strader’s expert medical opinions are unrebutted by affirmative 

evidence, it is also undisputed that Arthur has not seen or been examined by a 

cardiologist or other cardiac specialist since 2009; that there are no current test 

results or other recent evidence of Arthur’s present health condition; that he 

repeatedly has refused such examination (see generally Doc. # 364-6 (2009–15 

medical records))15; and that Dr. Strader opines without ever having examined 

Arthur. Nor did Dr. Strader, who appears to be an expert of the highest caliber in 

his field, offer a specific method to address both Arthur’s alleged health needs and 

the Baze/Glossip alternative method requirement.

Based on controlling precedent and for the reasons explained below, Arthur 

has not established that he is entitled to proceed on his as-applied Eighth 

Amendment claim.

II. DISCUSSION

A. Defendants’ Motion for Judgment on the Pleadings and Alternatively for

Summary Judgment

1. Standard of Review

At the court’s direction, Defendants moved for judgment on the pleadings, 

and alternatively, for summary judgment. (Doc. # 364.) As grounds, Defendants 

 

15 In fact, Arthur has refused or interfered with all medical care, including drug regimen 

and annual checkups, since 2009. (Id.) He refused to get out of the ADOC vehicle at his last 

cardiologist appointment in March 2009. (Doc. # 364-6, at 15–20.)

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submit that, although Arthur asserted claims regarding his alleged health concerns, 

the record reflects that he has no remaining claims pending. Defendants also 

contend that Arthur failed to raise an as-applied Eighth Amendment claim, but even 

if he had raised that claim, he failed to plead and prove it adequately. Defendants 

further argue that even if Arthur is deemed to have alleged an as-applied claim, 

summary judgment is warranted on that claim because Arthur has failed to produce 

evidence that establishes a genuine dispute of material fact that (1) the use of 

midazolam is “sure or very likely to cause serious illness or needless suffering” by 

causing him to experience a painful heart attack, and (2) there are known and 

available alternatives that are feasible, readily implemented, and in fact 

significantly reduce a substantial risk of severe pain. 

The parties have engaged in extensive discovery, and their present 

submissions rely largely on the evidence. Given the posture of this case and 

notwithstanding the Third Amended Complaint’s shortcomings, see supra at Part 

I.C., the court finds that the better course is for it to decide Defendants’ motion 

under the summary judgment standard. Defendants’ motion for judgment on the 

pleadings will be treated, therefore, as a motion for summary judgment under 

Federal Rule of Civil Procedure 12(d) (If a court considers “matters outside the 

pleadings,” a Rule 12(c) “motion must be treated as one for summary judgment 

under Rule 56.”).

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Summary judgment is proper only when the record evidence, including 

depositions, affidavits, and other materials, shows “that there is no genuine dispute 

as to any material fact and the movant is entitled to judgment as a matter of law.” 

Celotex Corp. v. Catrett, 477 U. S. 317, 322 (1986); Fed. R. Civ. P. 56(a), (c). “The 

moving party bears the burden of proof,” Allen v. Bd. of Pub. Educ. for Bibb Cty., 

495 F.3d 1306, 1313 (11th Cir. 2007), and the court must “view the evidence and 

all factual inferences therefrom in the light most favorable to the non-moving party, 

and resolve all reasonable doubts about the facts in favor of the non-movant,” Skop 

v. City of Atlanta, 485 F.3d 1130, 1143 (11th Cir. 2007).

2. Standard of Proof for § 1983 Method-of-Execution Claim

Summarizing and paraphrasing the Baze/Glossip test, to successfully 

challenge a method of execution (facial or as-applied), a prisoner must establish 

that the method presents a risk that is ‘“sure or very likely to cause serious illness 

and needless suffering,’ and give rise to ‘sufficiently imminent dangers.”’ Glossip,

135 S. Ct. at 2737 (emphasis in original). To prevail, “there must be a ‘substantial 

risk of serious harm,’ an ‘objectively intolerable risk of harm’ that prevents prison 

officials from pleading that they were ‘subjectively blameless for purposes of the 

Eighth Amendment.’” Id.

Further, a prisoner “cannot successfully challenge a State’s method of 

execution merely by showing a slightly or marginally safer alternative.” Baze, 553 

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U. S. at 51. He “must identify an alternative that is ‘feasible, readily implemented, 

and in fact significantly reduce[s] a substantial risk of severe pain.’” Id. at 52.

In short, Arthur must point to admissible evidence that would, if credited, 

establish a risk and a known and available alternative method of execution that 

significantly reduces that risk. As noted earlier, Arthur fails on the alternative 

method prong, just as he did in the January 2016 trial of the facial challenge. That 

failure will be addressed first; discussion regarding Arthur’s unique health concerns 

and associated risks, i.e., the risk prong, will follow.

3. Alternative Method Prong

 Post-Baze and Glossip, it is clear that before a prisoner is entitled to relief, he 

must also establish a remedy, that is, “the existence of a known and available 

alternative method of execution that would entail a significantly less severe risk.” 

Glossip, 135 S. Ct. at 2737 (quoting Baze, 553 U. S. at 56-60). Arthur failed entirely 

to do so. During the meet-and-confer process previously described, Arthur

proposed modifying the protocol “to administer midazolam gradually [undefined] 

and with due consideration [undefined] for [his] medical condition—including with 

medical monitoring of [his] health by a trained professional during the protocol [not 

identified]” with the use of various types of medical equipment “and/or other 

appropriate methods [not specified]. . . .” (Doc. # 354-1.) He allowed that “[s]uch 

a modified protocol may also require the administration of other medication to 

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prevent cardiac complications,” (id.), without defining “other medication.” Arthur 

further stated that these proposed modifications to the protocol “may reduce to some 

extent the likelihood of [his] suffering the pain of a heart attack during 

administration of the protocol,” (id.), “but would not ameliorate those risks entirely

. . . .” (Id.)

 Arthur admits in the language set out above that his nebulous, nonspecific, 

and unexplained proposed modifications “may reduce to some extent” the 

likelihood of unconstitutional pain. (Doc. # 354-1.) His initial proposed alternative 

method of execution is a marginal one and does not satisfy Baze.

Later, Arthur added a measure of detail to his proposal with the filing of Dr.

Strader’s supplemental declaration (Doc. # 355-12; Doc. # 378-2), which offered a 

range of prebolus doses of midazolam together with a time range of administration, 

but which failed to suggest how long to administer the prebolus protocol, how to 

determine when it has reached its intended effect, or even what would constitute the 

intended effect. He opined that the gradual rate “would reduce the risk,” though the 

reduction is unspecified and cannot be deemed to be more than marginal when 

considering the rest of Dr. Strader’s requirements:

(1) A trained professional

(2) who assesses the patient’s response to the prior dose; and, 

commonly,

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(3) continuous EKG monitoring (which of course requires an EKG 

and qualified technician);

(4) continuous pulse oximetry monitoring; 

(5) frequent blood pressure monitoring;

(6) agents to increase blood pressure (“pressors”) if required by EKG 

results; and

(7) the addition of opioid fentanyl, which “is often administered with 

midazolam.”

(Id.) Dr. Strader understandably identified these procedures as relevant “in the 

clinical setting” (¶ 7) and “in clinical practice” (¶¶ 8, 9). It is understandable 

because his opinion is a medical one, describing medical procedures, not execution 

procedures. See Baze, 553 U. S. at 59–60 (distinguishing executions from medical 

procedures). Thus, the outlined general procedures cannot be credited as 

constitutionally required modifications to the execution protocol in Alabama and 

do not constitute viable execution alternatives that are easily implemented and 

readily available.

Contrary to the court’s clear directives requiring “specific, detailed and 

concrete alternatives or modifications to the protocol” with “precise procedures, 

amounts, times and frequencies of implementation,” there is no evidence from 

which the court could craft a modification to the existing protocol, at least not 

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without itself engaging in the unauthorized practice of medicine and requiring 

medical procedures in the execution context.

A challenge to a method of execution that merely shows “a slightly or 

marginally safer alternative,” Baze, 553 U. S. at 51, fails to meet the remedy test. 

Further, “because it is settled that capital punishment is constitutional, it necessarily 

follows that there must be a constitutional means of carrying it out.” Glossip, 135 

S. Ct. at 2732–33 (quoting Baze, 553 U. S. at 47) (alteration omitted)). Moreover, 

“because some risk of pain is inherent in any method of execution [,] . . . the 

Constitution does not require the avoidance of all risk of pain.” Id. at 2733 (citation 

omitted).

To the extent that Arthur relies on any one-drug protocol using pentobarbital 

(as suggested by Dr. Strader) or sodium thiopental, those options were foreclosed 

by the evidence and findings thereon in the prior opinion. (Doc. # 359.) To the 

extent he suggests the use of midazolam at all, he also has insurmountable problems 

in terms of proof and evidentiary estoppel. One need consider only the 28-page 

declaration of Dr. Alan Kaye, a world-renowned anesthesiologist and Ph.D.

pharmacologist (see Doc. # 355-13), submitted as evidence by Arthur himself, and 

cited repeatedly in Arthur’s briefing. Dr. Kaye testifies, and binds Arthur to the 

notion, that midazolam absolutely and under no circumstances should ever be used 

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in lethal injection executions. Paragraph 67 illustrates but one of many avenues Dr. 

Kaye attacks midazolam:

Because midazolam’s pharmacological effect is reached at 

doses far below 500 mg, and at this dose an inmate will not be placed 

in a deep enough state of anesthesia such that he will not experience 

consciously the effects of the second and third drugs, the size of the 

dose Alabama intends to administer is no cure to the fundamental 

unsuitability of midazolam as the first drug in the ADOC protocol.

(Doc. # 355-13 (emphasis added).) At the end of 75 impressive paragraphs 

supported by his own and numerous other texts and opinions, copious footnotes, 

and metaphors and analogies that speak to a layperson’s understanding, in 

paragraph 76 Dr. Kaye sums it up:

In short, the chemical properties of midazolam limit its ability 

to depress electrical activity in the brain. The lack of another chemical 

property – analgesia – renders midazolam incapable of maintaining 

even that limited level of depressed electrical activity under the 

undiminished pain of the second and third lethal injection drugs.

(Id. (emphasis added).) Arthur cannot credibly propose the use of midazolam in 

any argument for a remedy, based upon his own evidence.16

Arthur’s as-applied vehicle crashes at the same intersection as did his facial 

challenge. He has failed to point to admissible evidence that, if credited, would 

 

16

 Kaye’s opinions are untested in court, due to Arthur’s inability to provide a remedy in 

his facial, and now as-applied, challenges. Kaye’s opinions are cited here only to illustrate 

Arthur’s wholly inconsistent argument that midazolam may be used in an alternative method of 

execution, not as evidence on the risk prong of the Baze/Glossip test.

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establish an alternative method of execution that is readily available and more than 

“a slightly or marginally safer alternative.” Baze, 553 U. S. at 51.

4. The Risk: Arthur’s Idiosyncratic or Unique Medical Condition 

Arthur’s Eighth Amendment as-applied challenge is doomed for lack of proof 

of an alternative method of execution that satisfies the second prong of the

Baze/Glossip test. The risk prong is therefore not dispositive, but is analyzed in the 

alternative, for two reasons. First, it is not at all clear that Arthur has sufficient 

evidence to go to trial on the issue of his unique health concerns. If his evidence of 

unique health risks rises to a level sufficient to survive summary judgment, it is 

barely so. Second, Dr. Strader’s opinion that Arthur’s blood pressure will drop 

precipitously before the anesthetic effects of midazolam take effect, thereby 

creating a likelihood of a painful heart attack before Arthur is sedated, is speculative 

and unreliable when extrapolated from a clinical dose of 2 to 5 mg, to a non-clinical, 

bolus dose of 500 mg. Neither Dr. Strader nor Dr. Kaye can testify to a reasonable 

degree of medical certainty that the “gap” between hemodynamic effects and 

sedative effects will occur at a bolus dose —a dose at least 100 times larger than 

any clinical dose with which Dr. Strader is familiar—at all; and if the gap does 

occur, in what sequence, e.g., will the massive dose create sedative effects first, or 

hemodynamic effects first? No science has been offered on the question.

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The science that is of record is, as they say, all over the place. Just one 

example: There is no agreement in the record as to the basic definitions of “sedate” 

and “sedative,” and more importantly, “anesthesia.” Dr. Kaye opines that 

midazolam will never produce a plane of anesthesia, as he defines it, even in a 500 

mg dose (or presumably a 5000 mg dose, based on his foundational opinions). He 

would never, he says, use midazolam as a sole anesthetic agent for painful, invasive 

procedures. On the other hand, the FDA-approved label on midazolam says it will 

induce anesthesia in 1.5 minutes when used in conjunction with certain other 

medications, and in 2 to 2.5 minutes when used alone. Nevertheless, the court will 

venture into this technical thicket, hopeful of a logical and reasoned exit on the other 

side.

Dr. Strader opines that given Arthur’s known, independent risk factors for 

heart disease, there is a significant risk that Arthur has clinically significant 

obstructive CAD. If Dr. Strader’s opinion is admissible and credited, Arthur has 

cleared the first proof hurdle on summary judgment on the risk prong. He must still 

prove the risk of severe pain is very likely or sure to arise from Alabama’s protocol.

Some background science must first be addressed.

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5. Hemodynamic and Anesthetic Effects of Midazolam

a. Hemodynamic Effects

Dr. Strader’s foundational opinion about the hemodynamic effects of 

midazolam is that “the injection of midazolam as directed by the ADOC protocol 

will likely induce a rapid and dangerous reduction in blood pressure more quickly 

than it results in sedation.” (Strader 11/16/15 Decl. Ex, A, at 2, ¶ 3; Doc. # 364-1, 

at 2, ¶ 3.) In his clinical experience with clinical doses “midazolam typically will 

produce a 10-20% decline in arterial blood pressure.” (Strader 11/16/15 Decl. Ex. 

A, at 2, ¶ 4; Doc. # 364-1, at 2 at ¶ 4.) Consistent with Dr. Strader’s statement, the 

manufacturer’s package insert for midazolam states that “IV induction of general 

anesthesia with midazolam was associated with a slight to moderate decrease in 

mean arterial pressure.” (Doc. # 364-7 at 3.) Dr. Strader connects the hemodynamic 

effects with the anesthetic effects, postulating a gap in time between them, with 

hemodynamic effects occurring first. 

b. Anesthetic Effects

Midazolam is characterized by Dr. Strader as both a sedative and anesthetic.

Indeed, there is no dispute that ADOC uses midazolam for those very effects, before 

the introduction of the last two drugs in the protocol. Nor is it disputed that the 

consciousness assessment, addressed in a prior opinion (see Doc. # 359), is designed 

to measure in some fashion whether the sedative or anesthetic effect has occurred. 

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At trial in January 2016, Arthur presented medical expert testimony from 

Alan David Kaye, M.D., Ph.D., who is an anesthesiologist and Doctor of 

Pharmacology. Dr. Kaye explained the differences among these terms. First, 

“consciousness is being [in] a state of awareness, being able to perceive stimuli 

from the environment.” (Kaye Trial Tr. vol. 2, 14:6-8.) Distinguishing between 

sedation and anesthesia, Dr. Kaye explained:

Q. And what does sedation mean?

A. Well, sedation is . . . a continuum. And . . . it would be being 

calm or relaxed or at ease relative to the environment and 

perception of stimuli.

Q. And when you talk about a continuum, what do you mean by 

that?

A. And so in anesthesia, of course, this is a very big deal. There 

can be mild sedation in which a person can easily respond to verbal 

cues and then moderate sedation where there is less response and 

finally deep sedation for which the person would be in a deeper 

plain of sedation. And in the far end of the continuum would be 

anesthesia. Anesthesia would basically be the deepest level of the 

continuum in the sedation kind of overview.

THE COURT: Is this continuum widely recognized among 

academics in your field?

THE WITNESS: Oh, absolutely. It’s . . . understood at the level of 

the first-year anesthesia resident . . . .

(Kaye Trial Tr. vol. 2, 14:9 – 15:1.)

These definitions, from a highly qualified anesthesiologist, are useful in 

assessing Dr. Strader’s “gap” testimony, i.e., the suggested gap in time between the 

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onset of the hemodynamic and sedative effects one might expect with the 

administration of a bolus, rather than clinical, dose of midazolam. Analysis of that 

testimony follows.

c. Clinical Dose for Sedation (2-5 mg)

Dr. Strader’s clinical experience is limited to administering small clinical 

doses of midazolam (2-5 mg) for purposes of sedation. (Strader Dep. 43:20-22.) In 

section D of his declaration, he summarizes the hemodynamic and anesthetic effects

of a clinical dose of midazolam: 

1. Administration of midazolam in large doses has significant 

hemodynamic effects, in that it can result in a quick and significant 

drop in blood pressure. The hemodynamic effects of midazolam 

occur quickly and are independent of midazolam’s sedative effects. 

In my clinical experience, where midazolam in small doses (2-5 

mg) is used to sedate patients undergoing invasive cardiac 

procedures, midazolam’s sedative effects generally take 5 minutes 

or more to take effect. The hemodynamic effects of lowering blood 

pressure can occur much more rapidly (1-2 minutes).

 

2. Midazolam is a commonly used medication in clinical 

medicine. When used in clinical doses (typically 2-5 mg), 

midazolam often exerts significant effects on hemodynamic 

variables (e.g., blood pressure, pulse) prior to the onset of sedative 

effects. When used in clinical doses, midazolam typically results 

in a 10-20% fall in arterial blood pressure. Such a drop is especially 

common in elderly patients. A rapid drop in blood pressure can 

result in an immediate heart attack, particularly in individuals with 

obstructive coronary artery disease. Because of the significant risk 

of the onset of hemodynamic effects prior to the onset of anesthetic 

effects, clinical protocols have been established to ensure patient 

comfort and safety, including constant hemodynamic monitoring 

and waiting a sufficient length of time following administration of 

midazolam before the initiation of invasive or painful procedures. 

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(Strader 11/16/15 Decl., Ex A, at 5-6, ¶¶ 1-2; Doc. # 364-1 (emphasis added) 

(footnotes omitted).)

Because of the time gap of three to four minutes between the hemodynamic 

and sedative effects of a clinical dose (2-5 mg), Dr. Strader reports that the standard 

practice is to give midazolam to a CAD patient in small doses and to monitor the 

patient’s response to the medication by closely observing the patient’s vital signs 

for a rapid drop in blood pressure. If a rapid decrease in blood pressure occurs in 

the clinical setting, countermeasures are taken with drugs called “pressors” to raise 

blood pressure to avoid the onset of a heart attack. (Strader Dep. 17:10-16.)

Dr. Strader acknowledged that the medical literature referenced in his 

Declaration did not caution against using midazolam in patients with CAD and 

stated that “we use it in patients with coronary disease all the time in routine clinical 

practice.” (Strader Dep. 37:1-10.) As of November 16, 2015, he had performed 

approximately 3,500 cardiac catheterizations using midazolam as a sedative. 

(Strader 11/16/15 Decl., Ex A, at 3, ¶ 5; Doc. # 364-1.) Dr. Strader reported that 

approximately 24 of these patients experienced a heart attack after being sedated 

with a clinical dose of midazolam. (Strader Dep. 53:10-17.) The statistics from Dr. 

Strader’s practice reflect that less than 1% (0.00686%) of these 3,500 patients

suffered a heart attack following administration of a clinical dose. 

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d. Clinical Dose for Anesthesia 

Dr. Strader has little experience administering doses of midazolam that 

exceed a clinical dose (2-5 mg) for sedation. He explained: “In the clinical use in 

this setting, in the cardiac cath[erization] lab, it’s administered in small doses 1/2 to 

1 milligram at a time. Then there’s a waiting period to assess response, and then 

readminister it if you need more.” (Strader Dep. 11:6-11.) The largest dose of 

midazolam Dr. Strader has administered is a cumulative 20-mg dose that was given 

in small doses over time (“titrated”). (Id. at 13:19-24, 15:13-15.) Because Dr. 

Strader administers midazolam for sedation purposes only, he had no opinion as to 

what would be a clinical dose of midazolam sufficient to induce anesthesia. Dr. 

Strader testified that he was aware that midazolam had been approved for use to 

induce anesthesia, and he “thinks some anesthesiologists use it for that purpose. I 

don’t have any direct knowledge of what they do.” (Strader Dep. 25:11-17.) “To 

what extent midazolam would produce full unconsciousness or anesthesia, again, I 

would defer that to an anesthesiologist. It’s outside the scope of my practice.” 

(Strader Dep. 115:18-21.) As a board-certified internal medicine and cardiac 

disease specialist, Dr. Strader has never offered expert testimony, before this case,

concerning anesthesia. (Strader Dep. 7:5-7.)

Some evidence is found in the manufacturer’s package insert accompanying 

midazolam, which acknowledges midazolam’s use for anesthesia and states 

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generally that its effects are dose-dependent: “The effects of midazolam on the 

CNS [central nervous system] are dependent on the dose administered, the route of 

administration, and the presence or absence of other medications.” (Doc. # 364-7 

at 2.) According to the package insert, when midazolam is “given IV as an 

anesthetic induction agent,” anesthesia is induced in approximately 1.5 minutes, 

when narcotic premedication has been used, and in 2 to 2.5 minutes when there is 

no narcotic premedication. (Doc. # 364-7 at 3). While there is no direct medical

evidence of the time required by a bolus dose to induce anesthesia, the 

manufacturer’s label is direct evidence that at clinical doses (1) midazolam will 

induce anesthesia (not just sedation) (2) in as little as 2 minutes without narcotic 

premedication.

e. Non-Clinical Dose (500-mg) 

The 500-mg bolus dose of midazolam in the ADOC’s protocol is a dose much 

larger than that administered in clinical practice, as Dr. Strader explains in his 

Declaration:

 4. There is no institutional experience within the field of human 

medicine using the dose proposed by the ADOC (500 mg). Based

on the expert report of Dr. Bannister, I understand that the 

midazolam called for in the ADOC lethal injection protocol may 

precipitate, i.e., fall out of the solution, at the site of injection as it 

is first diluted with blood. Given the immediate and severe effects 

of midazolam on blood pressure, it is highly unlikely that 75% or 

more precipitation of the agent would preclude the hemodynamic 

effects noted above. Accordingly, the application of 500 mg of 

midazolam would be expected to create a significant risk of the 

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onset of hemodynamic effects prior to the onset of sedative effects, 

even with more than 75% precipitation.

(Strader 11/16/15 Decl. Ex. A, at 6-7, ¶ 4; Doc. # 364-1 (footnotes omitted).)

While Dr. Strader has no experience with the effects of a 500-mg bolus dose 

of midazolam (a dose at least 100 times larger than any dose with which he is 

familiar), he yet opines that the hemodynamic effects would occur more quickly 

from a 500-mg dose than they would from a clinical dose. Dr. Strader was careful 

to qualify many times that his experience with midazolam is only with clinical (very 

small) doses. Especially with the critical gap in time between the sedative effect 

and the hemodynamic effect, Dr. Strader makes a point of the small (2-5 mg) dose 

of midazolam that results in the “gap.” Dr. Strader declined to offer any opinion as 

to the amount of time it would take a 500-mg bolus dose to render one unconscious, 

reiterating “[t]hat’s outside my realm of practice.” (Strader Dep. 19:4-9.) 

Nevertheless, extrapolating from his clinical practice, Dr. Strader remained of the 

opinion that the sedative effects of a 500-mg bolus dose would take longer than the 

hemodynamic effects. (Strader Dep. 19:14-25.) 

The court finds the latter opinion unreliable. See generally Daubert v. 

Merrell Dow Pharm., Inc., 509 U. S. 579 (1993) (setting forth the standard for the 

admissibility of expert testimony). Because Dr. Strader cannot render an opinion

regarding how much time it would take a 500-mg dose to render one unconscious, 

it is impossible for him to extrapolate a sequence of hemodynamic effect and 

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sedation. Moreover, any argument based upon the time-gap Dr. Strader emphasizes 

between midazolam’s hemodynamic and sedative effects is speculative because the 

time-gap is associated with the clinical dose (2-5 mg) for sedation, not for 

anesthesia or bolus doses. Also, the argument is based upon an opinion of an expert 

who has never administered more than a 20-mg dose of midazolam, and typically 

only a 2-5 mg dose, in more than 3,500 invasive procedures in which he used 

midazolam. 

In any event, taking all the available evidence, Arthur falls short of producing 

evidence that the current protocol as applied to him has a demonstrated risk, sure or 

very likely to cause severe pain. Arthur has pointed to no admissible medical expert 

opinion testimony to establish either the clinical dosage of midazolam necessary to 

induce anesthesia or the time-frame within which that would occur. Nor is there 

admissible scientific or medical evidence connecting Dr. Kaye’s “consciousness 

continuum” directly to the time required for a 500-mg dose of midazolam to 

produce anesthesia.17

 

17 Ironically, Arthur’s expert in the field of anesthesiology, Dr. Kaye, says that there is no 

dosage of midazolam that will “hold an inmate unconscious in the presence of pain stimuli from 

the second and third drugs” in the ADOC’s protocol. (Doc. # 378-11, at 1, ¶ 59.) Based upon 

midazolam’s “inability to maintain unconsciousness in the presence of noxious stimuli,” Dr. Kaye 

“would never attempt nor teach . . . [his] trainees to use midazolam by itself to induce and to 

maintain general anesthesia in a healthy adult patient undergoing a painful, invasive procedure.” 

(Doc. # 378-11, at 12, ¶¶ 60–61.) The irony is that, as to this as-applied heart-attack challenge, 

Dr. Kaye’s opinions drift into the facial challenge of the protocol itself, which is not relevant 

directly to Arthur’s as-applied challenge. Arthur’s argument is based solely on the “gap” between 

the onset of the blood pressure drop and the sedative effect, which he says will produce a painful 

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Moreover, the diagnosis of CAD is tenuous. Arthur could have cured that 

very easily by submitting to a medical examination, which he refused.18 As it 

stands, he has not been examined for the alleged unique health condition since 2009, 

if then. Because he is relying on information that is more than six years old, with 

no tests or other findings of recent origin, Dr. Strader’s diagnosis of CAD borders 

on being speculative and unreliable. 

In any event, his diagnosis cannot support a finding that Arthur is sure or very 

likely to suffer a painful heart attack during the administration of midazolam. And 

it is not sure or very likely, from the evidence, that any drop in blood pressure will 

precede the anesthetic effects of midazolam. Both must exist—the heart condition 

and the gap Dr. Strader expects—for there to be a realistic likelihood of the heart 

attack. Arthur’s evidence is based on clinical doses (2-5 mg) of midazolam for 

sedation, not a dose for anesthetic or execution purposes. Arthur presented no 

reliable, non-speculative evidence regarding the effects of a large, 500-mg bolus 

 

heart attack. He has made no reliable scientific connection between the two at a 500- mg bolus 

dose.

18 It was not until May 4, 2016—nearly five years after the commencement of this lawsuit 

and sixteen months after he raised his as-applied claim (see Doc. # 197)—that Arthur’s counsel 

moved for a court order to require Arthur to submit to a medical examination pursuant to Federal 

Rule of Civil Procedure 35(a) for a determination by a cardiologist as to whether he has clinically 

significant coronary artery disease that may be impacted by ADOC’s execution. As explained in 

the Order entered on May 10, 2016 (Doc. # 366), that request came too little and too late in the 

litigation day and, consequently, was denied. Besides, Arthur has not wavered in his refusal: “I 

am not going to endure the pain and the absolutely unnecessary bruising that accompanies taking 

my blood.” (See Doc. # 378 n.5.)

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dose of midazolam and the speed at which it produces a decrease in blood pressure 

or anesthesia. Thus, it cannot be said that a heart attack is sure or very likely at all; 

one cannot make that connection from the medical evidence.

Arthur has failed to raise a genuine dispute of material fact of a sure or very 

likely risk of severe pain in the application of Alabama’s execution protocol as 

applied to him. This failure also dooms his as-applied Eighth Amendment claim.

B. Arthur’s Motion for a New Trial

Pursuant to Federal Rule of Civil Procedure 59(a)(2), Arthur has moved for 

a new trial on his facial Eighth Amendment claim19 based on newly discovered 

evidence that he obtained post-trial. (Doc. # 367.) Specifically, Arthur states that 

on April 14, 2016, his counsel learned from plaintiffs’ counsel in Grayson v. Dunn, 

et al., No. 2:12-cv-316-WKW (M.D. Ala.)20, another method-of-execution 

challenge pending before the undersigned, that Dr. Daniel Buffington, a pharmacist 

and Defendants’ expert in this case and the Midazolam Litigation, testified during 

his deposition in March 2016 that he knew of qualified pharmacists who were 

willing to compound pentobarbital for the ADOC. Arthur contends that this new 

evidence undermines Defendants’ position that the ADOC cannot obtain 

 

19

 Arthur did not request a new trial on his Fourteenth Amendment claim and has reserved 

all rights to appeal the court’s decision on all of his claims once the court enters a final and 

appealable order under 28 U.S.C. § 1291 and Federal Rule of Appellate Procedure 4(a)(1)(A). 

20 That consolidated case is known as the Midazolam Litigation.

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compounded pentobarbital, as well as the court’s prior finding that compounded 

pentobarbital is not available to the ADOC. For this reason, Arthur submits that a 

new trial is necessary.

Federal Rule of Civil Procedure 59(a)(2) provides that, “[a]fter a nonjury 

trial, the court may, on motion for a new trial, open the judgment if one has been 

entered, take additional testimony, amend findings of fact and conclusions of law 

or make new ones, and direct the entry of a new judgment.” The Eleventh Circuit 

has held that “[t]o obtain a new trial based on such a motion, the movant must 

demonstrate that [(1)] the evidence was discovered after trial, [(2)] that due 

diligence was shown, and [(3)] that the evidence was neither cumulative nor 

impeaching but actually material and likely to produce a new result.” Branca v. 

Security Benefit Life Ins. Co., 789 F.2d 1511, 1512 (11th Cir. 1986). 

Arthur contends that the evidence from Dr. Buffington satisfies the three 

Branca requirements and that, therefore, he is entitled to a new trial. On first blush, 

Arthur’s argument has some appeal. But upon closer inspection of Dr. Buffington’s 

deposition testimony and his post-deposition affidavit, the court concludes that 

Arthur’s “new evidence” is nothing but generic testimony from Dr. Buffington 

describing passing conversations he has had with other pharmacists during national 

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conventions21 concerning the use of pharmaceuticals, including pentobarbital, for 

lethal injection. Dr. Buffington testified, in general terms and without disclosing 

names, that he knew pharmacists who had indicated that they would prepare 

compounded pentobarbital for use in lethal injections. (Buffington Dep. 101:6-17.) 

However, he declined to provide any names, noting that he would need to obtain 

permission from these pharmacists to disclose their names before he could identify 

them. (Buffington Dep. 101:18-21.) Dr. Buffington’s testimony taken out of 

context could create the impression that compounded pentobarbital might be 

available to the ADOC.

In response to Arthur’s motion for a new trial and pursuant to Federal Rule 

of Civil Procedure 59(c), Defendants submitted the affidavit of Dr. Buffington to 

clarify his testimony concerning compounded pentobarbital. (Buffington Aff., Ex. 

B; Doc. # 383-2.) Summarizing his affidavit, Dr. Buffington states that Defendants 

retained him as an expert to provide information about the pharmacological effects 

of medications used in lethal injection protocols, midazolam in particular, but that 

he was not asked to render an opinion as to the availability or feasibility of obtaining 

either compounded pentobarbital or sodium thiopental for the ADOC or to assist 

 

21 Dr. Buffington, a pharmacist licensed in Florida and Georgia, is on the Board of 

Trustees of the American Pharmacists Association. (Buffington Dep. 97:11-16; 98: 16-19.) 

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the ADOC in locating a pharmacist to compound pentobarbital. (Buffington Aff.,

Ex. B, at 1-2; Doc. # 383-2.) 

In his affidavit, Dr. Buffington explains that in response to questions by 

plaintiffs’ counsel in the Midazolam Litigation about compounded pentobarbital, 

he “testified that the use of pharmaceuticals in lethal injections is an area of open 

discussion in the pharmacy community and that some colleagues [he] ha[s] 

encountered at professional events such as national conventions and conferences 

have commented that they would be willing to compound pentobarbital for use in 

lethal injections.” (Buffington Aff., Ex. B, at 2; Doc. # 383-2.) However, he did 

not disclose the identity of any of these pharmacists. Id. He states that after his 

deposition, Defendants’ counsel asked him to contact the compounding pharmacists 

and pharmacies that he thought “were capable of compounding pentobarbital to 

inquire if they were willing to be contacted directly by the ADOC concerning the 

performance of this type of technical service.” Id. To comply with that request, 

Dr. Buffington states that he contacted fifteen pharmacists, some of whom were 

located in Alabama, to inquire as to their interest and willingness to provide 

compounded pentobarbital to the ADOC. Dr. Buffington reported their responses:

7. None of the 15 pharmacists [whom] I contacted were able and 

willing to supply compounded pentobarbital for use in lethal 

injections to the ADOC. In addition, none of the pharmacists 

provided me permission to share their names and contact 

information with the ADOC or counsel for the Defendants.

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(Buffington Aff., Ex. B at 3, ¶ 7; Doc. # 383-2.)

Thus, Arthur’s reliance on Dr. Buffington’s testimony to support his motion 

for a new trial is misplaced. This testimony is insufficient to warrant granting 

Arthur a new trial because it is speculative as to compounded pentobarbital’s 

availability to the ADOC. When examined in context, the testimony confirms that 

Arthur cannot prove that compounded pentobarbital is an alternative that is 

available to the ADOC. See Glossip, 135 S. Ct. at 2737. The testimony is “not 

likely to produce a new result,” Branca, 789 F.2d at 1512, and Arthur’s motion for 

a new trial is due to be denied. 

III. CONCLUSION

For the reasons stated, it is ORDERED as follows:

1. Defendants’ Alternative Motion for Summary Judgment on Arthur’s 

as-applied Eighth Amendment claim (Doc. # 364) is GRANTED; and

2. Plaintiff’s Motion for a New Trial on his Eighth Amendment claim 

(Doc. # 367) is DENIED. 

A Final Judgment in Defendants’ favor on all claims will be entered 

contemporaneously with this Memorandum Opinion and Order.

DONE this 19th day of July, 2016.

/s/ W. Keith Watkins

 CHIEF UNITED STATES DISTRICT JUDGE

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