Opinion ID: 1360652
Heading Depth: 4
Heading Rank: 1

Heading: Challenges to IV Injection and Ohio's Implementation of the New Protocol

Text: The majority of the claims regarding the one-drug IV injection are foreclosed by Baze and its progeny. a. Undue Risk of Improper Implementation of Ohio's Protocol, In Baze, the Court held that Eighth Amendment challenges to lethal injection protocols on the grounds that the protocol could be improperly administered are insufficient to demonstrate a violation. The Court stated: Petitioners agree that, if administered as intended, that procedure will result in a painless death. The risks of maladministration they have suggestedsuch as improper mixing of chemicals and improper setting of IVs by trained and experienced personnelcannot remotely be characterized as objectively intolerable. Kentucky's decision to adhere to its protocol despite these asserted risks, while adopting safeguards to protect against them, cannot be viewed as probative of the wanton infliction of pain under the Eighth Amendment. Baze, 128 S.Ct. at 1537-38; see also Beardslee, 395 F.3d at 1071-72 (rejecting a prisoner's claim that the lack of specificity in the protocol leading to many variables that can complicate the proper administration of the drugs, such as the use of Valium as a pre-execution sedative, and the problems in finding acceptable veins for the insertion of an intravenous tube). Consequently, Biros's general claim that the possibility of maladministration of the IV could lead to severe pain is without merit. To demonstrate a likelihood of success on this ground, therefore, Biros must distinguish his maladministration claims from those rejected in Baze. He has failed to do this. Biros relies heavily on Ohio's halted execution of Broom to distinguish his case from that of Baze. [3] The Supreme Court has found, however, that evidence of prior accidents in the administration of an execution protocol does not render the protocol itself per se unconstitutional. In Resweber, Louisiana attempted to execute a prisoner by electrocution, but when the executioner flipped the switch, nothing happened. The Court first noted that we must and do assume that the state officials carried out their duties under the death warrant in a careful and humane manner. Accidents happen for which no man is to blame. Resweber, 329 U.S. at 462, 67 S.Ct. 374. It then found that a subsequent execution of the same prisoner by electrocution would not be unconstitutional. See id. at 464, 67 S.Ct. 374 (The fact that an unforeseeable accident prevented the prompt consummation of the sentence cannot, it seems to us, add an element of cruelty to a subsequent execution. There is no purpose to inflict unnecessary pain nor any unnecessary pain involved in the proposed execution.). The Court in Baze affirmed 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, 128 S.Ct. at 1531 (citation omitted). Furthermore, in a case similar to the one before us today, the Eighth Circuit addressed a challenge to Missouri's lethal injection protocol after a series of mistakes in administration of the protocol came to light. See Clemons, 585 F.3d at 1119. The Eighth Circuit rejected the prisoner's claim that there was a substantial risk of pain due to incompetent personnel despite the fact that the court had previously found that medical personnel administering the protocolsince removedhad been incompetent. Id. at 1127 (We reject the prisoners' attempt to distinguish their case from Baze on the basis of alleged past incompetence on the part of Missouri's medical personnel.). For the same reasons, we cannot assume that the same misfortunes that befell Broom will befall Biros, nor can we assume that Ohio's execution teamif faced with difficulty administering the lethal injection intravenouslywill not cease searching for veins and turn to the back-up intramuscular protocol. Speculations, or even proof, of medical negligence in the past or in the future are not sufficient to render a facially constitutionally sound protocol unconstitutional. Permitting constitutional challenges to lethal injection protocols based on speculative injuries and the possibility of negligent administration is not only unsupported by Supreme Court precedent but is also beyond the scope of our judicial authority. See, e.g., Gregg, 428 U.S. at 174-75, 96 S.Ct. 2909 ([W]hile we have an obligation to insure that constitutional bounds are not overreached, we may not act as judges as we might as legislators.). While the Eighth Amendment does provide a necessary and not insubstantial check on states' authority to devise execution protocols, its purpose is not to substitute the court's judgment of best practices for each detailed step in the procedure for that of corrections officials. See Baze, 128 S.Ct. at 1537 ([A]n inmate cannot succeed on an Eighth Amendment claim simply by showing one more step the State could take as a failsafe for other, independently adequate measures. This approach would serve no meaningful purpose and would frustrate the State's legitimate interest in carrying out a sentence of death in a timely manner.); Gregg, 428 U.S. at 175-76, 96 S.Ct. 2909 (We may not require the legislature to select the least severe penalty possible so long as the penalty selected is not cruelly inhumane or disproportionate to the crime involved.... Caution is necessary lest this court become, `under the aegis of the Cruel and Unusual Punishment Clause, the ultimate arbiter of the standards of criminal responsibility ... throughout the country.' (quoting Powell v. Texas, 392 U.S. 514, 533, 88 S.Ct. 2145, 20 L.Ed.2d 1254 (1968) (alteration in original))); Emmett, 532 F.3d at 303 (While Dr. Henthorn is of the view that such delay [of administering each subsequent injection] would be a better practice, we are not at liberty to dictate what is in our judgment or the judgment of any expert a `better' or `less risky' procedure.). Indeed the Court has all but foreclosed this form of Eighth Amendment challenge: Given what our cases have said about the nature of the risk of harm that is actionable under the Eighth Amendment, a condemned prisoner cannot successfully challenge a State's method of execution merely by showing a slightly or marginally safer alternative. Permitting an Eighth Amendment violation to be established on such a showing would threaten to transform courts into boards of inquiry charged with determining best practices for executions, with each ruling supplanted by another round of litigation touting a new and improved methodology. Such an approach finds no support in our cases, would embroil the courts in ongoing scientific controversies beyond their expertise, and would substantially intrude on the role of state legislatures in implementing their execution proceduresa role that by all accounts the States have fulfilled with an earnest desire to provide for a progressively more humane manner of death. Baze, 128 S.Ct. at 1531. Thus, Biros's advocacy for modest improvements to the administration of Ohio's lethal injection protocol is not sufficient to demonstrate that a protocol without those improvements is unconstitutional. b. Employment of Untrained and Insufficiently Competent Medical Personnel. Biros's more specific criticisms of the Ohio protocol with respect to proper training of personnel, supervision, and lack of guidance on when and how to determine that the back-up procedure should be used also fail to demonstrate a likelihood of success. Biros argues that Ohio's requirement of one year of medical training and the use of medical assistants, phlebotomists, and EMTs is insufficient to ensure competent execution personnel. [4] In considering Kentucky's protocol, however, the Baze Court noted the existence of important safeguards to ensure that an adequate dose of sodium thiopental%[,] ... [t]he most significant of [which] is the written protocol's requirement that members of the IV team must have at least one year of professional experience as a certified medical assistant, phlebotomist, EMT, paramedic, or military corpsman ... [and] participate in at least 10 practice sessions per year. Baze, 128 S.Ct. at 1533-34; see also id. at 1528 (explaining the qualifications and training of Kentucky's execution team); cf. R. 617-1 at 4, 8. Baze found that the same training and qualification requirements also substantially reduce the risk of IV infiltration. 128 S.Ct. at 1534. This court and other circuits that have addressed challenges to the competency and training of execution personnel have upheld requirements similar to those listed in Ohio's protocol. See Harbison, 571 F.3d at 538 (finding that the use of two paramedic technicians to administer the IV and monthly training sessions of the execution team provided sufficient safeguards to assume proper administration of Tennessee's protocol); Emmett, 532 F.3d at 295 (finding sufficient Virginia's requirements that the execution team undergo eight hours of training per month and that at least two team members have received training as military corpsmen, cardiac emergency technicians, or should receive on-the-job training from a physician in receiving and dispensing medications, to include starting and administering IV fluids (citation omitted)); Hamilton, 472 F.3d at 816 (rejecting a similar challenge to Oklahoma's protocol, which requires that an EMT-P or person with similar qualifications and expertise in IV insertion establish the IV drips (citation omitted)). Biros's claim that Ohio's protocol is constitutionally deficient on the basis of poorly trained personnel or the ceding of too much discretion to those personnel is therefore meritless. Biros's medical expert, Dr. Heath, further suggests that Ohio should employ physicians to implement the new protocol. [5] This alternative is not required by Baze and state law itself would subject any participating physician to severe discipline by the state medical board. It is undisputed that the American Medical Association guidelines prohibit physician participation in execution. American Medical Association, Opinion 2.06Capital Punishment (2000), http://www.ama-ass n.org/ama/pub/physician-resources/medical-ethics/codemedical-ethics/ opinion206.shtml. Ohio permits the state medical board to limit, revoke or suspend an individual's certificate to practice [medicine in the state for a] ... violation of any provision of a code of ethics of the American Medical Association. Ohio Rev.Code. Ann. § 4731.22(B)(13). Indeed, so long as the medical board has reliable, probative, and substantial evidence of a violation of the AMA guidelines, a doctor is subject to its penalty without resort even to the courts. Schechter v. Ohio State Med. Bd., No. 04-AP-1115, 2005 WL 1869733, at  (Ohio Ct.App. Aug. 9, 2005) (When the board's order is supported by reliable, probative, and substantial evidence and is in accordance with law, a reviewing court may not modify a sanction authorized by statute.). Dr. Heath's proposed alternative is therefore not feasible. c. Lack of Supervision of the Execution Process by a Licensed Physician. For similar reasons, we find that Biros's claim that a lack of proper supervision of the IV injection by a physician constitutes an Eighth Amendment violation also must fail. Like the Kentucky protocol upheld in Baze, Ohio's protocol calls for the medical team members to administer the drug remotely by IV while the Warden and Director of ODRC remain in the execution room to visually inspect the prisoner to determine if he is unconscious, needs further injections, or exhibits any problems with the IV catheters and tubing such as infiltration of the tissue. Compare Baze, 128 S.Ct. at 1528, 1534, with R. 617-1. This court and other circuits have rejected allegations of the unconstitutionality of similar supervisory procedures. See Harbison, 571 F.3d at 536-38 (Medical experts in Baze testified that identifying signs of possible infiltration occurring at the IV site would be very obvious to the average person because of the swelling that would result. (citing Baze, 128 S.Ct. at 1534)); Emmett, 532 F.3d at 295-96; Hamilton, 472 F.3d at 816 ([W]hile monitoring of anesthetization level is the optimal practice appropriate for a surgical operating room ..., the risk inherent in the lethal-injection procedure under review is already so attenuated that we cannot say there is a significant likelihood that a challenge to the protocol under the minimal requirements imposed by the Eighth Amendment on executions could succeed on our record.). Thus Biros cannot demonstrate that Ohio's supervision procedures are unconstitutional.