Opinion ID: 2485659
Heading Depth: 1
Heading Rank: 3

Heading: Constitutionality of Florida's Lethal Injection Procedures

Text: In this claim, Valle raises various challenges to the constitutionality of Florida's lethal injection procedures, but the bulk of his argument focuses on the DOC's June 8, 2011, substitution of five grams of pentobarbital for five grams of sodium thiopental as the first of three drugs used in the lethal injection protocol. In Florida, the first drug is used to anesthetize the condemned inmate prior to the administration of the final two drugs in the three-drug sequence, pancuronium bromide (a paralytic agent that can stop respiration) and potassium chloride (a substance that will cause the heart to stop). Valle acknowledges that aside from substituting pentobarbital for sodium thiopental, both of which are barbiturates, Florida's lethal injection protocol has remained unaltered since this Court's decision in Lightbourne, which upheld the August 2007 lethal injection protocol against a similar constitutional challenge. He therefore argues that the DOC's plan to use pentobarbital constitutes cruel and unusual punishment because as a result of the substitution, he may remain conscious after being injected with pentobarbital, thereby subjecting him to significant pain during the administration of the final two drugs. As presented, the DOC's recent replacement of sodium thiopental with pentobarbital in Florida's three-drug lethal injection sequence is the primary claim underlying Valle's Eighth Amendment challenge. Pursuant to this Court's order of relinquishment, the circuit court conducted a two-day evidentiary hearing, which included the admission of expert testimony from both parties, letters authored by Lundbeck, and eyewitness testimony from individuals who were present during the executions of Alabama inmate Eddie Powell and Georgia inmate Roy Blankenship. After receiving this evidence, the circuit court denied relief, concluding that the substitution of pentobarbital as an anesthetic did not violate the Eighth Amendment because the evidence failed to establish that the intravenous administration of pentobarbital creates a substantial risk of serious harm. After a thorough review of the record, we affirm the circuit court's denial. This Court has previously recognized its duty to ensure that the method used to execute a person in Florida does not constitute cruel and unusual punishment. Lightbourne, 969 So.2d at 349. To fulfill its obligation, this Court is guided by article I, section 17 of the Florida Constitution, which provides that [a]ny method of execution shall be allowed, unless prohibited by the United States Constitution. Specifically, Florida's provision on the prohibition against cruel and unusual punishment shall be construed in conformity with decisions of the United States Supreme Court which interpret the prohibition against cruel and unusual punishment provided in the Eighth Amendment to the United States Constitution. Art. I, § 17, Fla. Const. Therefore, in accordance with our state constitution, this Court is bound by the precedent of the Supreme Court regarding challenges to this state's chosen method of execution. See Lightbourne, 969 So.2d at 335 ([W]e must evaluate whether lethal injection is unconstitutional `in conformity with decisions of the United States Supreme Court.' (quoting art. 1, § 17, Fla. Const.)). The parties agree that Valle's various challenges to the DOC's lethal injection procedures are governed by the Supreme Court's plurality decision in Baze v. Rees, 553 U.S. 35, 128 S.Ct. 1520, 170 L.Ed.2d 420 (2008), which defined the contours of a condemned inmate's burden of proof for mounting a successful Eighth Amendment challenge to a state's lethal injection protocol. [9] Although acknowledging that subjecting individuals to a risk of future harmnot simply actually inflicting paincan qualify as cruel and unusual punishment, the Supreme Court in Baze explained that to prevail on such a claim, condemned inmates must demonstrate that the conditions presenting the risk must be `sure or very likely to cause serious illness and needless suffering,' and give rise to `sufficiently imminent dangers.' 553 U.S. at 49-50, 128 S.Ct. 1520 (quoting Helling v. McKinney, 509 U.S. 25, 33, 34-35, 113 S.Ct. 2475, 125 L.Ed.2d 22 (1993)) (plurality opinion); see also Brewer v. Landrigan, ___ U.S. ___, 131 S.Ct. 445, 445, 178 L.Ed.2d 346 (2010) ([S]peculation cannot substitute for evidence that the use of the drug is `sure or very likely to cause serious illness and needless suffering.' (quoting Baze, 553 U.S. at 50, 128 S.Ct. 1520)). That is, 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.' Baze, 553 U.S. at 50, 128 S.Ct. 1520 (quoting Farmer v. Brennan, 511 U.S. 825, 842, 846 & n. 9, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994)). This standard imposes a heavy burden upon the inmate to show that lethal injection procedures violate the Eighth Amendment. Id. at 53, 128 S.Ct. 1520 (quoting Gregg v. Georgia, 428 U.S. 153, 175, 96 S.Ct. 2909, 49 L.Ed.2d 859 (1976)). Cognizant of this standard, we now turn to Valle's challenge to the DOC's substitution of pentobarbital for sodium thiopental. In the lethal injection context, the condemned inmate's lack of consciousness is the focus of the constitutional inquiry. Ventura, 2 So.3d at 200; see also Schwab, 995 So.2d at 924, 927 (adopting the trial court's order, which stated that the critical Eighth Amendment concern is whether the prisoner has, in fact, been rendered unconscious by the first drug). As we explained in Lightbourne, [i]f the inmate is not fully unconscious when either pancuronium bromide or potassium chloride [the second and third drugs in the protocol] is injected, or when either of the chemicals begins to take effect, the prisoner will suffer pain. 969 So.2d at 351; see also Baze, 553 U.S. at 53, 128 S.Ct. 1520 ([F]ailing a proper dose of sodium thiopental that would render the prisoner unconscious, there is a substantial, constitutionally unacceptable risk of suffocation from the administration of pancuronium bromide and pain from the injection of potassium chloride.). In order to show the risks of using pentobarbital as a substitute, Valle relies extensively on the testimony of Dr. Waisel, who testified that pentobarbital and sodium thiopental are not interchangeable barbiturates, that five grams of sodium thiopental are not proportionally equivalent to five grams of pentobarbital, and that due to a lack of research, he would be unable to determine a dose of pentobarbital that would properly anesthetize an individual. Instead, he could only testify as to the amount needed to sedate someone. According to Dr. Waisel, a sedated patient may still be responsive while an anesthetized patient may be unconscious enough to undergo an open-chest surgery. In his opinion, the allowable upper dose needed to sedate a person would fall between 200 and 500 milligrams of pentobarbital, but he acknowledged that the amount used by the DOC for anesthetizing an inmate is 5000 milligrams. Although Dr. Waisel identified the use of pentobarbital to induce anesthesia as off label, since the drug's package insert [10] does not mention induction of anesthesia as an indication, he testified that there are legitimate off-label uses for drugs. In fact, Dr. Waisel agreed that pentobarbital is used as part of physician-assisted suicide and animal euthanasia procedures. In sum, Dr. Waisel opined that because there is insufficient data regarding the use of pentobarbital as an anesthetic, there would be no way to know, in any given case, how an overdose of the drug will affect healthy inmates. In opposition, the State presented the testimony of Dr. Dershwitz, who testified that 5000 milligrams of pentobarbital, as provided for in the DOC's lethal injection protocol, is far in excess of the dose that would be used in a human for any reason. According to Dr. Dershwitz, that dosage of pentobarbital is lethal standing alone, and when administered, the drug will induce a total flat line on the electroencephalogram (EEG) in brain activity, meaning that the person into whom the drug is injected will have no perception or sensation. Although Dr. Dershwitz acknowledged that the FDA had not approved pentobarbital for use in lethal injections, like Dr. Waisel, he explained that its use for such purposes was considered off label and that using a drug in an off-label manner is common in medicine. In reviewing this portion of Valle's claim, the circuit court credited the testimony of Dr. Dershwitz over that of Dr. Waisel, specifically finding Dr. Dershwitz's testimony to be credible and persuasive and Dr. Waisel's testimony to be based on speculation and therefore, inherently unreliable. As we have previously explained, where the trial court's findings are supported by competent substantial evidence, this Court will not substitute its judgment for that of the trial court on questions of fact, likewise of the credibility of the witnesses as well as the weight to be given to the evidence by the trial court. Provenzano v. State, 761 So.2d 1097, 1099 (Fla.2000) (quoting Blanco v. State, 702 So.2d 1250, 1252 (Fla.1997)); see id. at 1098-99 (applying competent, substantial evidence standard to review Provenzano's Eighth Amendment challenge to Florida's lethal injection procedure following an evidentiary hearing on the issue). In applying this standard, [w]e recognize and honor the trial court's superior vantage point in assessing the credibility of witnesses and in making findings of fact. Porter v. State, 788 So.2d 917, 923 (Fla.2001). This stems from our recognition that the trial court is in the best position to evaluate the credibility of witnesses, and appellate courts are obligated to give great deference to the findings of the trial court. Durousseau v. State, 55 So.3d 543, 562 (Fla.2010), petition for cert. filed, No. 10-10518 (U.S. May 10, 2011). Based upon the testimony presented, the circuit court concluded that Dr. Dershwitz refuted any suggestion that the dose of pentobarbital in the Florida lethal injection protocol would leave an inmate conscious and able to experience pain and suffering during the lethal injection process. [11] The circuit court's findings are borne out by the testimony and are well-supported by the record. While Dr. Waisel opined that he would be unable to determine whether pentobarbital would produce its intended effect (i.e., to anesthetize the inmate before the administration of the last two drugs in the three-drug sequence), in the end, he did not testify that the drug would fail to do so. By asserting that no evidence exists concerning whether pentobarbital will render an inmate unconscious, Valle has failed to meet his burden of proof. [12] As the circuit court correctly recognized, Dr. Waisel's asserted lack of knowledge about pentobarbital's effects falls short of the heavy burden of affirmatively showing that the drug is sure or very likely to cause serious illness and needless suffering or that its use will result in a substantial risk of serious harm. See DeYoung v. Owens, 646 F.3d 1319, 1326 n. 4 (11th Cir.2011) (DeYoung also alleges that pentobarbital has not been sufficiently tested for its ability to cause an anesthetic coma in fully conscious persons. However, DeYoung's expert candidly admits he does not know how the State's dosage of pentobarbital will affect inmates because he claims there is no way to know. This asserted lack of knowledge obviously cannot satisfy DeYoung's burden of affirmatively showing that a substantial risk of serious harm exists.). [13] Despite Dr. Dershwitz's testimony, Valle also relies on a collection of letters sent from Lundbeck, the manufacturer of pentobarbital, to the DOC and the Governor stating that the use of pentobarbital outside of the approved label has not been established, and that consequently, Lundbeck could not assure the associated safety and efficacy profiles in such instances. These letters further requested that this state stop using pentobarbital to execute prisoners. [14] The circuit court concluded that these letters carried no weight and exhibited no legal value because [t]here was no mention of medical evidence or anything relevant to the court's inquiry. We agree. The experts for both Valle and the State recognized that a variety of drugs have acceptable off-label uses. Lundbeck's opposition to the use of pentobarbital and asserted lack of information as to the drug's efficacy and safety for use in lethal injections do nothing to establish a substantial risk of serious harm. See, e.g., West v. Brewer, No. CV-11-1409-PHX-NVW, 2011 WL 2836754, at  (D.Ariz. July 18, 2011) (finding the manufacturer's warning against the use of pentobarbital in executions unpersuasive since it did not establish a substantial risk of harm), aff'd, 652 F.3d 1060 (9th Cir. 2011); Powell v. Thomas, 784 F.Supp.2d 1270, 1281 n. 7 (M.D.Ala. 2011) (Williams emphasizes that the manufacturer of pentobarbital has pronounced that it is opposed to its drug being used for executions, but fails to demonstrate how that fact is in any way relevant to the issues and his burden.), aff'd, 641 F.3d 1255 (11th Cir.), cert. denied, ___ U.S. ___, 131 S.Ct. 2487, 179 L.Ed.2d 1243 (2011). To further buttress his assertion that the drug's substitution amounts to an Eighth Amendment violation, Valle points to the recent executions of Alabama inmate Eddie Powell and Georgia inmate Roy Blankenship. Valle contends that Alabama's and Georgia's use of pentobarbital to execute inmates resulted in botched executions or executions that did not go according to plan. With respect to the Powell execution, Valle presented the testimony of Powell's attorney, Matt Schulz, who was able to observe Powell's left side, face, and right arm during the execution. As Schulz explained, after the warden permitted Powell to recite his last words, the warden walked behind Powell and made an announcement that the execution was to be carried out; the intravenous (IV) lines ran into a wall, which led to a room outside the execution chamber. Schulz testified that he could not see the drugs being administered and did not know when the injections began. After the warden left the execution chamber, Schulz explained, a chaplain took Powell's left hand and spoke to Powell for around thirty seconds to a minute, during which Powell turned to Schulz, nodded a little bit and then took a deep breath and laid his head back. By Schulz's account, approximately one minute later, Powell suddenly jerked his head up, it appeared as though his upper body was pressing against the restraints, and he looked around with confusion. Schulz asserted that Powell clenched his jaw, flexed his muscles, and his arteries bulged. This episode lasted approximately one minute, and then Powell's eyes glazed over, rolled back into his head, and then his head rested. As Schulz described it, after a few minutes, a guard approached Powell, yelled his name three times, and then ran his finger over Powell's left eyelash; Powell did not respond to the guard's actions. After a couple of minutes, Schulz noticed that Powell's eyes were slightly opened, although Schulz did not actually see at what point they opened. Schulz also did not see Powell's eyes close, but remembered that by the end of the procedure, which lasted around twenty to twenty-five minutes, Powell's eyes were fully closed. The circuit court rejected Schulz's testimony as speculative and concluded that [e]ven if the entire situation lasted one minute, it certainly does not establish that [Powell] suffered to establish an Eighth Amendment claim. As the circuit court more fully explained: The only witness testifying about the execution of Powell did not know when the pentobarbital was administered. The relationship between the supposed short term movements reported and the administration of pentobarbital is totally speculative. Nor was Schulz aware of the amount of drugs used in that instance. Schulz stated that the inmate did not move after the consciousness check was done by the prison officials. This same consciousness check is included in the Florida protocol. If after the initial administration of pentobarbital the inmate shows any signs [of] responsiveness, more anesthetic (pentobarbital) is administered. No additional drugs were necessary for Powell, according to the testimony, suggesting that the inmate was unconscious and the pentobarbital was effective in rendering him unconscious. We accept the circuit court's findings as supported by competent, substantial evidence. As to the Blankenship execution, Valle again relies on the testimony of Dr. Waisel, who was not present at the execution but testified that Blankenship suffered extremely. After reviewing various materials, [15] Dr. Waisel opined that based on reports, Blankenship looked at his arms with discomfort and pain, grimaced, jerked his head up, and continued breathing and mouthing words for up to what was reported to be three minutes. Dr. Waisel explained that Blankenship's movement should have stopped fifteen seconds after the pentobarbital reached his body, and given that Blankenship's body movements lasted for three minutes, the drug did not work as it was intended. Dr. Waisel never opined as to what time the pentobarbital was actually administered. To rebut Dr. Waisel's testimony, the State presented the eyewitness testimony of John Harper and Dr. Jacqueline Martin. According to Harper, who works for the Georgia Department of Corrections, Blankenship had an IV line running into each of his arms. Harper observed Blankenship look at his left arm about five seconds after the start of the first syringe, which was injected into Blankenship's right arm. Harper testified that within ten seconds of the first drug's administration, Blankenship appeared to be unconscious, and other than Blankenship looking at his left arm and making what he described as a grunt sound, he did not observe anything else. Similarly, Dr. Martin stated that two or three minutes after the warden left the execution chamber, Blankenship looked at his left arm, moved his mouth, looked at his right arm, put his head down on a pillow, and then did not move. She observed no obvious signs of distress or facial features indicating pain, and in her medical opinion, Blankenship was not in pain during the execution. In reviewing the above testimony, the circuit court determined that the State presented two very credible witnesses who testified consistently with one another and found that that there was no indication that Blankenship experienced pain or suffering. The court more fully explained: Of all the witnesses on the issue of the Blankenship execution, Harper [was] the most credible on this topic. He actually could hear and could see the pushing of the syringes and was keeping a time log. His testimony [was] in keeping, ironically, with the acceptable parameters testified to by Dr. Waisel. Waisel stated that if the pentobarbital were to work properly that it would take effect within fifteen (15) seconds. That it did, according to the only witness able to testify with any degree of certainty as to the timing of the administration of the drugs and rendering of unconsciousness. . . . . Dr. Martin's testimony [was] consistent with that of Mr. Harper. She is a medical professional who could see Blankenship's actions and facial features. Her interpretation of his reactions to the drugs substantiate that Blankenship in no way experienced pain or suffering. After noting that Dr. Waisel was not present at the execution, but rather relied upon the affidavit of a reporter who was not called to testify, the circuit court further found as follows: The testimony of the witnesses to Blankenship's execution differed with regard to the amount and nature of the movement by Blankenship. No one could testify conclusively about the relationship between the reported movement and the administration of pentobarbital with the exception of the state's witness, John Harper. He reported only minimal movement and within seconds of the pushing of the syringe. There is no indication that the inmate was in any discomfort much less pain or suffering; only that he glanced at his arm and gave a grunt. Within ten (10) seconds the inmate was unconscious, according to Harper, who was not only in a more advantageous place to see and note what was taking place. He also kept a time log. To the extent that the witnesses differed in their testimony, this court resolves credibility issues in favor of Mr. Harper who is accustomed to watching executions and thus, has a more objective view. He testified quite credibly and persuasively. Further, there was no movement of the inmate reported by any witnesses after the prison official's consciousness check. The circuit court's resolution of this issue is supported by competent, substantial evidence. Valle attempts to use the Powell and Blankenship executions to show that the administration of pentobarbital does not adequately render an inmate unconscious. However, the record before this Court supports the circuit court's findings to the contrary. Nevertheless, even if we were to assume that problems arose during the course of the Blankenship and Powell executions, the United States Supreme Court has advised that an isolated mishap alone does not give rise to an Eighth Amendment violation, precisely because such an event, while regrettable, does not suggest cruelty, or that the procedure at issue gives rise to a `substantial risk of serious harm.' Baze, 553 U.S. at 50, 128 S.Ct. 1520 (quoting Farmer, 511 U.S. at 842, 114 S.Ct. 1970). Thus, Valle has failed to satisfy the Baze standard, which requires proof that the replacement of the drug is  sure or very likely to cause serious illness and needless suffering. Id. (quoting Helling, 509 U.S. at 34, 113 S.Ct. 2475). Valle does not, however, premise his Eighth Amendment claim solely on the DOC's recent substitution of pentobarbital for sodium thiopental. Rather, Valle contends that the substitution of the drug, coupled with inadequate procedural safeguards and a cavalier attitude toward lethal injection, puts him at risk of serious harm. Specifically, Valle notes the existence of various inadequacies in Florida's lethal injection procedures, including how the drugs are administered and the manner in which consciousness is assessed and monitored. Referring to what he describes as Florida's unique history of deviating from written execution protocols and citing to the Angel Diaz execution in 2006 as one example, Valle also asserts inadequate qualifications, certification, training, and experience of execution team members, inadequate monitoring of the IV lines, and the DOC's failure to conduct a meaningful review and certification of its process. Because Valle agrees that other than replacing sodium thiopental with pentobarbital, the DOC's June 2011 protocol is identical to the August 2007 lethal injection protocol that this Court upheld in Lightbourne, the circuit court did not err in summarily denying this portion of Valle's claim. The factual circumstances surrounding the execution of Diaz were thoroughly litigated in Lightbourne, and since that time, there have been five executions without subsequent allegations of newly discovered problems with Florida's lethal injection process. See Tompkins v. State, 994 So.2d 1072, 1081-82 (Fla.2008) (affirming summary denial of challenge to lethal injection procedures and noting that after the Lightbourne decision, two executions had been conducted in Florida with no subsequent allegations of problems giving rise to the investigations following the Diaz execution). The remaining aspects of the protocol to which Valle currently takes issue were rejected on the merits in Lightbourne, 969 So.2d at 350-53, and in subsequent cases. See, e.g., Baze, 553 U.S. at 53-61, 128 S.Ct. 1520 (rejecting claims regarding the inadequate administration of the lethal injection protocol, the risk that the procedures will not be properly followed, the absence of additional monitoring by trained personnel, inadequate training, issues with the placement and monitoring of IV lines, the lack of professional medical experience, and the need for a significant consciousness test); Troy v. State, 57 So.3d 828, 839-40 (Fla. 2011) (rejecting Troy's claims regarding deficiencies in Florida's lethal injection protocol including that the protocol fails to require that the execution team and the medical personnel who perform lethal injection have appropriate training, credentials, and supervision, fail to require adequate record-keeping and an adequate review and certification process, and fail to require adequate standards to manage complications inherent in the procedure). [16] As recognized above, the Baze standard requires proof that Florida's lethal injection procedures are sure or very likely to cause serious illness and needless suffering or will result in a substantial risk of serious harm. See 553 U.S. at 50, 128 S.Ct. 1520. After reviewing the evidence and testimony presented below, we conclude that Valle has failed to satisfy the heavy burden that Florida's current lethal injection procedures, as implemented by the DOC, are constitutionally defective in violation of the Eighth Amendment of the United States Constitution. We thus affirm the circuit court's orders.