Was the Executioner of Troy Davis an Illegal Drug Runner?

Dr. Carlos Musso's Year of Living Dangerously

"You guys … are life savers." -- a California Corrections Department official, on receiving a supply of drugs used to kill death penalty inmates [1]

It's been a long strange year for Dr. Carlos Anthony Musso, the contractor in charge of the Georgia Department of Correction's death chamber. What with allegations of botched executions and illegal drug-running, formal requests to suspend his license to practice medicine in Georgia, human experiments using medically unapproved drugs for killing people, and, of course, his role as the hired killer of Troy Davis, the death row inmate against whom the evidence was so flimsy that a million protestors signed petitions to have his death sentence commuted--Musso's calendar has been as loaded as his bank account.

When the State of Georgia finally put Troy Davis to death last week, ignoring the the pleas of three Nobel laureates, the pope, and a long list of prominent figures in government and popular culture, Musso, one of the bit players in the 34 state-run death mills, was exposed to a brief glare of notoriety. The physician contracted to kill Davis owns several medical services companies with offices in the Atlanta area, including Correct Health and Rainbow Medical Associates. Oddly, while Correct Health's mission statement proclaims that "our primary purpose is to provide healthcare services to patients in correctional facilities" [2], Musso's Rainbow Medical Associates earns a handsome fee for each inmate it sedates, paralyzes, and kills. Even his Correct Health firm has been implicated in the illegal sale of deadly drugs for executions. Both companies share the same business address: 9020 Peridot Parkway, Stockbridge, GA 30281.

As a licensed physician, Dr. Musso's direct involvement with executions raises ethical questions. The American Medical Association's Code of Medical Ethics reads, in part, "A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution." [3] The American Board of Anesthesiologists issued a mandate in 2010 that any member who participated in executing a prisoner by lethal injection would have their certification revoked. [4] But Musso found a way to enrich himself while skirting professional ethics. Prior to the granting of a contract to Rainbow Medical Associates, the State of Georgia had been paying the supervising physician $850 per execution. Under pressure to find a contractor to handle an upcoming execution, the state agreed to Musso's demand for contracted fee of $18,000 per execution [5]--a 2,100% increase.

Dr. Musso's human experiments with deadly poisons and alleged illegal sales to two other states offers a glimpse into the bizarre world of the state "death mills" and the paradoxical relationships among the medical profession, the pharmaceutical industry, international views of the death penalty, and the law. The death drug "crisis" began when Hospira, the only US manufacturer of sodium thiopental, one of the drugs in the three-drug "cocktail" used to execute prisoners, stopped production of the drug in 2010. The states of Oklahoma, Kentucky, and California announced that they had been forced to delay scheduled executions. Hospira's response to its cutoff of the supply is notable. The Guardian reported that "in a statement, the company insisted the shortage was due to a breakdown in the supply chain. But it also reiterated its longstanding complaint about the use of its drug in executions, saying: 'Hospira manufactures this product because it improves or saves lives, and the company markets it solely for use as indicated on the product labeling. The drug is not indicated for capital punishment, and Hospira does not support its use in this procedure.'" [6]

The three-drug protocol of which sodium thiopental is a component was developed in 1977 by an unqualified medical tinkerer for the state of Oklahoma, Dr. A. Jay Chapman [7], without any qualified review of its suitability for killing a person, effective dosage levels, monitoring methods or handling, particularly to avoid torturing the subject in the process. Incredibly, Chapman's protocol was eventually adopted virtually unchanged, and without professional review, by most states that currently enforce a death penalty. Along the way, corrections officials with little or no medical training have been left to their own devices as to the methods, dosages, administration and monitoring practices for killing their inmates.

The classical lethal injection recipe that Chapman pioneered is an initial shot of sodium thiopental, an anesthetic, followed by pancuronium bromide, a muscle relaxant that causes paralysis, and finally potassium chloride, which causes death by heart arrest within a couple of minutes. To avoid torturing the recipient, it is essential that the subject be anesthetized and rendered unconscious (by the sodium thiopental) before either of the other two drugs are administered. The pancuronium bromide paralyzes the breathing apparatus and causes suffocation, while the potassium chloride causes severe, painful burning of the nerve endings along the veins and in the heart before heart arrest and death. It is important to note that while the second drug, pancuronium bromide, is not necessary to kill the subject, its paralyzing action prevents body movements that might indicate extraordinary pain and suffering.

Once Hospira cut off the flow of sodium thiopental to the state death mills, scrambling to find a supply of sodium thiopental from overseas sources got underway in earnest in several states during 2010. Enter an obscure British company with its headquarters tucked into the back of a driving school in a West London suburb, Dream Pharma Ltd. The company's website boasts that it can source and supply "discontinued products …hard to find products … orphan drugs … [and] products that are licensed in other parts of the world." [8]

Liliana Segura, writing in The Nation [1], reports that Arizona placed an order from Dream Pharma in September, 2010, and that "part of the stash was sent to California. ('You guys in AZ are life savers,' one California official wrote.) Another portion was used to kill Jeffrey Landrigan a few weeks later, despite his lawyers' protests that Arizona 'provided no information regarding the integrity of the drug.' Afterward, his attorney described his execution. 'Mr. Landrigan's eyes were still open,' he said."

Meanwhile, Dr. Musso and his Georgia death squad were busy executing people and not having any better luck with the procedure. Segura's reporting tells of two Georgia death chamber "eyes open" executions--of Brandon Rhode, in September, 2010, and of Emmanuel Hammond in January, 2011. "Dr. Mark Heath, a physician and anesthesiologist who teaches at Columbia University Medical Center, wrote after Rhode's execution that 'it is very unusual and surprising for a prisoner's eyes to remain open after the efficacious administration of thiopental.' The implications were grim. 'There is no dispute that the asphyxiation caused by pancuronium [bromide] and the caustic burning sensation caused by potassium [chloride] would be agonizing in the absence of adequate anesthesia,' he wrote."

Where had the State of Georgia obtained its supply of sodium thiopental? That became clear after the Drug Enforcement Administration raided the Georgia Diagnostic and Classification Prison at Jackson (the site of Georgia's death chamber) on March 15, 2011, and seized their entire supply of sodium thiopental [9]. With the seizure came documentation from July, 2010, showing that the drug, as in the case of Arizona, had been obtained from Dream Pharma Ltd.

According to Segura, "An image of the shipping label from Dream Pharma bears the name of the now defunct Link Pharmaceuticals Ltd., which was bought out by another company in 2006. While the label shows the expiration date as 2014, sodium thiopental has a shelf life of about four years, meaning that even the freshest supply coming from Link would have been spoiled. In February lawyers trying to save the life of Roy Willard Blankenship argued that Georgia's batch of sodium thiopental had 'almost certainly' expired." [1] Blankenship's execution was delayed, but his subsequent execution, discussed below, represents a further, horrific chapter in the Dr. Musso's strange year of contract killings of Georgia inmates.

While the Georgia Department of Corrections had purchased sodium thiopental from Dream Pharma, it turns out that Dr. Musso and his company, Correct Health, had not only purchased their own supply from that same source--they got into the act of illegally trafficking in the controlled substance, according to a June, 2011 complaint lodged by the Southern Center for Human Rights (SCHR) with the Georgia Composite Medical Board. In fact, DEA agents raided and seized the stockpiles from the corrections departments of both Kentucky and Tennessee, and according to SCHR, documentation showed that the drugs had been obtained from Dr. Musso's Correct Health and Rainbow Medical Associates. [10]

The DEA raided other corrections departments during 2011; for example, Arkansas turned over the last of its supply of sodium thiopental that it had obtained from Dream Pharma on July 5, 2011 [11]. The DEA action may have helped to get a tainted and illegally-imported drug out of circulation, but it again left the state death mills without a crucial tool to kill its death row inmates. And again, Dr. Musso enters the story. Rainbow Medical Associates would try out a new drug for its contract killings: pentobarbital.

Pentobarbital is sold under the trade name Nembutal by Lundbeck Corporation, headquartered in Denmark. The Palm Beach Post reports that its president, Staffan Schüberg, twice earlier this year wrote Florida Governor Rick Scott, urging that their drug not be used in executions. “We are adamantly opposed to the use of Nembutal to execute prisoners because it contradicts everything we are in business to do – provide therapies that improve people’s lives." In another letter to Scott he wrote, “The use of pentobarbital outside of the approved labeling has not been established. As such, Lundbeck cannot assure the associated safety and efficacy profiles in such instances. For this reason, we are concerned about its use in prison executions." [12] According to the Guardian, "Lundbeck now demands that its US distributors sign an agreement stating that they will not make pentobarbital, which is a sedative with a wide range of uses, available for prisons using it for lethal injections." [13]

Dr. Musso wasn't the first executioner to prescribe pentobarbital in a killing; John David Duty had received it in December 2010 in Oklahoma--a state which would once again pop up as the innovator in methods of killing humans. Pentobarbital, like sodium thiopental, is a sedative and anesthetic, but it is slower-acting, and susceptible to being ineffectual, particularly on a "trial" basis when administered by inexperienced staff. And no one had experience--the drug is used as an animal sedative, and its effect on humans wasn't clearly known. The possible ineffectiveness of pentobarbital was the subject of a lawsuit filed on the behalf of Georgia death row inmate Roy Willard Blankenship in June, 2011 [14]--a suit which was rejected. So once legal objections were rebuffed , Dr. Musso was granted his first "patient" on whom he was free to experiment. According to an Associated Press report, Blankenship's execution did not go smoothly.

"First, [Blankenship] jerked his head toward his left arm and made a startled face while blinking rapidly. His mouth tightened, and he lurched to his right arm, and then lunged twice with his mouth wide open. He then pushed his head forward and his chin smacked as he mouthed words that were inaudible to observers. His eyes never closed.

"Blankenship’s movements stopped within three minutes after the lethal injection started, and his breathing rapidly slowed. He was deemed unconscious about six minutes after it started, and pronounced dead about nine minutes later.

"[Harvard medical professor Dr. David] Waisel warned it could be difficult to determine what went wrong, if anything, partly because independent experts were restricted from watching the execution. 'No one actually knows if it’s going fine. … The Department of Corrections people are invested in having a dead inmate and they’re not experienced enough to know if this is humane or not humane.'" [15]

A week earlier in Alabama, Eddie Duval Powell was executed using the same drug, showing similar signs of alertness and pain, according to a report by the British human rights organization Reprieve: “his eyes opened again and he raised his head and neck off the gurney. Seemingly confused and startled, he jerked his head to one side and began breathing heavily, his chest rose and contracted. The execution cocktail drugs had begun to be administered.” [16]

It was Dr. Musso and Rainbow Medical Associates who oversaw the execution of Troy Davis a few days ago. Davis got the pentobarbital treatment, but this time there was no report of a jerking head, facial expressions or heavy breathing. Had Dr. Musso altered the protocol to kill Davis? No one knows. There is no published protocol, no standards, no professional review, and no formal sharing of the information.

In an environment where contract killings, allegations of illegal importation of drugs, illegal interstate trafficking, untested protocols, unsupervised subject responses to executions are the norm, Dr. Musso has banked his strange year's $90,000 and awaits his next $18,000 fee.

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Postscript: on September 28, the State of Florida is scheduled to experiment with pentobarbital for the first time in the state's history, after clearing a state supreme court hurdle, in the execution of Manuel Valle.

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[2] Correct Health website

[3] AMA Code of Medical Ethics - Opinion 2.06 - Capital Punishment

[4] Doctors and Death Penalty Cases

[5] Doctors' Role in Executions Debated

[6] US executions delayed by shortage of death penalty drug

[7] Baze-d and Confused: What's the Deal with Lethal Injection?

[8] Dream Pharma Ltd. website

[9] Agency Seizes Georgia’s Supply of Execution Drug

[10] Southern Center for Human Rights Files Complaint Seeking Revocation of Dr. Carlo Musso’s Medical License

[11] Arkansas latest state to turn over execution drug

[12] Danish manufacturer of lethal injection drug twice asked Scott not to use it to kill prisoners

[13] Troy Davis case brings calls for execution drug controls

[14] Blankenship Complaint

[15] Medical experts divided over Georgia execution