EXECUTION BY LETHAL INJECTION
LETHAL INJECTION MACHINE MANUAL STATE of MISSOURI
FRED A. LEUCHTER ASSOCIATES, INC.
Lethal Injection System
OPERATION and INSTRUCTION MANUAL
Department of Corrections
and Human Resources
State of Missouri
Missouri State Penitentiary
Bill M. Armontrout, Warden
October 15, 1988
Fred A. Leuchter Associates, Inc.
231 Kennedy Drive
Boston, Massachusetts 02148
HARDWARE AND CHEMICALS...................................10
1. Assembly--Delivery Module.
2. Schematic--Complete System.
MISSOURI LETHAL INJECTION MACHINE
The Fred A. Leuchter Associates, Inc. Modular Lethal Injection Machine is designed to sequentially deliver variable quantities of three solutions at variable time periods. Utilizing standard 60cc disposable syringes, it is essentially driven by weighted pistons depressing the syringe plungers. It is designed to sequentially deliver the solutions at time intervals controlled by an electrical, solid-state, timing system powered by a sealed battery which receives its charge from the power line. The system is designed to be activated by two executioners: a solid-state digital circuit will randomly determine which executioner controls the system, but will not retain the chosen executioner in memory. Since it operates from battery power, it is not subject to power line failure. Three electrical solenoids cause the weighted pistons to depress the respective syringe plungers. Chemical delivery is via a single intravenous line, commoned by an eight-port stainless steel manifold with luer lock entry ports. This line joins with a standard intravenous administration set dispensing saline solution on a continuous basis into the subject. Three solid state timers operate the solenoids and the stages are initiated by switch-controlled relays monitoring the volume of solution in each syringe.
In the event of a timing system failure, an electrical override is provided to control the solenoid operation. Two switches are used to control the depression of each successive plunger. Any one, or all three plungers, may be controlled, depending upon the problem encountered. The controlling switch group is preset during machine makeready. Thus, the system still functions as a one-of-two executioner controlled system. In the event of total electrical failure, or a partial mechanical failure of the Prime System, a second Back-up System, which is strictly mechanical, is employed. This system consists of a redundant set of piston driven syringes and is operated by three sets of double pull knobs. Determination of which executioner will control the system is made during makeready. Both knobs of each set are pulled in tandem sequentially and the system operates as a one-of-two executioner system. The use of either back-up system requires that sequential timing between successive plunger actuations be determined by clock and command. All three systems have been engineered with a minimal amount of components for trouble free operation, and it is unlikely that a systems failure should occur in any of the three systems. However, should failure occur, the redundant systems should insure a problem-free execution.
Provision is made for systems purge via two saline filled syringes and an external saline supply is utilized to prevent coagulation at the needle tip, in the usual manner. The system is designed to accept eight 60cc syringes; two for saline, two for Pentathol, two for Pancuronium Bromide, and two for Potassium Chloride. Each of the six functional syringes has a positive piston stop pin to prevent premature operation of the system.
The system consists of two modules; The Control Module and The Delivery Module. The Control Module is made up of the power, sequential timing and control circuitry. The Delivery Module consists of the electro-mechanical and mechanical drive assemblies, syringes, and manifold, to ensure proper fluid delivery.
THE CONTROL MODULE
The Control Module is designed utilizing state-of-the-art, solid-state, power, digital and timing circuitry and conventional electrical switches. The on/off and function switches are key controlled to prevent accidental operation. The battery, power supply and charging circuit are also part of this package.
The Control Panel itself contains the Key-controlled on/off switch and two executioner switches (which are pushed simultaneously) for the prime system; the key-controlled function switch for the electrical back-up system (to determine which executioner activates the system) and six operating switches, arranged in three pairs, for the back-up system. These switches are thrown simultaneously by the executioners and control the sequential dispensing of the fluids, individually. Each pair is thrown simultaneously with the proper time interval between operations when the electrical back-up system is utilized.
There are two sets of monitoring lights, one on The Control Module and a redundant set on The Delivery Module. A system- on light indicates power on. Each syringe is monitored by a three light sequence. Red indicates Ready, Yellow indicates Operating and Green indicates Completion. The sequence occurs three times, once for each syringe. The Control Module shall be in The Control Room.
THE DELIVERY MODULE
The Delivery Module consists of an eight inlet, one outlet stainless steel manifold containing two purge syringes filled with saline solution, two syringes filled with Sodium Pentathol, two syringes filled with Pancuronium Bromide, and two syringes filled with Potassium Chloride. The outlet is connected to a disposable intravenous administration set terminating in a needle tip and connected to a saline dispensing bag a short distance from the manifold. Additional hardware includes the cylinder matrix for supporting the syringe assembly, three electrical solenoids, three solenoid pull rods, six mechanical pull knobs, six connecting cables, six weight stop pins, six weighted pistons, six cylinders, and nine indicator lights. A total of eight disposable 60cc syringes are utilized in the system. During system makeready, all three solenoid pull rods are used, but only three of the six connecting cables, one for each set of two. The pull knobs are arranged in three pairs and both from each pair are pulled, one by each executioner, but only one from each pair is connected (either all odd or all even numbers). All manifold inlet connections are accomplished by luer lock fittings. Two purge syringe back flow stop brackets and twelve piston spaces are also part of The Delivery Module.
During makeready, the two saline syringes are used to bleed the system, the other syringes are installed, after filling, in the proper order, as assemblies, with the weighted piston, cylinder and piston stop pin. The cables are connected in the proper sequence and the solenoid pull rods inserted into the pistons. The Delivery Module shall be in the Execution Chamber.
It is suggested that the following procedure might be followed to facilitate a smooth execution. These dosages are established, although not recommended, through consultation with pharmaceutical manufacturers. We at Fred A. Leuchter Associates, Inc., not being pharmacologists, do not recommend, or in any way guarantee the efficacy of these chemicals or dosages, but simply communicate the recommendations of the manufacturers.
1. Pre-injection 10cc antihistamine, one half hour prior to execution.
2. Pre-injection 8cc 2% Sodium Pentathol (5 grams/250 ml, Abbott Labs #6108-01) five minutes prior to transmittal of subject to death chamber.
3. Machine injection 15cc Sodium Pentathol 2% Solution (as above) delivered over a ten second time period.
4. One minute wait.
5. Machine injection 15cc Pancuronium Bromide (Pavulon, Organon Drug Co., 2ml/2mg/ml) over a ten second time period.
6. One minute wait.
7. Machine injection 15cc Potassium Chloride (KCl Injectable solution).
8. Two minute wait.
9. Execution over.
Times may be varied up to two and one half minutes by setting the timer in The Control Module.
Volumes to be dispensed may be varied by reducing the volumes in the syringe and utilizing the appropriate piston spacer.
Speeds of injection may be varied by using needles of different sizes. It is recommended not to exceed a twelve gauge. Fourteen gauge angiocaths are supplied.
The battery contains sufficient power at full charge to sustain operation for at least six usages of the system at fifteen minute time intervals before recharge is necessary. A uniform, slow-rate charge circuit, designed to guarantee a maximum battery life, will completely charge the battery over a 14 hour time period from 110 vac line power. The battery is a 12-volt 15-ampere hour battery.
Fred A. Leuchter Associates, Inc. assumes no liability for the intended or actual use of this device.
1. Charge battery for 18 hours or more prior to usage. To charge battery, plug unit into 110 vac and turn key switch to charge position.
2. Remove all cylinders and pistons. This is IMPORTANT.
3. Test electrical operation. Turn both key switches to ARMED.
4. Pull solenoid pins forward.
5. Push both actuator switches and watch solenoid rods pull in sequence. One minute will occur between successive pulls. Depress each syringe switch located in Delivery Module after its solenoid rod has pulled.
6. Repeat using override switches, twice: once for left and once for right position.
7. Check syringe switches for proper clearance with piston disk in down position. Adjust switch up or down, with locknuts, for clearance at proper dosage. In all cases, switch must be set with piston resting on depressed syringe plunger (zero cc), with syringe properly installed in cylinder and on luer lock connection. If spacer is required for dosage, spacer must be affixed to piston. After height is determined, switch is locked into position with nuts; actuator arm at maximum position under switch disk, but not bent or flexed beyond proper depression point.
8. Verify switch operation by manually dropping pistons on switches in sequence while repeating step 5.
1. Remove all six pistons and cylinders from Delivery Module.
2. Cylinders are numbered from right to left from 1 thru 6, with the two end syringes for purge.
3. Consult chart for dosages and spacers.
4. Assemble pistons and spacer with velcro pads.
5. Fill purge syringes with 60cc saline solution and install on manifold by inserting into bracket and gently pushing luer lock tip into mating inlet with graduations on syringe facing operator. Turn one full turn to the right (clockwise from top).
6. Depress both purge syringes until fluid escapes from all manifold inlets. Pinch outlet on extension set.
7. Fill syringes with proper chemical dosages.
8. Insert proper cylinder and lock proper syringe into cylinder retaining ring (slot) with graduations facing operator. Lift cylinder/syringe assemble and set luer lock tip of syringe into mating inlet. Pushing gently down, twist assemble one full turn to the right (clockwise from top) until graduations face operator. Install in order of 1 thru 6 from right. Install piston and stop pin after each cylinder/syringe installation. Note: cylinders 2, 4 and 6 use pistons with switch disk. Cylinders 1 & 2,
Pentathol; cylinders 3 & 4, Pavulon; cylinders 5 & 6, KCl.
9. Unpinch iv extension and depress both purge syringes until fluid escapes from outlet in iv extension. Install purge syringe back flow stop brackets. Pinch iv extension outlet.
10. Slip solenoid pull rods through piston holes, cylinders 2, 4 & 6. Twist cylinder to check insertion. If it will not twist, insertion was proper. This is IMPORTANT.
11. Install pull cable through piston holes cylinders 1, 3 & 5. Verify insertion visually. This is IMPORTANT. Use cables 1, 3 & 5 or 2, 4 & 6.
12. STOP. Are the necessary spacers in place and backflow brackets installed? If so, proceed.
13. When ready, remove piston stop pins. DANGER. System is now ARMED. Close door. See item 5 under use.
N.B. Spacers and back flow stop brackets MUST be used as described.
After completing test procedure and setup of Delivery Module, proceed as follows:
1. Pre-inject subject with 10cc antihistamine one half hour before execution.
2. Pre-inject subject with 8cc Pentathol 5 minutes before execution.
3. Strap subject to gurney and install iv, 1000ml 0.9% sodium chloride via 14 gauge x 1.5 inch angiocath and start iv.
4. Transmit subject to execution chamber and connect Delivery Module iv to saline iv.
5. Remove piston stop pins from Delivery Module cylinders.
6. Turn both key switches to armed.
7. Begin execution on command by depressing both station buttons.
8. After activation, the following will occur:
A. First syringe begins 4 seconds after start and a yellow light will light.
B. Green light will indicate first stage complete in approximately 10 seconds.
C. Second syringe will activate with yellow light one minute after first green light and will deliver solution and green light in approximately 10 seconds.
D. Third syringe will activate with yellow light one minute after second green light and a third green light will indicate completion in approximately 10 seconds.
E. After third green light, turn main switch to off. One minute later the execution will be completed. (Approximate total time, 4 minutes.)
Note: if a malfunction occurs, it should be handled in the following manner:
1. Any yellow light fails to operate.
Cause: Timer malfunction.
Remedy: Continue execution using electrical override switches. If the first yellow light fails, use all switches. If second yellow light fails, use switches two and three. If third yellow light fails, then use switch three.
2. Any green light fails to operate.
Cause: Defective syringe.
Remedy: Continue execution using mechanical pull knobs. If the first green light fails, use all six knobs. If second green light fails, use phase two knobs. If third green light fails, then use only phase three knobs.
Note: Mechanical override can be used alone by pulling both knobs marked phase one and waiting 70 seconds, then pulling both knobs marked phase two and waiting 70 seconds, then pulling both knobs marked phase three.
9. After subject has been removed, remove back flow stop brackets from purge syringes and depress completely to purge system.
Sodium Pentathol 2%/5gr/250ml Abbott Labs #6108-01
Pavulon (Pancuronium Bromide) 2ml/2mg/ml, Organon Drug Co.
KCl (Potassium Chloride) injectable solution
Syringes are numbered right to left from one to six, plus two purge syringes, either end. Both purge syringes 60cc saline solution.
Syringe Spacer Volume
1 & 6 #4 24cc
2 & 5 #5 22cc
3 & 4 #6 20cc
1 & 6 #1 34cc
2 & 5 #2 32cc
3 & 4 #3 30cc
36cc 1 & 6 none 45cc
38cc 2 & 5 none 45cc
40cc 3 & 4 none 45cc
Note: Maximum system volume loss with Abbott 30 inch extension set (#4481) and Abbott Venoset # 78 vented iv set with Cair clamp #1181:
Syringe 1 & 6 9cc
Syringe 2 & 5 7cc
Syringe 3 & 4 5cc
Dosages are computed to compensate for loss.
N.B. In all cases, Spacers MUST be utilized where described and back flow stop brackets MUST be installed on purge syringes. Failure to use brackets and spacers will cause chemical backflow, and solutions will not be properly delivered to the subject.
HARDWARE and CHEMICALS
1. 2 ea. 10cc 22ga x 1 in. syringes B - D 5640.
2. Antihistamine, injectable 10cc.
3. Sodium Pentathol, 8cc, as below.
1. 1 ea. Venoset #78 vented iv set with Cair clamp. Abbott #1181.
2. 1 ea. 30 in. extension set. Abbott #4481.
3. 1 ea. angiocath 14 ga x 1 1/4 in. Deseret #2876.
4. 8 ea. Monoject 60cc syringes #8881-560125.
5. Sodium Pentathol, 5 grams/250 ml Abbott #6108-01 (100 cc).
6. Pancuronium Bromide (Pavulon) Organon Drug Co., 2ml/2mg/ml, (100cc).
7. Potassium Chloride (KCl) injectable solution (100cc).
Missouri State Penitentiary Execution Protocol
Lethal Injection Procedure
The following procedure is to be followed while the subject is in the holding cell. Mix the following chemicals and load into their respective syringes as per the Operational Procedure section of this manual. (Not more than two  hours prior to usage.) A Lethal Injection Technician shall perform these functions.
1. Utilizing two (2) units of Sodium Pentathol, mix each with 40 cc of sterile water (to make a stronger solution) and fill Syringes #1 and #2 with 40 cc each.
2. Load 40 cc of Pavulon into Syringes #3 and #4.
3. Load 40 cc of KCL (Potassium Chloride) injectable solution into syringe #5 and #6.
Load all syringes into machine including bleed syringes and follow Operational Procedure carefully. Three (3) syringes are the prime syringes and three (3) the back-up syringes.
1. Strap subject onto gurney and insert needle into the subject. The subject is now on the saline IV. An IV Technician shall perform this function.
2. Connect the Lethal Injection Machine manifold line to the subject's saline IV. Observe all bleed procedures and install backflow stop brackets prior to connection. A Lethal Injection Technician shall perform this function.
3. Ten (10) minutes prior to the commencement of the execution inject 5 cc of Versed (Midazolam HCL) 1 mg/ml followed by 200 mg of Benadryl directly into the subject's saline IV. The Versed is a tranquilizer and the Benadryl an antihistamine to prevent spasm and choking. At five (5) minutes prior to commencement, it may be expected to give the subject an additional 5 cc of Versed. An IV Technician shall perform this function.
1. On order of the Warden, the Execution shall begin by pushing the two (2) activating buttons on the Control Module. (The Control Module having been previously set up by a Lethal Injection Technician.)
2. The machine will activate and deliver the three (3) chemicals over ten (10) second time periods respectively, spaced with a one (1) minute wait, automatically. The subject should be dead in something longer than four (4) minutes, total time. This will be determined by a straight line on the heart monitor by the attending physician.
In the event of a syringe or system's failure, follow the prescribed back-up procedure.
1. Drill and set expansion anchors for five holes in Delivery Module 1/4 in (9/32 clearance) in Execution Chamber.
2. Make minimum cut 15 in. long (horizontal) x 2 in. high in wall separating Death Chamber and Control Room, at proper height, to accommodate pull rods.
3. Make 2-1/2 diameter hole in wall between Death Chamber and Control Room, below location of Delivery Module, to accommodate control cable.
4. Remove cylinders, pistons, spacers and back flow stop brackets from Delivery Module. Insert pull rods through 2 in. x 15 in. cutout and bolt Delivery Module to wall. Level.
5. Remove knobs and insert wall plate over pull rods. Mark holes. Drill and set 4 ea. 1/4 in anchors for 9/32 diameter clearance holes. Fasten plate to wall. Re-install knobs.
The following adjustments should be checked prior to each use:
1. Level internal parts.
A. Level base with 4 leveling feet. Tighten locknuts.
B. Level manifold with 4 ea. 1/4 in. hex cap screws behind backplate.
2. Connect control cable via 2 mil spec Amphenol connectors. Note: Do not proceed with further adjustments until reading manual.
3. Set solenoid stop bracket to allow piston release pin approximately 1/4 in. into cylinder. Verify setting by installing extended, empty syringe (as per operation instructions) and piston and electrically operating each piston, in sequence, with the override switches. If piston fails to drop, readjust stop bracket to allow for slightly less extension of pin into cylinder. Switches may have to be adjusted as per instructions.
4. Make sure all screws and nuts are tight.
5. Lubricate cylinders, pistons and pull rods with silicone spray.
6. Proceed with test, as per Set-Up and Operation Instructions, using water in syringes instead of chemicals.
7. Set electrical timers with watch, by adjusting knobs:
T1 4 seconds
T2 60 seconds
T3 60 seconds
Alternate times may be designated, if desired.
N.B. DO NOT ADJUST instrument until reading Operation Instructions.
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