Are states withholding life-saving drugs from covid-19 patients because they’re stockpiling them for executions instead? It’s quite the question—and one that seems to have gotten buried this week in the deluge of horrors now visited upon the American public daily.
A wing of medical professionals—nearly a dozen surgeons, pharmacists, and anesthesiologists at elite American universities—have been asking death penalty states to hand over drugs that are in short supply, which doctors say could “save the lives of thousands of people,” including potentially hundred critically ill from the coronavirus.
“Many of the medicines needed during this critical time are the same drugs used in lethal injection executions,” the medical professionals wrote in a letter to state officials. It lists midazolam, vecuronium bromide, rocuronium bromide, and fentanyl as medicines sorely needed by hospitals buckling under an influx of critical patients.
“Sedatives and paralytics are already in dangerously short supply across our nation and will become scarcer as this virus continues to sweep through our hospitals,” it goes on to say.
The letter was first reported by the Associated Press. (A full copy is available here.)
Midazolam, which is used as an anesthesia, and Fentanyl, a powerful opioid, are listed “currently in shortage” by the Food and Drug Administration, as well as by the American Society of Health‐System Pharmacists (ASHP). The ASHP also lists in short supply vecuronium and rocurionium, both of which hospitals use to in the intubation of patients requiring ventilators.
These four drugs are among the dozen or so known to be used in death chambers. But as lethal injection cocktails vary wildly by state and many have refused to publicly acknowledge their supply, it’s difficult to know how many vials of the ingredients have been stockpiled and where. The neuromuscular blocking agent vecuronium, for example, is a known fixture of the so-called “three-drug cocktail,” which also includes a barbiturate for anesthesia and potassium chloride to induce cardiac arrest.
Most drug companies have sought to disaffiliate themselves from executions out of concern that public knowledge of the supply chain would irreparably harm their image (read: stock price). Several have sued to keep their products out of the hands of prison officials, whom they’ve accused in some cases of using deceit to obtain them.
Though most depictions of executioners in black hoods throughout history are considered apocryphal, in states that still practice capital punishment obscuring their identities is common practice. “Anonymity shrouds the executioners. They do their work in secret chambers, behind drawn curtains,” AP reporter John Barbour wrote in 1986. “In Florida, the executioner is a hooded stranger, picked up at roadside in the dead of night.”
“Some never touch the person they kill,” he noted. “Some never see anything more than a hooded target in a chair.”
States more recently have fought with varying degrees of success to conceal the names of the pharmacies that supply their poisons. In some cases, this involves buying them in secret with envelopes of cash. These steps are taken to protect a supply chain that, if exposed, would inevitably collapse.
Pentobarbital, for instance, became the executioner’s drug-of-choice after drug manufacturer Hospira quit making sodium thiopental in an effort to disassociate itself from the death chambers. Pentobarbital’s European manufacturer faced considerable blowback for supplying U.S. prisons in 2011 and halted distribution. The European Union then banned the exportation of drugs for use in executions altogether. When the Trump administration announced that it was going to reinstate the federal death penalty last summer, U.S. Attorney General William Barr declared that pentobarbital would be its drug of choice. It’s unclear how it plans to acquire it.
In their letters to state officials, the doctors seeking to put the drugs to saving lives rather than taking them said that many states have refused to disclose even the number of vials they’re holding.
“Based on publicly available information from a handful of states, stockpiled execution drug supplies could be used to treat over a hundred COVID‐19 patients. When one factors in the drugs held by states that refuse to release details of their supplies, it is likely many times that number of patients could benefit from their release.vi All told, these supplies could be used to save the lives of potentially hundreds of patients suffering from COVID‐19 and potentially thousands of patients in other ICU settings.”
The AP did its own legwork and tried to locate the meds, but had no success.
While some states contacted by The Associated Press, including Alabama and Florida, didn’t respond to inquiries about the letter, others, including Arkansas, Texas and Utah, limited their comment to mainly saying they don’t have the medications in question. Tennessee wouldn’t confirm whether it has the drugs and indicated it has no plans to give any medications to a hospital. Oklahoma said it hadn’t received any requests for such medications from state hospitals.
The doctors’ plea is not a dispassionate one—“Those who might be saved could include a colleague, a loved one, or even you,” they told officials—but cosigner Joel Zivot, a fellow of the Royal College of Physicians (Canada) and associate professor of anesthesiology and surgery at Emory University, told the AP this has nothing to do with criticising the death penalty.
“I’m not trying to comment on the rightness or wrongness of capital punishment,” he said. “I’m asking now as a bedside clinician caring for patients, please help me.”
Other medical doctors who signed the letter include Leonidas George Koniaris, professor of surgery at Indiana University School of Medicine; Joshua M. Sharfstein, vice dean for public health practice at Johns Hopkins University; David B. Waisel, associate professor of anesthesia at Harvard Medical School; and Robert B. Greifinger, a health care policy consultant and professor of health and criminal justice.
Other signatures include: Kenneth Goodman, who founded and directs the University of Miami’s bioethics and health policy institute; Prashant Yadav, Harvard lecturer and scholar of health supply chains; Donald Downing, clinical professor of pharmacy at University of Washington; an Philip D. Hansten, noted expert on drug interactions and professor emeritus at the University of Washington in Seattle.