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Friday, Oct 4, 2013

Missouri must return surgery drug immediately


Missouri plans to execute Allen Nicklasson on Oct. 23 with an overdose of the drug propofol. That would jeopardize the well-being of millions of Americans. Gov. Jay Nixon should halt the execution and return the drug, which was shipped to a Missouri prison by mistake.

Most people associate propofol with the overdose death of singer Michael Jackson. Less commonly known, but far more important, is its role in medicine. Anesthesiologists use it in the vast majority of surgeries. They also use it as a sedative for procedures such as colonoscopies.

Doctors like it because it has few side effects and it has been well studied. They know what it does with the proper dosage, and patients will have a relatively uneventful awakening from surgery.

The Missouri Department of Corrections, however, has another use in mind. Courts and human decency have curtailed how the state may execute prisoners, but propofol remains a legal option. Administered in a large enough dose, the prisoner will not wake up.

But executions don’t fit into the marketing plan of German company Fresenius Kabi, which produces 85 percent of the more than 50 million vials of propofol administered in the United States every year.

The company’s mission statement is “Caring for life.” Not surprisingly it does not consider capital punishment as fitting with that mission.

Corporate ethics are only part of the problem. The European Union is firmly anti-death penalty and forbids companies from exporting products reasonably expected to be used in executions. If Missouri sets the precedent, Fresenius Kabi could have no choice but to cut off supplies to all of America, at least temporarily. It would need to apply for a special permit for each shipment, causing delays of up to six months.

A critical propofol shortage would hit operating rooms. In 2010, when there was a propofol shortage, hospitals reported that they delayed procedures and patients experienced post-operative complications.

The Missouri Society of Anesthesiologists therefore has pleaded with state officials all the way up to Nixon not to risk the national supply.

The Department of Corrections acquired propofol only because of a shipping mix-up. It has enough for at least two executions, and plans to carry out a second in November.

This wouldn’t be the first time Europe cut off access to a drug over its use in capital punishment. In 2011, the Italian manufacturer of sodium thiopental stopped providing that drug because states were using it in executions. It wasn’t too much of a problem then because propofol already had replaced sodium thiopental in anesthesiologists’ drug kits. The only disruption was to executions.

This time, no good, affordable medical replacement exists for propofol. Other drugs have risky and expensive side effects.

If they truly sought justice, Missouri and Kansas would abandon the death penalty. Enlightened lawmakers would finally concede capital punishment costs taxpayers tremendously compared to lifetime imprisonment. They would acknowledge the many investigations that have found wrongfully convicted death-row prisoners and conclude irreversible punishment in a fallible justice system is a barbaric practice.

Alas, Kansas and Missouri are not there politically. Surely, however, bloodlust does not so consume Nixon and other Missouri leaders that they would risk sparking a critical nationwide shortage of an essential medical drug to hold another execution. What an abhorrent value system that would present to the world.

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