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Arkansas judge’s decision centers on how 3 drugs work

Arkansas Gov. Asa Hutchinson prepares for a TV station interview at the Governor's Mansion on Thursday, April 13, 2017, in Little Rock. The governor met with reporters to discuss a series of seven upcoming executions. (AP Photo/Kelly P. Kissel)

LITTLE ROCK, Ark. (AP) — A federal judge on Saturday granted stays of execution to eight Arkansas inmates who were scheduled to be executed before the end of the month, when the state’s supply of an execution drug expires.

In her order, which the state promptly appealed, U.S. District Judge Kristine Baker said the inmates have the right to challenge the state’s method of execution in an attempt to show it “creates a demonstrated risk of severe pain” and that she thinks they have a significant chance to succeed.

Arkansas, which hasn’t put anyone to death since 2005 due to legal challenges and difficulty getting execution drugs, plans to use three drugs to kill the inmates, including two that are typically used in surgery and one that benefits cardiac patients. The manufacturers of the three drugs object to their use in executions.

Here is a look at the drugs:

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MIDAZOLAM

Midazolam is the key drug in the procedure and one that Arkansas hasn’t yet used in an execution. It would be the first of the three drugs administered and would be used to sedate the inmate. Because the state’s supply reaches its expiration date April 30, Arkansas scheduled eight executions before then.

At normal adult doses of around 4 mg, midazolam can slow or stop breathing to the point that medical literature advises doctors to monitor patients closely. With a 500 mg dose listed in the state’s execution protocol, Arkansas expects that the inmates will not be aware they are dying.

In federal court testimony over the past week, doctors differed on whether midazolam is an appropriate execution drug, though the U.S. Supreme Court has ruled that it is.

In her ruling, Baker said that, regardless of the difference, Arkansas’ execution protocol doesn’t outline what would happen if the inmate were to remain conscious even if given a double dose. She also said the protocol doesn’t lay out what executioners intend to do to ensure that the inmates are unconscious.

In typical medical settings, midazolam relaxes people and produces amnesia.

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VECURONIUM BROMIDE

The second drug, vecuronium bromide, is a muscle relaxant, but not in the typical sense. Rather than being prescribed for tightness or muscle pain, vecuronium is used to prevent muscles from moving so they don’t interfere with surgeons. After receiving the drug, patients must be on a ventilator or they will suffocate because their diaphragm cannot move.

One doctor testified that being given vecuronium bromide without sedation and ventilation would be equivalent to being held underwater. The typical dose is up to .1 mg/kg intravenously, or 8.5 mg for the typical inmate set to die this month. Under Arkansas’ protocol, executioners would administer 100 mg, or more than 11 times the typical dose, five minutes after the midazolam is administered and once the inmate is unconscious.

Medical supply company McKesson says Arkansas obtained its vecuronium bromide under false pretenses and that the state will not return it, even though the company has refunded Arkansas’ money. A state judge Friday directed Arkansas to not use its current supply of vecuronium bromide pending a hearing Tuesday on whether it was obtained properly, though McKesson said Saturday that, with Baker’s stays, it no longer needs the hearing.

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POTASSIUM CHLORIDE

Potassium is essential for maintaining a proper heart rhythm, and levels that are too high or too low can cause heart trouble. Medical experts who testified before Baker said that the final drug, potassium chloride, causes considerable pain when injected and is typically diluted when given to patients.

A typical dose is 20 milliequivalents delivered over several hours. Arkansas plans to use 240 mEq immediately after the inmate is injected with vecuronium bromide.

The director of the Arkansas Department of Correction, Wendy Kelley, testified this week that Arkansas was not charged for its current supply of potassium chloride. She said the supplier wished to remain anonymous and did not want to generate a bill of sale to decrease the risk of being identified. According to Baker’s order, Kelley said Arkansas did not obtain its execution drugs directly from any manufacturer, though she wouldn’t say who provided the drugs, citing a state law that allows her department to keep most execution information secret.

The Associated Press previously determined, using package labels, who made the state’s supply of midazolam and vecuronium bromide. Drugmaker Fresenius Kabi intervened in the lawsuit before Baker, saying it believed that potassium chloride Arkansas obtained last month came from its factory. It objects to its use in executions.

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Follow Kelly P. Kissel on Twitter at https://twitter.com/kisselAP and go to http://bigstory.ap.org/author/kelly-p-kissel to see his work.

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