From the testimony of :
Dr. David Dershwitz, M.D.
On Tuesday, August 2, 2011 the State presented the testimony of Martin Dershwitz, M.D., who testified that he is a physician who has also had a Ph.D. in Pharmacology since 1982. He has had his license and certification in anesthesiology since 1987. He has taught Medical Pharmacology since 2001 at the
University of Massachusetts Medical School and also teaches Medical Biochemistry. He has written numerous articles, books and contributed chapters to books on pharmacology. He is presently an anesthesiologist at UMass Memorial Medical Center in Worcester, Massachusetts.
Dershwitz testified that pentobarbital, also known as Nembutal, is used primarily to induce a barbiturate coma or as a sedative or to treat intractable seizures. He explained that the dose usually administered was established in the 1970‘s. It is based on a person‘s body weight, age, and sometimes genetic factors though this last factor is not well-understood. The range of doses is quite large. However, the effect of 5000 mg. of Nembutal (pentobarbital), as provided for in the Florida lethal injection protocol, is ―far in excess of the dose that would be needed or used for a human‖. Two things would occur with the administering of this amount of drugs: first, the cardiovascular system and, second, the respiratory system would experience a shut-down. That is, the blood pressure would plummet and the circulatory system would cease to function. He distinguished the amount of the drug as well as the rate of administration of drugs given for hospital use versus that used in the execution protocol. The dose used in the lethal injection protocol at the rapid rate at which it is administered, would bring about a total flat line on the EEG in brain activity. Therefore, the person would have no perception of pain
or sensation. However, he did point out that unconscious patients, while under sedation, can still have active EEG‘s while remaining unconscious and being in an anesthetized state. It is even possible for anesthetized patients to move and/ or react to stimuli as a reflex at the spinal cord level. This reaction does not necessarily indicate consciousness. He also stated that it is possible, though it does not occur frequently that people‘s eyes remain open while unconscious. It would then be necessary to close their eyes to prevent corneal damage or drying out.
According to Dr. Dershwitz, Nembutal is not used as an anesthetic because it lasts longer and causes a longer ―hangover‖ after medical procedures; doctors prefer their patients awake at the end of surgery. The FDA has not approved it for use in lethal injection. This is considered an ―off label use‖. There are a number of drugs which are commonly used by doctors for an ―off label use‖ . Interestingly, both Dr. Waisel and Dr. Dershwitz referred to Fentanyl as such a drug.
Dr. Dershwitz admitted that he had testified in the Dickens and Alderman cases about the efficacy of sodium thiopental. However, that drug is no longer available and has not been, to his knowledge, for some two (2) years or more.
Ultimately he testified that no one could survive 5000 mg of pentobarbital intravenously. The doses and rates of administering the drug for surgery are one tenth of what is used in the protocol.
Dr. Dershwitz‘ testimony was credible and persuasive. Further, he refuted any suggestion that the dose of pentobarbital in the Florida lethal injection protocol would leave an inmate conscious and able to experience pain and suffering during the lethal injection process. The court credits the testimony of Dr. Dershwitz over that of Dr. Waisel.