Document ID: ./input/supremecourt_opinions/opinions/14pdf/14-7955_aplc.pdf
Page Number: 108.0

12 

GLOSSIP v. GROSS 

SOTOMAYOR, J., dissenting 

that  a  low  dose  of  midazolam  may  occasionally  be  toxic, 
see  ante,  at  27—an  issue  I  discuss  further  below—Dr. 
Evans’  testimony  seems  to  have  been  based  on  the  Web
site  www.drugs.com.  The  Court  may  be  right  that  “peti­
tioners  do  not  identify  any  incorrect  statements  from 
drugs.com  on  which  Dr.  Evans  relied.”    Ante,  at  27.  But 
that  is  because  there  were  no  statements  from  drugs.com 
that supported the critically disputed aspects of Dr. Evans’ 
opinion.    If  anything,  the  Web  site  supported  petitioners’ 
contentions,  as  it  expressly  cautioned  that  midazolam 
“[s]hould  not  be  used  alone  for  maintenance  of  anesthe­
sia,” App. H to Pet. for Cert. 6159, and contained no warn­
ing  that  an  excessive  dose  of  midazolam  could  “paralyze 
the brain,” see id., at 6528–6529. 

Most importantly, nothing from drugs.com—or, for that
matter,  any  other  source  in  the  record—corroborated  Dr.
Evans’  key  testimony  that  midazolam’s  ceiling  effect  is
limited  to  the  spinal  cord  and  does  not  pertain  to  the 
brain.  Indeed,  the  State  appears  to  have  disavowed  Dr. 
Evans’  spinal-cord  theory,  refraining  from  even  mention­
ing  it  in  its  brief  despite  the  fact  that  the  District  Court
expressly relied on this testimony as the basis for finding 
that larger doses of midazolam will have greater anesthetic 
effects.  App.  78.  The  Court  likewise  assiduously  avoids 
defending this theory.

That  is  likely  because  this  aspect  of  Dr.  Evans’  testi- 
mony was not just unsupported, but was directly refuted by
the studies and articles cited by Drs. Lubarsky and Sasich.  
Both  of  these  experts  relied  on  academic  texts  describing
benzodiazepines’  ceiling  effect  and  explaining  why  it  pre­
vents  these  drugs  from  rendering  a  person  completely
insensate.   See  Stoelting  &  Hillier  141,  144  (describing 
midazolam’s  ceiling  effect  and  contrasting  the  drug  with 
barbiturates);  Saari  244  (observing  that  “abolishment  of
perception  of  environmental  stimuli  cannot  usually  be
generated”).  One study further made clear that the ceiling