EARL RINGO, Jr., ) This is a capital case ) Execution scheduled for Applicant, ) September 10, 2014 ) v. ) ) No. 14A_________ George Lombardi, et. al ) TROY STEELE, ) Respondents. ) EARL RINGOS APPLICATION FOR A STAY OF EXECTION PENDING APPEAL AND DISPOSITION
New facts relevant to this case have surfaced over the last week greatly increase the likelihood that Mr. Ringo will experience serious and severe pain if he is executed by the state of Missouri in any manner currently being contemplated by the Department of Corrections. After months of litigating what Respondents in this action have repeatedly called a single-drug protocol, based on the use of one drug -- compounded pentobarbital -- it has become clear that behind closed curtains, the Department has been administering high doses of the controversial and torturous drug midazolam (aka Versed) intravenously into each and every prisoner who has been executed. They have been administering this drug through an IV while the prisoner is strapped to a gurney in the execution chamber prior to execution, and in most cases at a time when the execution warrant is not in effect and they therefore have no legal authority to begin the execution. Respondents
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claims in the lower courts that nothing has changed and that Mr. Ringo and the other prisoners were on notice of this based on the mention of Versed during depositions ring false in light of highly misleading statements associated with that testimony, the deponents own constant and continuance insistence that midazolam was not used in executions, and pleadings filed by the Attorney Generals office in this and other courts repeatedly asserting that Missouri did not use the same chemicals as were used in the botched executions in Oklahoma, Arizona, and Ohio. The Wardens own statements also highly suggest that at least two of the inmates may have experienced considerable suffering for 20-30 minutes following the injection of the first dose of midazolam, but prior to opening the curtain so that witnesses can see the inmate. All of this suggests that, though Respondents may have been successful in protecting the public from the trauma of having to view a long, gruesome, and painful execution, it is likely failed in protecting various prisoners from experiencing one. A stay of execution must be granted so that Mr. Ringos appeal may be pursued, so that the factual issues regarding Missouris actual method of killing prisoners may be explored and further developed, and so that Mr. Ringo may pursue the very legitimate constitutional claims raised by these issues.
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I. New Facts Increase The Likelihood Of Success On The Merits When Mr. Ringos Claims Are Ultimately Heard.
Mr. Ringos case is unlike others before it because over the past week, new facts have developed that greatly increase the ultimate likelihood of success on the merits of Mr. Ringos claims. Respondents in the lower courts have not denied certain fundamental facts to be true: First, by their own admission, the Department of Corrections (hereinafter, DOC) has been administering high doses of Midazolam through an IV while an inmate is strapped to the gurney and prior to opening the curtain, and prior to administering the compounded pentobarbital; second, that the DOCs own doctor/executioner determined that in every case, midazolam administered through an IV is a necessary part of carrying out the execution; third, that in at least two cases, the DOCs doctor/executioner made a determination that the already high dose of IV midazolam that was administered was not having, the desired effect on the prisoner who was lying strapped to a gurney on the execution table, and after 20-30 minutes decided to administer even more Midazolam through the prisoners IVs. Affidavit of Terry Russell, Submitted
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as Exhibit 7 to Respondents Suggestion In Opposition To Motion to Continue (hereinafter Resp. Ex. 7) 1 . In every one of the nine executions that have occurred in the past 10 months, midazolam was injected into the prisoners veins through an IV as the prisoner was strapped to a gurney prior to the time the DOC claims the execution began. In in lower Courts, the DOC has argued that the midazolam was not part of the protocol so it did not need to be disclosed. But this Court knows well from having had these issues before it approximately once per month for the past ten months that the use of an incredibly high dose of midazolam administered through an IV was absolutely relevant to the claims that were before it, and the very solemn and important responsibility this Court had to make decisions that bore on whether a person lived or died. Officers of this Court submitted pleadings arguing time and again that the botched executions in Ohio, Oklahoma, and later Arizona bore no relevance to requests for stays of executions or the case before this Court because Missouri did not use the same chemicals as were used in those states. See Suggestions in Opposition To Michael Worthingtons Motion For A Stay Of Execution, filed 7/31/2013. However, it is now undisputed that after strapping each prisoner to a gurney, Respondents have injected into the prisoners veins the
1 All docket entries reference the Case in the Court of appeals, Zink v. Lombardi, Case 14-2220, unless otherwise noted.
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same drug that is the one drug common to the botched executions in each one of those states: midazolam. The iv-injected midazolam is being given in doses that greatly exceed doses which would be used as a normal sedative. The first five prisoners that were executed each received two grams of midazolam; the next two received three each, and the last two received six grams each. Dr. Heath explains the difference between the drugs at the various dosages: Even in normal doses, midazolam is a drug that is well-known for producing rapid, and substantial easily measurable cognitive and intellectual impairments. Indeed, those are high among the desired effects that lead us to use midazolam in so many anesthetic procedures . . . . Two milligrams is a substantial dose of midazolam when administered intravenously. The average adult receiving this dose would become quite drowsy, and may doze off and be difficult to fully arouse. A dose of three milligrams of intravenous midazolam is likely to place a typical adult male in a substantially intoxicated state characterized by marked compromise of the intellect, marked reduction in cognitive capacity, profound impairment of memory functionality, and deeply impaired judgment. . . . I rarely administer doses above 2 -3 mg IV for purposes of pre-anesthetic sedation. For the great majority of my patients, ranging above this dose would court the risk of over-sedation and respiratory depression . . . . After receiving 3 mg of IV midazolam, it would likely be difficult for most people to speak coherently or articulate anything beyond a short sentence or simple thought. Any spoken or written statement made by a person to whom 3 mg IV midazolam was recently (within the past hour) administered would necessarily be considered unreliable and not reflective of their otherwise normal state of mind.
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Motion for Stay of Execution, Exhibit 1 (filed September 8, 2014) 2 (hereinafter, Applicants Ex. 1). The very large doses of midazolam that were given the first seven inmates who were executed in Missouri over the past nine months then could cause the person to become substantially impaired, incoherent, and unable to articulate their thoughts. Higher doses could cause over sedation or respiratory depression. These are clearly not normal dosages. Id. 18-19.
That midazolam will likely prevent the prisoner from responding to painful contaminants in the compounded drug greatly undermines the claims that Missouri has been making throughout this litigation that past executions that allegedly went forward without any visible problems provide evidence of the functionality of Missouris protocol. It is now clear not only that prisoners are being injected with a drug that is known to have been a part of three other botched executions behind closed curtains, and that the drug itself may render the prisoner helpless to express pain he is experiencing as a result of contaminants in the compounded pentobarbital. Missouris claims that it has not botched any executions are highly questionable in light of this.
2 References hereinafter to Applicants Exhibit refer to exhibits filed to the above referred-to stay motion and available through the electronic system, unless otherwise indicated.
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The Respondents claimed in lower court that Mr. Ringos counsel should have known that midazolam was being used based on the statements in the depositions concerning the drug Versed. In one sense, this is irrelevant. The question on granting a stay is not what counsel should have known at some point, but rather whether there is a likelihood of success once the claims are fully litigated. In this case, there is. Additionally, counsel has long been aware that it is not uncommon for corrections officials to offer the prisoner an oral sedative a few hours prior to the scheduled execution. The statements by both Lombardi and Dormire, when read in the context of the entire relevant section of questioning make clear that both deponents played into counsels reasonable assumption that the Versed being administered was given orally a few hours prior to the execution. Neither Dormire nor Lombardi said anything to dispel or contradict this belief . Both Lombardi and Dormire indicated that the sedative would be offered to the prisoner, and that even though the anesthesieologist could, under some unknown standard decide to administer the drug, it would primarily be used when the prisoner requested it. See Depostion of David Dormire, submitted as Exhibit 3 to Respondents Suggestions In Opposition To Defendants Motion To Continue (hereinafter Resp. Ex. 3) at 89-90 (First priority is that the prisoner requests a sedative) ; Deposition of George Lombardi, submitted as Exhibit 4 to Respondents
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Suggestions In Opposition To Defendants Motion To Continue (hereinafter Resp. Ex. 4) at 53. The entire discussion with Lombardi regarding Versed went as follows:
Q. And both of them mention the use of a chemical called Versed? A. Yes. Q. Do you know what that was used for? A. Yes, it's used as a sedative in advance, either the offender requests it, or the physician decides that it's should be used. Q. Okay. When you say "in advance", when in advance? A. In advance of the execution process. Q. Okay. Do you know how long in advance? A. I don't remember in this particular case. I don't know. Q. And you've been through other executions -- A. Yes. Q. -- correct? And were sedatives used in previous protocols also? A. Yes. Q. Okay. So is there a variation in how long before the execution -- A. It's usually a few hours before, if a person requests it in particular.
Resp. Ex. 4 at 53 (emphasis added).
Lombardis comments are particularly telling. He said that the Versed was used as a sedative, in advance of the execution. Moreover, he clarified, that it was not merely before the injection of the lethal chemicals that this occurred, but before the execution process. No reasonable interpretation of before the execution process could encompass the intravenous delivery of at least one high dosage of a sedative administered intravenously after the prisoner had already been strapped to the gurney in the execution chamber for close to 30 minutes , and delivered as late
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as within five minutes of the injection of lethal chemicals. Yet, as Warden Russels Exhibit A establishes, that is exactly what occurred. Moreover, Lombardi stated that it was usually administered a few hours before the execution process commenced. This is also in considerable contrast to what was said by Lombardi elsewhere in his deposition, where he was adamant that midazolam would not be used: Q. Why will there be no use of [midazolam] in an execution? A. Because we have no intention to do that. We have Pentobarbital that we use. Q. Well, I -- the subsection B says that if the Department Director -- which is you, correct? A. Right. Q. Determines that a sufficient quantity of Pentobarbital is not available, then Hydromorphone or Midazolam will be used. Are you saying that -- A. And Im testifying right now to tell you that will not be the case. We will not use those drugs.
Resp. Ex. 4 at 21. As Dr. Mark Heath explains, midazolam when intravenously injected is much more potent than when given orally. Applicants Ex. 1. Counsel for plaintiffs in the Zink litigation, and in prior years, have been on the phone with their clients in the hours, minutes and seconds prior to them being taken away to the execution chamber. At no point has any client relayed to counsel that an IV was placed in their arm while they were in a holding cell two to three hours before they were killed. Such an invasion of bodily integrity prior to an execution surely would
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have been reported by a client. Based on the sworn testimony of Lombardi and Dormire that this drug was offered to the prisoner hours before the execution process began, the only reasonable inference was that the drug was being administered orally. This understanding was also consistent with past and current protocols. In the recent history of Missouris protocols, pancronium bromide was included in the protocol, even though its only purpose was to render the prisoner unconscious, not to kill him. Applicants Ex. 2. Moreover, Missouris own protocol narrates step by step through the execution process, beginning with the pre-execution mix of chemicals, and includes a narration of when saline is run through the IV both before and during the execution. Applicants Ex. 3. Though the current protocol therefore does list other non-lethal agents that run through the IV after the prisoner is strapped to the gurney, it does not list midazolam or Versed. Moreover, the Attorney General, in both public statements and statements filed in court insisted repeatedly that Missouris execution protocol was a one-drug protocol that only utilized pentobarbital. Counsels assumption therefore, that the Versed was being orally administered in a reasonable dose a few hours before the execution is the only logical and reasonable conclusion that could be drawn from the testimony as presented. To assume otherwise would require counsel to presume that DOC officials purposely misled the plaintiffs and possibly their
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counsel and that representatives of the Attorney Generals Office were guilty of making material misstatements in court pleadings. It is certainly not unreasonable for counsel to expect that the Attorney Generals regard for candor would be sufficient to assure that his office was not lying to the federal courts on matters so fundamental as life and death. In documents recently filed in court in Mr. Ringos case, DOC officials have recently stated for the first time that valium is the sedative that is offered to an inmate ahead of time, a number of hours before the execution, and that Versed is administered at the choice, not of the inmate, but of M3, who has administered it through the IV in every single execution that has occurred in the last nine months. Resp. Ex. 7. Defendant Lombardi and Dormires statements otherwise in this very action in district court, that Versed was giving primarily at the option of the prisoner, were patently false. II. These New Facts Are Significant To Violations Of Law That Are Directly At Issue In This Case.
a. The Eighth Amendment And Ex Post Facto Claims
1. New Facts Suggest A More Than Significant Likelihood On The Merits Of These Claims
The new facts bear significant relevance to Mr. Ringos claim that the execution process is coupled with a substantial likelihood of significant pain and that this is an increased punishment that is unacceptable under the equal protection
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clause. First, midazolam is a drug that has been used in the past three highly botched executions that have occurred. Ohio executed Dennis McGuire with a combination of drugs never before used in lethal injection in the United States, and he struggled, made guttural noises, gasped for air and choked for about 10 minutes. 3 A few months ago, Clayton Locketts execution in Oklahoma was horribly botched: he regained consciousness, writhed, groaned and took 43 minutes to die, reportedly from a heart attackonly after the blinds were drawn on the execution chamber to obscure what really happened from public scrutiny 4 . In J uly, it took Arizona death row inmate J oseph Wood nearly two hours to die after he was injected with drugs obtained in secrecy from a compounding pharmacy. 5
There is one thing that these three executions have in common: midazolam. While reports are still unclear as to the cause of these significant botches, each of these states has taken actions to assure that the issues are adequately resolved before they kill again. The Governor of Oklahoma recently vacated any execution
3 Error! Main Document Only. Error! Main Document Only.Alan Johnson, Inmates Death Called Horrific Under New, 2-Drug Execution, The Columbus Dispatch, Jan. 17, 2014. 4 Error! Main Document Only.Error! Main Document Only.Katie Freckland, Clayton Lockett writhed and groaned. After 43 minutes, he was declared dead, The Guardian, April 30, 2014, available at http://www.theguardian.com/world/2014/apr/30/clayton-lockett- oklahoma-execution-witness. 5 Error! Main Document Only.Michael Muskal, HOW DID ARIZONA EXECUTION GO WRONG, Los Angeles Times, July 24, 2014.
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warrants through November. 6 Ohio does not have any more executions scheduled until 2015. Applicants Ex. 4. And in Arizona, Governor Brewer called for an independent investigation, and no further executions have been conducted since that time. 7
The new information very much calls into question the Respondents repeated claims that there have been no botched executions in Missouri under the current protocol. Specifically, what the new information tells us about the executions of J ohn Middleton and Micheal Worthington is disturbing at best: At 6:31 PM on the day he was to die, J ohn Middleton was strapped to a gurney, hooked up to an IV and administered through that IV 3 milligrams of midazolam, a drug that the state has consistently claimed it does not use in executions. Resp. Ex. 7. It is clear that when the injections were given at this time, the curtains were not open and public witnesses did not see what was occurring. According to Defendant Russell, Mr. Middleton continued to show signs of anxiety and agitation while strapped to the gurney with an IV in his arm awaiting his death, as clearly indicated by his statement that the sedative drug, was not having its desired effect. Resp. Ex. 7. At 6:54 p.m., Defendant M3
6 Associated Press in Oklahoma City, Oklahoma Executions on Hold After Release Of Report Of Botched Injection, The Guardian (September 5, 2014). 7 Associated Press, Arizona Inmate Dies in 2 Hours Afer Execution Begins, The New York Times (J uly 23, 2014).
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administered three more milligrams of midazolam. Id. According to DOC records, the execution began at 6:57 p.m. and Mr. Middleton was pronounced dead at 7:06 p.m. Id. In public pleadings filed in this Court and others in Mr. Worthingtons case, the state boasted about how quickly and easily Mr. Middleton died. See Suggestions in Opposition To Michael Worthingtons Motion For A Stay Of Execution, filed 7/31/2013 (The witness statements from the most recent execution, the execution of J ohn Middleton, indicate the chemical took effect within seconds of injection.) Those pleadings made no mention of what was happening to Mr. Middleton or what he was doing while strapped to the gurney between 6:31 p.m. and 6:54 p.m. that made the doctor believe that the drugs were not having their desired effect, and that more midazolam needed to be injected into his veins just three minutes before they opened the curtain and began the execution. At 11:31 p.m. on the day before the state was authorized to execute him, Michael Worthington was strapped to a gurney, hooked up to an IV and administered through that IV 3 milligrams of midazolam, a drug that the state has consistently claimed it does not use in executions. Resp. Ex. 7. It clear that at this time, the curtains were not open and public witnesses did not view what was occurring. According to the Warden himself, Mr. Worthington continued to show signs of anxiety and agitation while strapped to the gurney with an IV in his arm
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awaiting his death and after having been administered the drug, as indicated by his statement that the drug was not having its desired effect. Twenty-four minutes later, while still strapped to a gurney and still hooked up to an IV, the state administered 3 more milligrams of midazolam. Resp. Ex. 7. According to DOC records, the execution began at 12:01 a.m., and Mr. Worthington was pronounced dead at 12:11 p.m. Defendant Russell has as much as admitted that after being administered the midazolam (the same drug that is common to the botched executions in Oklahoma, Arizona and Ohio), both Michael Worthington and J ohn Middleton continued to show signs of anxiety while strapped to the gurney for more than twenty minutes, inspiring Defendant M3 to administer even more midazolam just prior to opening the curtain. Had these periods transpired in front of an open curtain and before witnesses, there would likely have been reports similar to those that emanated from Ohio, Arizona, and Oklahoma, and a public outcry calling for the governor to impose a moratorium on executions. Missouri would have joined the list of states with botched executions. Instead, the DOC has kept the curtains closed during this crucial period in their de facto protocol and thus there are no witnesses to see what actually occurred. The Attorney Generals Office argued in subsequent pleadings before this court that J ohn Middletons execution was a model of how executions should proceed. The truth is that for more than 20 minutes after the first injection,
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J ohn Middleton continued to show signs of distress. By the time the curtain was open, the state had injected into J ohn Middletons veins something between 3 and 24 times the normal dose of a highly powerful drug. The new information also highly calls into question the Defendants repeated claims that Missouri prisoners have not and will not feel considerable pain when being injected with the compounded pentobarbital. As Dr. Mark Heath Explains: I cannot see any legitimate reason for administering IV midazolam at doses of 6 mg. It seems likely to me that it may be motivated by an intention to render the prisoner in a deeply sedated state, so as to prevent the prisoner from responding to potential contaminants or inadequacies of the compounded execution drug (purportedly pentobarbital). 6 mg of midazolam is substantially more than would be needed for a typical unpleasant procedure such as a colonoscopy. J ust as 6 mg of midazolam would prevent voluntary and reflexive movement by a patient during a colonoscopy, 6 mg of midazolam will likely prevent the prisoner from responding to painful contaminants in the compounded drug. Thus, 6mg of midazolam would make them less likely to call out anything like I can feel my whole body burning (exclaimed by Michael Wilson when injected with compounded pentobarbital in Oklahoma on J anuary 10, 2014). And if the pentobarbital has a compounding flaw that reduces its potency, the administration of 6 mg midazolam would tend to mitigate the low potency and conceal the problem from the witnesses.
Applicants Ex. 1, 19. The statements of Dr. Heath and Dr. Sasich previously submitted to this Court and in the district court (Zink v. Lombardi, Case No. 2:12-cv-04209, Doc. 147-6, 147-7)) now seem to ring even more true in light of the fact that we know
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that for the past nine executions, Missouri prisoners who were injected with compounded pentobarbital were injected with a drug prior to the curtains being opened that would likely prevent the prisoner from responding to painful contaminants in the compounded drug. Thus, even if they were feeling considerable pain, their voluntary and reflexive movements would be suppressed, and they also would be prevented from screaming out in pain or articulating to their witnesses what they were experiencing, as Micheal Lee Wilson, an Oklahoma prisoner who was injected with compounded pentobarbital did, when he felt his whole body burning 8 . Moreover, the inability to articulate coherent phrases and sentences is another effect of the midazolam. After receiving 3 mg of IV midazolam, it would likely be difficult for most people to speak coherently or articulate anything beyond a short sentence or simple thought. Applicants Ex. 1, 15. As asserted in Dr. Mark Heaths declaration and argued in Mr. Ringos petition for habeas corpus, currently pending in the U.S. District Court for the Western District of Missouri 9 there is a strong likelihood that these doses of midazolam render a prisoner incompetent to be executed before the time when, according to the DOC, the execution actually begins. Applicants Ex. 1, 21-23. Even if it does not
8 Error! Main Document Only.Rick Lyman, Ohio Execution Using Untested Drug Cocktail Renews the Debate over Lethal Injections, New York Times, Jan. 17, 2014, at A15.
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render the prisoner completely incompetent (which there is strong evidence that it does so), this rendering of the prisoner unable to speak articulately in their last moments of life constitutes a separate assault on human dignity that is a violation of the Eighth Amendment and a violation of the ex post facto clause in that it is a punishment that was not present in prior executions, when prisoners were actually able to speak their last thoughts. There is strong evidence that in Missouri, there is no opportunity or ability to give spoken last words before witnesses or otherwise after administration of the midazolam. Specifically, while reports given to press contain a prisoners last statement, this too seems to be the result of a concerted effort to mislead the public and counsel for the prisoners. Undersigned counsel (Ms. Parish and Mr. Sindel) represented J ohn Middleton before he was executed. On the eve of Mr. Middletons execution, Ms. Parish was on the phone with Mr. Middleton throughout much of J uly 15th and J uly 16th. At one point, Mr. Middleton told Ms. Parish that someone had come by and given him a form where he could write his last statement. Mr. Middleton told Ms. Parish that he wrote, Youre killing an innocent man. Thereafter, Ms. Parish received a telephone call from Mr. Middletons sister, Rose, shortly after she left Bonne Terre, having witnessed the execution. When asked what happened and whether J ohn had said anything, Rose reported that he didnt say anything audible, but that he seemed to have mouthed,
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I love you. Reports of the execution the next day reported that J ohn Middletons last statement was Youre killing an innocent man, the same statement that Mr. Middleton had told Ms. Parish he had written on the paper given to him by DOC officials prior to be taken into the execution chamber. Reports of other executions mark a consistent pattern of inmates not speaking any official last words before witnesses. See Applicants Ex. 7, 8, 9, 10, 11, 12. Mr. Sindel contacted a reporter who has been present as a witness at all of Missouris recent executions. The reporter confirmed that the prisoner is covered with a sheet except for his face, that sometimes he can see the inmate seem to move his lips or mutter, but he cannot hear anything, and that after the execution, the press receives a written statement with the inmates last words. The new information demonstrates a clear Eighth Amendment violation and a punishment that is greater than it was at the time it was imposed. In light of this new information, Mr. Ringo has a more than substantial likelihood of success on the merits once these claims are ultimately resolved.
2. The Issue Regarding An Alternative Protocol Will Not Prevent Success On The Merits Of The Eighth Amendment Or Ex Post Facto Claims.
A stay applicant must show a significant possibility of success on the merits to obtain a stay. Hill v. McDonough, 547 U.S. 573, 584 (2006). In granting
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a stay of execution to Russell Bucklew, therefore, this Court necessarily ruled that he showed a significant possibility of success on the merits. Bucklew, 134 S.Ct. 2333 (2014). Mr. Ringo shows a significant possibility of success because the questions he presents are substantially the same as those underlying the Bucklew litigation. Obviously, this Court was following the law when it stayed Mr. Bucklews execution. Prominently featured before this Court in that case was the issue of whether Mr. Bucklew must propose an alternative method of execution in order to bring a viable Eighth Amendment claim. The district court answered that question affirmatively, and the state argued the point at length when opposing a stay. (App. 807-810). The state defended the district courts ruling that Mr. Bucklews complaint did not allege or even acknowledge a feasible and more humane alternative method of execution, and therefore, that Mr. Bucklew failed to allege sufficiently an Eighth Amendment claim under Baze. (Id. at 807). The state went on to criticize various modifications recommended by Mr. Bucklew, such as the proposal that the Department allow a non-execution team physician to be present in order to revive Mr. Bucklew during a botched execution, because the proposals are not really changes in the method of execution. (Id. at 808-810). Mr. Bucklews attorneys argued Baze does not require the prisoner to propose an alternative means of his demise, particularly in light of this Courts
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earlier rulings in Hill v. McDonough, 547 U.S. 573, 582 (2006), and Jones v. Bock, 549 U.S. 199, 213 (2007), both of which disclaimed such a pleading requirement. (App. 776-779, 821). Bucklew argued that he could not allege an alternative method without the ability to discover undisclosed facts regarding the drugs to be used, their origin, and the ingredients used in compounding them. (Id. 765, 794, 821-822). Finally, Bucklew argued that the alternative-method requirement creates a conflict of interest between the prisoner and counsel, who, in order to fulfill this requirement, must advocate for the clients death and lend their assistance to bring it about in a particular manner. (Id. 781-783, 794). Mr. Ringo advances the same arguments now as those described above, and indeed, the alternative-method issue is the only reason why the district court rejected his claim. (Add. 7-10). It bears repeating that a stay applicant must show a significant possibility of success on the merits. Hill, 547 U.S. at 584. If a prisoner were required to plead an alternative method in order to survive a motion to dismiss, then Mr. Bucklew could not have shown a significant possibility of success on the merits without specifying such an alternative himself. The Bucklew ruling casts grave doubt on the Eighth Circuits prior decisions in the Zink litigation. In re Lombardi, 741 F.3d 888, 896 (8th Cir. 2014) (en banc) (Lombardi I), states that an Eighth Amendment claim requires either a a plausible allegation of a feasible and more humane alternative method of execution or a
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purposeful design by the State to inflict unnecessary pain. Russell Bucklew would have been executed on May 21 if this statement accurately described the law. This Court in Bucklew declined to follow the rule of Lombardi I, and that development alone requires a stay. Moreover, standing precedent in this Court prevents adoption of such a rule. In Jones v. Bock, 549 U.S. 199, 213 (2007), this Court stated, In Hill v. McDonough, 547 U.S. 573 (2006), we unanimously rejected a proposal that 1983 suits challenging a method of execution must identify an acceptable alternative. Issued less than one year later, the opinion in Baze v. Rees, 553 U.S. 35 (2008), does not remotely suggest that the Court was departing from Jones and Hill, or creating a new pleading or proof requirement of an alternative execution method. The Court instead disapproved any test that compares one method to another, which would transform courts into boards of inquiry charged with determining best practices for executions, with each ruling supplanted by another round of litigation touting a new and improved methodology. Baze, 553 U.S. at 51. Indeed, Baze did not attempt to distinguish or even mention Jones or Hill. The Court in Baze was confronted with the specific claim that Kentuckys execution protocol violated the Eighth Amendment because the state could easily change to a one-barbiturate method or at least discontinue the use of the paralytic agent pancuronium bromide. 553 U.S. at 56-57. That specific claim required the
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prisoner to show that the proposed alternative was feasible, available, and likely to reduce a significant risk of pain. Id. at 52, 61. The Baze opinion simply addressed the claim before the Court. It did not erect a new standard for pleading or proving every Eighth Amendment claim relating to manner of execution. In order to do so, it would have had to overrule Jones and Hill. It is exceedingly unlikely that this was not this Courts intention. Shalala v. Illinois Council on Long Term Care, 529 U.S. 1, 18 (2000) (This Court does not normally overturn, or so dramatically limit, earlier authority sub silentio.). Even if the district courts ruling were consistent with Baze and Lombardi II, the prisoners could not satisfy it without full and fair discovery into the Departments efforts to identify, select, procure, and test execution drugs. Mr. Ringo cannot show that an alternative method is feasible and readily implemented, see Baze, 553 U.S. at 52, without knowing what efforts the defendants have attempted, even as the defendants themselves insist that suppliers are hesitant to furnish them with lethal injection drugs. As noted earlier, the state vigorously resisted any and all discovery of their present or previous suppliers, and they refused to comply with any such discovery after the Lombardi rulings. The Courts dismissal order stayed all discovery. Zink v. Lombardi, 2:12-cv-4205, Doc. 437. This order, therefore, prevents compliance with its own directive, because the prisoners cannot discover specific information that is uniquely and
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peculiarly available to the defendants. The practical effect is to disable any and every Eighth Amendment claim targeting a method of execution, unless the prisoner somehow knows how and where his executioner may readily obtain the instruments of his deathand in a regime where that very information is kept secret by the executioners, their supervisors, and their attorneys. The pleading standard imposed by the district court would require counsel and other death row attorneys to violate the rules of professional ethics. Mr. Ringos attorneys cannot suggest any means for the state of Missouri to kill him because he has neither selected a means of death nor directed his attorneys to seek such means. In every lawyer-client relationship, the client, not the lawyer, determines the goals to be pursued. Restatement (Third) of the Law Governing Lawyers, 16A cmt. c (2000). Rule 1.2 of the Missouri Rules of Professional Conduct requires a lawyer to abide by a clients decisions concerning the objectives of the representation. Mo. Sup. Ct. R. 4-1.2(a). By determining that Baze closes the courthouse door to Mr. Ringos Eighth Amendment pleading if counsel fails to recommend another method for killing him, the district courts rule violates counsels obligation under Rule 1.2(a). A court would instruct counsel to abandon the clients objective and instead to concede the constitutionality of an untested method of execution. If counsel meets the district courts understanding of the pleading standard by conceding an
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alternative means for the state to execute Mr. Ringo, counsel would violate Rule 1.2 by contradicting Mr. Ringos decision-making authority as client. But if counsel wants to avoid violating Rule 1.2 by not providing an alternative means of execution in the pleading, counsel has arguably violated Rule 1.3s requirement of diligence by refusing to comply with the alleged pleading requirement. See Mo. Sup. Ct. R. 4-1.3. Refusal to engage in the macabre task of actively supporting an alternative method of execution protects an important right for Mr. Ringo. As this Court has held, [b]y declaring his method of execution, picking lethal gas over the States default form of executionlethal injection[a death row inmate] has waived any objection he might have to it. Stewart v. LaGrand, 526 U.S. 115, 119 (1999) (emphasis added). Mr. Ringoand his counseltherefore are forced to abandon an important Eighth Amendment argument if they are required to affirmatively choose a method of execution. An alternative-method requirement would create a concurrent conflict of interest and would perversely require removal of Mr. Ringos present counsel. The concurrent conflict rule prohibits representation if there is a significant risk that the representation will be materially limited by the lawyers responsibilities to a third person . Mo. Sup. Ct. R. 4-1.7(a)(2). The conflict that arises from the alternative-method requirement is intrinsic to the representation. The district
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court would require counsel to make an argument that cuts against the very goal of the clients representation: preventing his execution. The courts application of Baze not only ignores that client-defined objective, but it describes advocacy on behalf of the death row inmate as a concession to the states desired result: that an alternative method of execution is constitutional. This is a cognizable, even palpable, conflict that poses all the dangers of the more traditional, extrinsic conflicts of interests. By embracing the conflict of interest inherent in the district courts directive, and helping the state select a method to kill Mr. Ringo, his attorneys would become ineffective. This Court has repeatedly recognized that the Sixth Amendment right to effective assistance of counsel includes the right to a representation free from conflicts of interest. See Glasser v. United States, 315 U.S. 60, 70 (1942). [T]he rule against representing adverse interests [of present clients] was designed to prevent a practitioner from having to choose between conflicting duties, or attempting to reconcile conflicting interests rather than enforcing a clients rights to the fullest extent. Smiley v. Dir. Office of Workers Comp. Programs, 984 F.2d 278, 282 (9th Cir. 1993). Requiring counsel to argue in favor of a method for killing Mr. Ringo is decidedly unjust; it prohibits counsel from enforcing [the] clients rightsor pursuing Mr. Ringos wishesto the fullest extent. Smiley, 984 F.2d at 282.
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Generally, the Rules address conflicts of interest by requiring the lawyer to remove herself from the representation. See Mo. Sup. Ct. R. 4-1.7, cmts. [2]-[4]. Under the circumstances of this case, however, such a remedy is both impractical and illogical. Removal would bring heavy burdens by replacing counsel who are familiar with the cases complex facts and procedural history with new counsel. Replacement counsel, in turn, would fail as a remedy because the new counsel would labor under the same conflict. A death row inmates lawyer would breach his duty of diligence should he fail to pursue a claim that might secure his clients desired outcome. See Mo. Sup. Ct. R. 4-1.3. The district courts pleading requirement is as unworkable and inequitable in practice as it is unjustified by precedent. This is not a pleading standard that is likely to be adopted and Mr. Ringo has a substantial likelihood of success on the merits of his claims.
3. The Claims Regarding The Compounded Pentobarbital Are Strong Even Absent The Midazolam Issue In This Regard.
An additional subsequent development affects the likelihood of success on the merits of this case, with regard to the compounded pentobarbital issue alone. That is the fact that the States prior expert, Dr. Derschwitz, is no longer willing to
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testify in lethal injection cases. Applicants Ex. 8 10 . The reason why is unclear. At this point though, counsel is aware of no medical expert that Defendants can put forth who will contradict the substance of Dr. Sasichs and Dr. Heaths findings and be willing to testify that administering compounded pentobarbital is a humane way of killing people. The district court agreed with Mr. Ringo and his fellow plaintiffs in a critical respect. It rejected the defendants argument that an Eighth Amendment claim requires that a prisoner allege and literally prove that the states method of execution is sure or very likely to cause serious illness or needless suffering, as opposed to the Baze courts definition of that term: [T]o prevail on such a 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 (2008) (opinion of Roberts, C.J .). That question was fiercely litigated in the Bucklew litigation, and the Supreme Court granted a stay. The natural starting point is, of course, Baze itself. The relevant portion of the Chief J ustices plurality opinion quotes Helling v. McKinney, 509 U.S. 25 (1993); see Baze, 553 U.S. at 50. At the place the Chief J ustice quotes it, this
10 This Exhibit was attached to Mr. Ringos Reply Suggestions In Support Of Motion To Set An Execution Date (Filed, September 8, 2014)
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noncapital opinion sets out a general principle to govern prospective relief concerning prison conditions that affect prisoners health: We have great difficulty agreeing that prison authorities may not be deliberately indifferent to an inmates current health problems but may ignore a condition of confinement that is sure or very likely to cause serious illness and needless suffering the next week or month or year. Helling, 509 U.S. at 34-35, cited in Baze, 553 U.S. at 50. Helling concerned a prisoners exposure to second-hand cigarette smoke from his cellmate, and the Court held that the prisoner stated a viable Eighth Amendment claim. 509 U.S. at 35. Needless to say, no single individual can possibly prove that second-hand smoke is sure or very likely to cause lung cancer or similarly serious harms. But that was not the actual test: McKinney states a cause of action under the Eighth Amendment by alleging that petitioners have, with deliberate indifference, exposed him to levels of ETS [environmental tobacco smoke] that pose an unreasonable risk of serious damage to his future health. Id. (emphasis added). The Chief J ustice in Baze explained what the sure or very likely language from Helling actually means: We have explained that to prevail on such a 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, 553 U.S. at 50,
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emphasis added, citing Helling, and quoting Farmer v. Brennan, 511 U.S. 825, 842, 846 & n. 9 (1994). This is the language that appears throughout the Chief J ustices opinion as the legal standard on the merits in Baze. Id. at 50, 52 & n.3; see also id. at 116 (Ginsberg, J ., dissenting) (reflecting three votes for similar standard, and not disputed by the Chief J ustice as to his phrasing of the test); id. at 36-37 (syllabus). Defendants also cited the one-paragraph summary ruling in Brewer v. Landrigan, 131 S. Ct. 445 (2010), but nothing in Landrigan altered Baze. It is true that the Court recited the sure or very likely language in vacating a stay. But it never altered the definition of that language from Baze, and it noted that the language came from the Courts earlier opinion in Helling, which, again, was a case about the risks caused by second-hand cigarette smoke in which the prisoner stated a viable Eighth Amendment claim. See Landrigan, 131 S. Ct. at 445. It is unlikely that this Court intended for Landrigan to modify Baze. See Edelman v. Jordan, 415 U.S. 651, 671 (1974) (lesser precedential value of summary rulings). And in any event, the district court in Landrigan expressly stated that it was issuing a TRO because it could only speculate that a non-FDA-approved drug will cause pain and suffering. 131 S. Ct. at 445. This Courts summary ruling means only that speculation does not satisfy Baze. And the Courts later grant of a
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stay to Mr. Bucklew reflects its agreement with Mr. Bucklews view of the relevant Eighth Amendment test. The district court agreed with the prisoners in a second critical respect: they bring an Eighth Amendment claim involving a sufficient risk and level of pain that the current execution protocol carries. Zink v. Lombardi, Case No. 4:12-cv- 4209. Plaintiffs plead that the defendants use in lethal injections of what they represent to be pentobarbital from an undisclosed compounding pharmacy creates a substantial risk of severe pain or an objectively intolerable risk of severe pain. Zink v. Lombardi, Case No. 4:12-cv-4209, Doc. 329. Compounding pharmacies are not subject to the government regulation on which Americans rely for the identity, purity, potency, and efficacy of the medications they takeand on which experts and courts have relied in rendering opinions and making judgments about the substances which the defendants have used in past lethal injection litigation. Id. Among other problems, reputable vendors of pentobarbital will not sell the drug to the Department of Corrections, unregulated compounded drugs involve precursor chemicals from unknown and unregulated suppliers, and compounding pharmacies lack the institutional competence to test either the precursor chemicals or the product they tender to their customers. Id.. Attached to and included within the complaint are analyses from pharmacology expert Larry D. Sasich and anesthesiologist Mark J .S. Heath. Dr.
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Sasich explains that compounded drugs are unreliable because they are largely unregulated. Id., Docs. 338-5, 338-6, 338-8, 338-42. Compounding pharmacies represent an emerging, substandard drug industry responsible for making large quantities of unregulated, unpredictable and potentially unsafe drugs. Id. The drugs they make often contain counterfeit or substandard ingredients, and drug compounders often use poor practices; as a result, the process of compounding often results in drugs which are contaminated, sub-potent or super-potent, or which do not have the strength, quality or purity ... required for the safe and effective treatment of patients. Id. Reputable suppliers of pharmaceutical ingredients generally sell directly only to FDA-approved manufacturers of finished products. Id. That leaves compounding pharmacies to depend on the unregulated grey market in which ingredients may come from China, India, or other countries that do not reliably inspect pharmaceutical ingredients; the drugs may not even be what they purport to be, and it is all but impossible to trace the active ingredient to its original manufacturer in order to verify its quality. Id. In light of these hazards, The potential harm associated with the use of such contaminated or sub-potent drugs is extremely high. Id. That harm is enhanced by the secrecy concerning the Department of Corrections supplier, which creates even greater uncertainty as to the origins and quality of the drugs ingredients. Id.
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Dr. Sasich outlines four specific hazards from the use of compounded pentobarbital in executions. First, there is a substantial risk that the drug may be sub-potent or super-potent, either from (a) the fact that Missouris protocol specifies no means of adjusting the measurements of the chemical to account for the drugs hygroscopic (water-absorbing) nature, (b) chemical degradation caused by impurities or contamination, (c) a compounding error, or (d) the possibility that Defendants drug is not actually pentobarbital. Id. Sub-potent pentobarbital risks acute intoxication, life-threatening but not fatal respiratory depression, and/or paradoxical stimulation. Id. Super-potent pentobarbital, meanwhile, may result in suffocation and gasping for breath, before the loss of consciousness. Id. A second problem Dr. Sasich identifies is the danger that compounded pentobarbital will be contaminated with dangerous allergens, toxins, bacteria, or fungusany of which could induce severe allergic or blood reactions that are highly unpredictable, rapidly evolving and potentially painful and agonizing. Id. A third danger arises from particle contamination. The compounded pentobarbital may contain foreign particles that will either contaminate the solution or precipitate out of it, creating a substantial risk of pain and suffering on injection, as well as a risk of pulmonary embolism. Id. Fourth and finally, Dr. Sasich states that the dosage form of the drug may fail to reach or maintain the proper pH, which risks burning on injection, the precipitation of solid particles that could cause a
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pulmonary embolism, or the multiplication of bacteria and fungus that may create instability and/or incompatibility with human blood. Id. Dr. Sasich concludes that compounded pentobarbital creates a substantial risk of serious, unnecessary and substantial harm and mental anguish. (Id). (emphasis added). Dr. Heath states that sub-potent pentobarbital may severely disable the prisoner without actually killing him. It carries a risk that the prisoner will be unconscious for an extended period of time while breathing inadequately, before waking up in a permanently brain-damaged state. Id.. Dr. Heath concludes that Missouris protocol is replete with flaws that present a substantial risk of causing severe and unacceptable levels of pain and suffering during the execution. Id. (emphasis added). To make matters worse, the defendants are administering expired drugs. Dr. Sasich explains that United States Pharmacopeia Chapter (USP) <797>defines the Beyond Use Date (BUD) as the date or time after which a compounded sterile preparation should not be administered, stored, or transported. Chapter <797>of the USP assigns BUDs for drugs compounded from non-sterile Active Pharmaceutical Ingredients (High Risk Compounding). If the drug is stored at room temperature, the BUD is 24 hours; if refrigerated, 3 days, and if frozen, 45 days. (App. 519-520). Based on laboratory reports disclosed by the defendants which they ceased disclosing after their first three pentobarbital executionsthe
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drugs used in J oseph Franklins execution were stored at room temperature and were compounded sixteen days before the execution, and the defendants administered an expired drug. (Id. 521). A similar analysis governs the drug with which Allen Nicklasson was executed. (Id. 521-522). Dr. Sasich described the states practices as a very troubling deviation from USP standards, which carries a very high risk that the compounded drug will degrade or allow for more rapid growth of bacteria. (Id. 104). Improper storage creates a very substantial, even grave, risk that the prisoner will suffer severe pain and/or an immediate severe allergic reaction. (Id. at 105). The state may argue, as it did below, that its eight pentobarbital executions have been relatively uneventful. (Id. 542, 685-686). This contention, however, does not defeat the prisoners claims. For one thing, the defendants switched suppliers after their third execution. (E.C.F. Doc. 360 at 2). For another, the drug cocktail used for each execution is separately compounded, and the evidence of record states that there is no way to ensure the reliability and safety of the states pentobarbital from batch to batch or execution to execution. (App. 519). Finally, the state now refuses to disclose whether it even tests its drugs at all, never mind the identity, credentials, or complaint-history of its current pharmacy. (See Depo of Matthew Briesacher (Mar. 21, 2014), at 43-44, 72-73; App. 560-561; 642-643, 651). Dr. Sasichs words ring even truer with the states about-face on testing:
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The additional documents that I have reviewed provide no evidence that Missouri actually knows what will be injected into a condemned prisoner. (Id. 522). b. Additional Claims Of Mr. Ringos Are Also Effected By The New Evidence And There Is a Substantial Likelihood Of Success On The Merits Of These Claims Once They Are Ultimately Resolved.
1. Due Process As Notice Of The Governors Actions And A Meaningful Opportunity To Be Heard
The briefing before the court of appeals raises issues of whether the due process clause is violated when state conduct affects a citizens' rights, the citizen is entitled to notice of what the government intends to do to him or her, as well as the opportunity to be heard at "a meaningful time and in a meaningful manner." Fuentes v. Shevin, 407 U.S. 67, 80 (1972). The district court ruled that there was no due process violation because the prisoners were able to bring a lawsuit, even though they were unable to bring what the district court considered to be a viable Eighth Amendment claim. This claim becomes stronger in light of the fact that the new evidence establishes that state actors made repeated affirmative mis- representations aimed at denying Mr. Ringo the ability to make effective use of the court system. There is a substantial likelihood of success on the merits as to this claim. 2. Deliberate Indifference To Plaintiffs Serious Medical Needs
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With regard to Mr. Ringos claims that state agents were acting with deliberate indifference to Mr. Ringos legitimate medical needs, the district court ruled that since lethal injection was not a medical procedure, plaintiffs could not go forward with this claim. Yet the new evidence reveals the administration of midazolam through an IV without the prisoners consent and at a time that Defendants insist is not part of the lethal injection process. In light of this new medical procedure Defendants claim is not part of the lethal injection process, there is a substantial likelihood of success on the merits of these claims. 3. Equal Protection Clause Claims With regard to plaintiffs equal protection claims, the district court ruled that the states allowance of pre-execution judicial review is not a core provision of its procedures, because it does not involve the administration of lethal chemicals or preparations for that act, and therefore the Defendants actions in moving forward with executions while stays were pending did not violate equal protection. Yet the new evidence suggests that Defendants further have violated their own protocol through the IV administration of midazolam in very high doses and by beginning the execution de facto before the time the warrant takes effect. These are clear violations of the core provisions of Defendants procedures that indicate a substantial likelihood of success on the merits once these claims are ultimately heard.
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III. The Remaining Considerations Justify a Stay
In addition to the merits of Mr. Ringos claim, the Court must also consider the balance of harms and whether Mr. Ringo has unduly delayed his claim. Nelson v. Campbell, 541 U.S. 637, 649-50 (2004); Nooner v. Norris, 491 F.3d 804, 808 (8th Cir. 2007). These factors also weigh in favor of a stay. Bearing in mind that the death penalty is obviously irreversible, Evans v. Bennett, 440 U.S. 1301, 1306 (1979) (Rehnquist, J ., granting stay as circuit justice), the protocol at issue here carries a substantial risk that Mr. Ringos last conscious memory will be the experience of severe pain. And although the state has an interest in enforcing criminal judgments without unnecessary delay, it does not have a legitimate interest in executing prisoners illegally or unconstitutionally. [T]he public interest has never been and could never be served by rushing to judgment at the expense of a condemned inmates constitutional right. In re Ohio Execution Protocol Litigation, 840 F. Supp. 2d 1044, 1059 (S.D. Ohio 2012). Neither has Mr. Ringo delayed his constitutional claims in the slightest. He brought suit on J une 26, 2012, six weeks after the Department announced an execution method featuring the use of the anesthetic propofol. The Department changed its protocol several times before announcing the compounded- pentobarbital method on October 22, 2013. Mr. Ringo and the other prisoners proffered an amended complaint as promptly as possible, on November 8, 2013,
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marshaling expert evidence in support of their claim that the protocol violates the Eighth Amendment. ECF Doc. 147. The prisoners proffered a second amended complaint on J anuary 27, 2014, which they filed with the district courts leave one week later. Mr. Ringo, then, has been asserting an Eighth Amendment claim against the current protocol since November 8, 2013, or some two weeks after the protocol was announced. Mr. Ringos execution was not scheduled until J une 30, 2014. The district court dismissed the Zink case on May 16, and the prisoners appeal will not be resolved before the scheduled execution date of August 6. This is certainly not a case, then, in which a claim could have been brought at such a time as to allow consideration of the merits without requiring entry of a stay. Hill, 547 U.S. at 584. On J uly 3, the eighth circuit ordered that this appeal be heard en banc and expedited the case. The case was argued this morning. Therefore, a stay of execution here will not be indefinite like the prior stay requests that were previously denied in this appeal. Under this accelerated schedule, this litigation will likely be completed in a matter of months, not years. The Court should stay Mr. Ringos execution to allow him to survive until this Court resolves this appeal.
Respectfully submitted,
Sindel, Sindel and Noble, P.C.
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s/ Richard H. Sindel s/ Kathryn B. Parish Richard H. Sindel, #23406 Kathryn B. Parish, #61781 8000 Maryland, Suite 350 Clayton, MO 63105 (314)721-6040 FAX: (314-721-8545 rsindel@sindellaw.com kparish@sindellaw.com
s/J ohn William Simon J ohn William Simon, J .D., Ph.D. Missouri Bar Enrollment #34535 Constitutional Advocacy, LLC 7201 Delmar Blvd., Suite 201 St. Louis, MO 63130-4106 (314) 604-6982 FAX (314) 754-9083 simonjw1@yahoo.com
Counsel for Mr. Ringo Earl Ringo
CERTIFICATE OF SERVICE I hereby certify that the foregoing motion was served on Assistant Attorney General Michael Spillane via Email on September 9, 2014.