Opinion ID: 3065887
Heading Depth: 2
Heading Rank: 2

Heading: eighth amendment claim—placement of iv lines

Text: [5] The Eighth Amendment to the Constitution prohibits the infliction of “cruel and unusual punishments,” not punishment itself. Part of Lopez’s ultimate punishment—a sentence of death—is the execution process itself. Lopez challenges Arizona’s procedures for conducting executions, specifically the placement of the IV lines, claiming that they present an intolerable risk of harm rendering the process unconstitutional. [6] To prevail on an Eighth Amendment 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.” Baze v. Rees, 553 U.S. 35, 50 (2009) (quotation marks omitted). Lopez’s argument that the ADC is not “subjectively blameless” for its actions is insufficient; instead, the appropriate benchmark is whether the ADC’s procedures create “an objectively intolerable risk of harm” that precludes a finding that the prison officials were subjectively blameless. In other words, “[s]imply because an execution method may result in pain, either by accident or as an inescapable consequence of death, does not establish the sort of objectively intolerable risk of harm that qualifies as cruel and unusual.” Id. Towery’s recent execution is the primary basis of Lopez’s claim. During the execution, which started at 9:52 a.m., the LOPEZ v. BREWER 5583 ADC spent approximately thirty minutes, and made at least six punctures, unsuccessfully attempting to place IV catheters in both of Towery’s arms near his elbows. The ADC’s records document that “[a]fter multiple attempts of the left and right peripheral — (approximately 4 in right — 2 in left), IV Team Leader recommended right femoral as primary and left peripheral as back-up.” According to attorney testimony, “[d]uring Mr. Towery’s last words, he also said that he should have gone left and he went right. He went right when he should have gone left. He then went on to say he made ‘mistake, after mistake after mistake.’ Based on my discussions with Mr. Towery, this phrase meant that there were problems or he was hurt during the insertion of the catheters.” At this point, the Director of the ADC called the Arizona Attorney General’s Office to “provide[ ] an update regarding the IV process.” The Team Leader’s recommendation was then attempted, and the “[r]ight femoral was successful; left peripheral was unsuccessful.” After further discussion between the Director and the Team Leader, the “[r]ight hand peripheral” was chosen as the back-up catheter site. This attempt was successful at 10:59 a.m., approximately an hour after the process began. Lopez claims that this sequence of events, along with other recent executions conducted by the ADC, demonstrate that he may be subjected to an unconstitutional level of pain during his execution. The district court held that “Lopez has not cited any legal authority or alleged any facts that bring into question the prior conclusion in West that the Eighth Amendment is not offended by administration of lethal chemicals through a femoral central line. Nor is there any persuasive or even colorable reason to think that placement of a peripheral IV line in a prisoner’s hand, while possibly more uncomfortable than other peripheral sites, poses an objectively intolerable risk of severe pain that qualifies as cruel and unusual.” In addition, “[w]hile undoubtedly disquieting to a condemned inmate awaiting execution, repeated efforts to set IV lines do not, in 5584 LOPEZ v. BREWER and of themselves, suggest malevolence from Defendants, extreme pain, or even unnecessary pain.” [7] We acknowledge, as demonstrated by the evidence, that there can be some pain and discomfort associated with the placement of IV lines and that, depending on the individual, such placement can be difficult from time to time. An inmate might also experience some pain from the administration of the lethal drugs through a relatively smaller vein. The relevant inquiry, however, is whether placement of the peripheral line in the hand, the femoral catheter, and the series of abortive IV placement attempts, either individually or in combination, lead to an objectively intolerable risk of pain. Lopez has not documented that they do. The record does not support, with any likelihood, the conclusion that the pain Towery purportedly suffered establishes an “objectively intolerable” risk of pain for Lopez, as required under the Eighth Amendment. See Baze, 553 U.S. at 50. Our sister circuits have taken a similar view. See Raby v. Livingston, 600 F.3d 552, 558-61 (5th Cir. 2010) (upholding Texas lethal injection protocol where evidence of problems with inserting IVs); Cooey v. Strickland, 589 F.3d 210, 217-18, 224, 233-34 (6th Cir. 2009) (upholding Ohio protocol despite evidence of problems inserting IV); Emmett v. Johnson, 532 F.3d 291, 303, 306-08 (4th Cir. 2008) (upholding Virginia protocol despite problems with IV lines). [8] At this stage, we credit Lopez’s characterization of the Towery execution, as the State offered nothing to the contrary. The somewhat increased pain suffered by Towery attendant to his execution was therefore a single, isolated incident, which “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 (citation omitted).3 The isolated nature is underscored by 3 Lopez also challenges the pain related to puncture of the femoral artery and vein. Assuming that puncture of the femoral artery or arterial adminisLOPEZ v. BREWER 5585 the fact that both Moormann’s and Kemp’s executions were completed without similar difficulties. Because Lopez does not demonstrate a likelihood of success on the merits, the district court did not abuse its discretion. [9] Lopez next argues that the increased pain is avoidable if qualified individuals are hired to place the IVs.4 The Director admitted in December 2011 that “he conducted the last five executions with full knowledge that at least one of the Medical Team members did not hold a medical license and did not administer IVs in his current employment.” West v. Brewer, No. CV-11-1409-PHX-NVW, 2011 WL 6724628, at  (D. Ariz. Dec. 21, 2011). Our decision in Towery explained that the 2012 Protocol, as amended by the State’s representation and commitments to this court, addresses this issue. The state represented, and we accepted, that “ ‘relevant experience,’ as used in Paragraph 1.2.5.1 of the 2012 Protocol, means that IV Team members must have no less than the training that is traditionally given for people to be licensed to place IVs. We view this representation as a binding one that cabins the meaning of ‘appropriately trained’ and ‘relevant experience’ in the context of the 2012 Protocol.” Id. at 658 (emphasis added). We reaffirm this holding, and note also that the ADC committed during oral argument that trained professionals, in this case a licensed physician and nurse, constitute the IV Team for Lopez’s execution. [10] Nonetheless, Arizona’s actions come perilously close to losing safe-harbor protection under Baze. The 2012 Prototration of the lethal drugs leads to pain, Lopez has not demonstrated that the increased pain meets the Baze standard, either in isolation or in combination with the other issues discussed here. 4 This challenge is limited to the personnel the Director might hire to insert the peripheral IV lines. Under the 2012 Protocol, a medicallylicensed physician must insert the femoral central line. 2012 Protocol, Attach. D, § E.1 (“In no event shall a femoral central line be used without being done by a medically-licensed physician.”). 5586 LOPEZ v. BREWER col does not provide for any time-limit with respect to the siting of IV lines, whereas the protocol blessed in Baze had a one-hour time limit. Compare 2012 Protocol, Attach. D, § E, with Baze, 553 U.S. at 45. This limitation was tested with the siting of Towery’s IV lines, which took almost an hour. Although this isolated circumstance does not, in itself, create a serious question going to the merits, the inability of the class of condemned prisoners to procure details about the execution process is troubling. This lack of access is compounded by the State’s touting of the public nature of the execution, while concurrently curtailing transparency by shrouding the IVsiting process in a cloak of secrecy. [11] Recent exercises of the Director’s discretion give us further cause for concern. For example, detailed execution logs have given way to vague generalities about the execution. The “Continuous Correctional Log” related to West’s execution provides minute-by-minute detail regarding the insertion of the IV lines.5 In contrast, the log for Towery’s execution simply concludes, for a 36-minute time period, that “[a]fter multiple attempts of the left and right peripheral — (approximately 4 in right — 2 in left), IV Team Leader recommended right femoral as primary and left peripheral as back-up.” And, when questioned about the Director’s exercise of his discretion, the State’s basic argument boils down to a conclusory statement that the Director is presumed to exercise his discretion in a constitutionally permissible manner. While the State correctly claims the Director may order that an execution attempt be aborted, it cannot explain what circumstances, if any, would trigger such an order. Although we uphold the district court’s decision, we caution, yet again, that 5 With respect to insertion of the lines, the log states: “Medical Team leader determined there is significant risk of adverse effects if the vein is defective. A central line was deemed necessary as a backup method to ensure the safest administration of the chemicals.” Five minutes later, the log reports that the left arm IV placement attempt failed due to “poor veins,” and that the right arm was designated as the primary line. LOPEZ v. BREWER 5587 Arizona’s ad hoc approach risks going beyond Baze’s safe harbor. Towery, 672 F.3d at 653.
Lopez’s equal protection claim is that Arizona treats inmates differently and that such differences result in unconstitutional disparate treatment. As we noted in Towery, the state’s decision as to how to administer the chemicals “may well depend on individualized and changing factors such as the availability of particular people to participate in the execution, the supply of drugs available to the State at a given time, and the condition of the prisoner’s veins.” Id. at 661. For the same reasons that a similar claim failed in Towery, the district court held that it fails here as well. The district court noted that at the time of our decision in Towery, the ADC had utilized either peripheral or femoral (or both) IV lines in carrying out each of the previous 26 executions by lethal injection. The district court found that the use of a femoral catheter is no more likely to create a risk of cruel and unusual punishment than the use of a peripheral catheter and held that Lopez had not raised serious questions or shown a likelihood of success on the merits of his equal protection claim. [12] Lopez points to our language in Towery to argue that an equal protection claim exists because he has shown “an actual pattern of treating prisoners differently in ways that did affect the risk of pain to which they would be subjected, and therefore the risk of being subjected to cruel and unusual punishment.” 672 F.3d at 660 (discussing In re Ohio Execution Protocol Litig, ___ F. Supp. 2d ___, 2012 WL 84548, at  (S.D. Ohio Jan. 11, 2012), motion to vacate stay denied, ___ F.3d ___, 2012 WL 118322, at  (6th Cir. Jan. 13, 2012)). This statement cannot be extracted from its context. The most significant part of the discussion preceded that statement: namely that a prisoner’s right to be free of cruel and unusual 5588 LOPEZ v. BREWER punishment “is not affected simply because that prisoner is treated less favorably than another, where one means of execution is no more likely to create a risk of cruel and unusual punishment than the other, and both are constitutionally available.” Id.6 [13] Since each condemned inmate is physiologically different, no two prisoners would necessarily be similarly situated with respect to the siting of IV lines. While Lopez may be correct that the pain suffered by an inmate could depend on whether the Director elects to use a peripheral or femoral line, Lopez does not demonstrate that the Director has exercised his discretion in a manner that increases a prisoner’s risk of being subjected to an objectively intolerable risk of pain. Nor does he demonstrate that the Director has exercised his discretion in a constitutionally prohibited manner, for instance, based on a suspect or any other classification. The district court did not abuse its discretion in holding that Lopez fails to raise a serious question going to the merits on his equal protection claim.