With hospitals throughout the country facing shortages of the medications needed to treat COVID-19 patients, a group of prominent medical professionals and experts called on death penalty states to release their stockpiles of drugs used to carry out lethal injections to state healthcare facilities. The open letter released April 9, 2020, was signed by seven leading anesthesiologists, pharmacists and medical academics and urged correctional facility directors in death penalty states to help combat the COVID-19 pandemic. Expressing the urgency with which such supplies are needed, the letter explained, “It is a central ethical directive that medicine values every life. Those who might be saved could include a colleague, a loved one, or even you.”
Drugs used in various state lethal injection protocols are highly sought after in hospital intensive care units around the country, especially now as shortages of these drugs put the lives of COVID-19 patients at greater risk. Sedatives and paralytics used in lethal injections are the same drugs needed to connect COVID-19 patients to ventilators and lessen the discomfort of intubation. According to the letter, the American Society of Health-System Pharmacists currently lists four drugs used in many state execution protocols as part of the shortage: midazolam (a sedative), vecuronium bromide (a paralytic), rocuronium bromide (a paralytic), and fentanyl. Although state execution protocols vary, many states use a three-drug protocol involving an anesthetic or sedative, a paralytic, and potassium chloride. Midazolam has become a popular choice in recent years as the first drug in three-drug execution protocols.
While many states have refused to disclose the quantities of drugs they possess, the experts predict that if such drugs were to be released by the state correctional facilities, they could potentially be used to save the lives of hundreds of COVID-19 patients. Citing publicly available information, the signatories estimated that Florida’s supply of rocuronium bromide alone could be used to intubate approximately 100 COVID-19 patients, Nevada’s supply of fentanyl could assist 19 patients over four days, and Tennessee’s supply of vecuronium bromide could be used to help 27 patients. When factoring in that patients may be treated at a faster rate as a result of early intubation, as well as the drugs potentially contained in the stockpiles of states that have not made any information public, the experts predict the numbers of lives saved might reach into the hundreds. According to Dr. Joel Zivot, one of the letter signatories, Wyoming was the only state to respond directly to the open letter by late April, stating that it did not have any of the drugs in question.
The letter also touched on concerns previously expressed in 2018 by pharmaceutical companies and health experts in an amicus brief to the U.S. Supreme Court, where they warned that states’ efforts to obtain lethal injection drugs could create a “public health crisis” by potentially depriving patients of critical medicines. The letter said:
In this time of crisis, these risks have never been more acute, and our health system has never more desperately needed the medicines you currently hold for use in executions. Every last vial of medicine could mean the difference between life and death … At this crucial moment for our country, we must prioritize the needs and lives of patients above ending the lives of prisoners.