Document ID: ./input/supremecourt_opinions/opinions/14pdf/14-7955_aplc.pdf
Page Number: 27

Cite as:  576 U. S. ____ (2015) 

23 

Opinion of the Court 

Sasich  testified  that  “all  drugs  essentially  have  a  ceiling 
effect.”  Tr.  343.  The  relevant  question  here  is  whether
midazolam’s ceiling effect occurs below the level of a 500-
milligram dose and at a point at which the drug does not
have  the  effect  of  rendering  a  person  insensate  to  pain
caused by the second and third drugs. 

its 

factual 

Petitioners  provided  little  probative  evidence  on  this
point,  and  the  speculative  evidence  that  they  did  present
to  the  District  Court  does  not  come  close  to  establishing
findings  were  clearly  erroneous. 
that 
Dr. Sasich  stated  in  his  expert  report  that  the  literature
“indicates”  that  midazolam  has  a  ceiling  effect,  but  he 
conceded that he “was unable to determine the midazolam 
dose for a ceiling effect on unconsciousness because there
is no literature in which such testing has been done.”  App.
243–244.  Dr.  Lubarsky’s  report  was  similar,  id.,  at  171– 
172, and the testimony of petitioners’ experts at the hear-
ing was no more compelling.  Dr. Sasich frankly admitted 
that he did a “search to try and determine at what dose of 
midazolam  you  would  get  a  ceiling  effect,”  but  concluded: 
“I  could  not  find  one.”    Tr.  344.  The  closest  petitioners
came was Dr. Lubarsky’s suggestion that the ceiling effect 
occurs “[p]robably after about . . . 40 to 50 milligrams,” but 
he added that he had not actually done the relevant calcu-
lations,  and  he  admitted:  “I  can’t  tell  you  right  now”  at
what dose the ceiling effect occurs.  App. 225.  We cannot 
conclude  that  the  District  Court  committed  clear  error  in 
declining to find, based on such speculative evidence, that
the ceiling effect negates midazolam’s ability to render an 
inmate  insensate  to  pain  caused  by  the  second  and  third
drugs in the protocol.

The  principal  dissent  discusses  the  ceiling  effect  at 
length, but it studiously avoids suggesting that petitioners
presented probative evidence about the dose at which the
ceiling  effect  occurs  or  about  whether  the  effect  occurs
before a person becomes insensate to pain.  The principal