Doctor banned from executions in Mo. now in Ariz.

Doctor banned from executions in Mo. now in Ariz.


A Missouri surgeon who was banned by a federal judge from taking part in capital executions by lethal injection in his home state apparently participated in Arizona's most recent execution.

Dr. Alan Doerhoff is believed to have taken part in the May 22, 2007, execution of Robert Comer, 11 months after Doerhoff's Missouri lethal-injection procedure was ruled unconstitutional and eight months after the physician was prohibited from further executions in Missouri because of questions about his standards and competence.

Doerhoff's signature appears below the flat line of an electrocardiogram tape that recorded Comer's last heartbeats, suggesting that Doerhoff at least monitored the murderer's condition in his final moments.

The doctor's techniques appear to have influenced new Arizona procedures for execution by lethal injection, specifically a practice of administering the killing chemicals through a catheter in the groin instead of through an arm. It's a method that some critics say is too complex and contributes to higher risks of error that could lead to undue suffering.

According to a prominent medical expert on lethal injection, that practice occurs only in the Missouri and federal protocols, which Doerhoff is believed to have influenced or devised. He is known to have participated in executions for those jurisdictions.

Association denied

The Arizona Department of Corrections at first denied having any association with Doerhoff, a Jefferson City, Mo., resident. When told that The Republic had his signature from Comer's electrocardiogram, Corrections officials cited state statutes that protect the identity of Arizona executioners.

Doerhoff did not return calls. Nor did Corrections Director Dora Schriro, who before coming to Arizona oversaw Missouri's prisons from 1993 to 2001, during the same period Doerhoff was advising that state on lethal injections.

The doctor is not forbidden from participating in Arizona executions, but the controversy surrounding his past may be another hindrance as the state seeks to resume executing death-row prisoners.

Competency questioned

Lethal injection is under a legal microscope nationwide. In April, the U.S. Supreme Court ruled that lethal injection is not cruel-and-unusual punishment in itself but that defense attorneys can argue that the various state methods of doing so are at least flawed. Defense attorneys have repeatedly questioned the competence of executioners.

Prisoners are usually killed by a dose of potassium chloride, a chemical that causes excruciating pain. At question in state protocols in Arizona and nationwide is whether the condemned prisoners are sufficiently anesthetized so that death is as painless as possible and whether a third chemical administered to paralyze the prisoner masks any reaction to pain.

In its April ruling, the high court upheld the lethal-injection protocol for Kentucky, but since then, a federal judge in Tennessee and a state judge in Ohio have ruled that the risk of an agonizing or painful death was too great because of the three-chemical procedure. They ordered a single-drug approach using an overdose of anesthesia or barbiturate, which might take slightly longer but is assuredly pain-free.

The Arizona protocol is already under legal analysis.

Jeffrey Landrigan, 48, the next Arizona prisoner awaiting execution, will be granted evidentiary hearings in Maricopa County Superior Court to determine if the Arizona procedure passes constitutional muster. A separate suit filed by the Office of the State Capital Post Conviction Defender is trying to obtain detailed information about the training of executioners.

Based on motions filed by the Arizona Attorney General's Office, the state is vigorously fighting the release of that information on the premise that it will reveal identities of people involved in executions.

Extensive experience

According to the St. Louis Post Dispatch, which first learned of Doerhoff's name in 2006, Doerhoff assisted in more than 54 executions in Missouri. Court records say that he also developed procedures, inserted catheters and monitored prisoner consciousness in federal executions in Indiana.

In 2006, according to court records, a doctor testified under the pseudonym "John Doe 1" and admitted under oath that he was dyslexic, that he "improvised" the dosages of the drugs (partly because of how conveniently or inconveniently they were packaged), had no set protocol and kept no records of procedures.

His testimony led the federal judge to rule that "Missouri's lethal-injection procedure subjects condemned inmates to an unnecessary risk that they will be subject to unconstitutional pain and suffering when the lethal-injection drugs are administered."

The judge ordered the state to develop an acceptable written state protocol and in September 2006 enjoined John Doe 1 from participating "in any manner, at any level," in Missouri's lethal-injection process.

The Post-Dispatch unmasked John Doe 1 as Alan Doerhoff. The newspaper also learned that Doerhoff had been sued for malpractice 20 times and had paid several settlements.

The paper reported that, in 2003, he was officially reprimanded by the Missouri Board of Healing Arts for not disclosing malpractice suits to a hospital where he practiced and was subsequently barred from some hospitals.

Identity admitted

Doerhoff later admitted to an Associated Press reporter that he was John Doe 1, stating that he was proud of his service to Missouri and displeased at being portrayed as an "ogre who is dyslexic."

The doctor had become a focal point in death-penalty appeals and an example of what can go wrong with the system. Attorneys appealing the death sentence of a Virginia killer learned that Doerhoff had devised the federal lethal-injection protocol and had participated in executions at a federal prison in Indiana, where high-profile prisoners such as Timothy McVeigh have been executed. The attorneys wrote in their briefs that the U.S. Justice Department relied "upon the services of the only person in this country who has been barred from participation in executions."

The doctor in question was referred to in court documents as "Protected Person No. 2," but in November 2007, the Los Angeles Times revealed that it was Doerhoff.

Arizona's protocol

Arizona's lethal-injection protocol came under scrutiny in the case of Landrigan, who killed a man in Phoenix in 1989 and whose scheduled Nov. 1, 2007, execution was stayed while the Supreme Court pondered the Kentucky case.

The Arizona protocol prescribes injecting 3 drugs in close succession: sodium thiopental to induce unconsciousness, followed by pancuronium bromide to paralyze the condemned person and potassium chloride to stop the heart. The dosages are spelled out in the protocol, and there are stated contingency plans if higher doses are deemed necessary.

Though the American Medical Association states that it is an ethical violation for a physician to participate in lethal injections, the Arizona protocol lists physicians as possible participants in the procedure. To cover their work, state law says that people participating in executions on behalf of the government cannot have their licenses revoked or suspended by state regulatory boards.

Under the supervision of a "medical team leader" appointed by the director of the Department of Corrections, the drugs are administered by six people into two separate ports. One dose of each chemical goes into the person to be executed, the other into a waste bucket so that none of the people injecting the drugs will know if he or she made a fatal injection.

Flaws in procedure

Filed with Landrigan's petition for hearings on the lethal-injection protocol was an affidavit by a Columbia University anesthesiologist named Mark Heath, who pointed out presumed flaws in the Arizona procedure.

Heath noted that Arizona's proposed use of a catheter placed in the femoral vein instead of an arm was used only in the Missouri and federal protocols. And he pointed out that the use of a waste bucket so that the people injecting the drugs would not know if they were injecting into the prisoner or into a dead-end tube was used only in federal executions. Those protocols were purportedly developed or influenced by Doerhoff.

Both of those details, Heath contended, made the process overly complex and prone to error. The Landrigan motions also ask that Arizona convert to a one-drug protocol as ordered in Tennessee and Ohio.

Nolberto Machiche, a Department of Corrections spokesman, said Doerhoff did not write the Arizona protocol. In a formal response, Machiche wrote: "The department has consulted with a number of correctional systems and conferred with a number of individuals in the medical field. The department assembled a team of physicians who were recommended by others. They worked collaboratively with each other, none of them assumed a lead role and none of them was responsible for administering any lethal chemicals."

Machiche further wrote that the department could not disclose names under state law.

Catheter method used

Comer, the only prisoner to be executed during Schriro's tenure, was put to death using a catheter in the femoral artery. The current protocol with the six executioners and the waste bucket was devised after his execution.

Comer's execution appeared peaceful to eyewitnesses, including a Republic reporter. The 6-minute-long EKG tape monitoring his last minutes shows his heartbeat holding steady at the point where someone has written in the moment that the first drug was injected, the point at which Comer lapsed into unconsciousness, and when the second and third drugs were administered. Then, about 30 seconds after the last fatal injection, the heartbeat wavers, the pointed regular peaks and nadirs of the EKG round out, and then, over the next 40-some seconds level off to a flat line. The moment of death is noted.

Then the signature: AR Doerhoff MD.

(source: Arizona Republic)