As questions linger about Missouri's shadowy lethal-injection protocol, the state is days away from killing another inmate.

As questions linger about Missouri's shadowy lethal-injection protocol, the state is days away from killing another inmate 

As questions linger about Missouri's shadowy lethal-injection protocol, the state is days away from killing another inmate.

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In those days, Department of Corrections personnel involved in the execution would shout "foxfire one" when the first drug began its flow to the inmate, "foxfire two" when the next drug was pushed, and "foxfire three" when the fatal drug began its course. "Checkmate" was the word when the inmate was pronounced dead.

O'Brien says when the first drug reached Foster, the inmate started coughing and twitching. Something seemed amiss. Prison officials closed the curtain to the window that allowed witnesses to observe the execution.

A prison official realized that a strap was restricting the flow of drugs to the rest of Foster's body. The band was removed, and Foster took 30 minutes to die.

The April 16, 2005, edition of the weekly medical journal The Lancet analyzed autopsy and toxicology reports of 49 executed inmates. It found that 43 of them had received doses of sodium thiopental lower than the standard for surgery, and that 21 had received such a low dose that they could have been aware of what was happening to them.

"That is: those being executed may have been awake," the report's abstract reads. "Of course, because they were paralyzed, no one could tell. It would be a cruel way to die: awake, paralyzed, unable to move, to breathe, while potassium burned through your veins."

The same report pointed out that the American Veterinary Medical Association and 19 states ban the use of drugs such as sodium thiopental in the killing of animals. In other words, the drugs that can be used in a state-sanctioned execution of a human are in some places deemed unsuitable to put down a dog with an untreatable case of heartworm.

The Lancet article came out a month ahead of Vernon Brown's scheduled execution in Missouri. His lawyers used the journal's findings as the basis to ask the state how much sodium thiopental it planned to use in Brown's execution. But Missouri fought Brown's attorneys in court, ultimately killing Brown without having to tell him how much of a drug they were going to give him.

The concern was well-founded. The following year, it was discovered that a doctor who had assisted in 54 Missouri executions was dyslexic and, according to his testimony, had improvised the dosages.

Missouri corrections officials couldn't keep the doctor from testifying in front of a federal judge, but they succeeded in obscuring his name from the public record.

A federal judge in Kansas City was furious about the doctor's testimony and lamented that Missouri lacked a written protocol for its lethal injections. He ruled that the state needed to come up with a better lethal-injection method and to stop using the doctor in question.

Despite the state's secrecy, reporters with the St. Louis Post-Dispatch figured out that the dyslexic doctor was Alan Doerhoff, a physician who had been reprimanded by the Missouri Board of Registration for the Healing Arts for trying to hide the fact that he had been sued for malpractice.

Missouri's embarrassment over the Doerhoff affair slowed the state's death-penalty pipeline. The state didn't execute another prisoner until Dennis Skillicorn, in 2009.

Missouri's capital-punishment methods returned to the international limelight in 2013, when the state prepared to execute Joseph Franklin. He was an admitted mass murderer, but his case attracted attention from someone he didn't kill.

Larry Flynt, the pornography magnate who doubles as a free-speech proponent and anti-death-penalty activist, has been in a wheelchair since 1978. That was when Franklin, a white supremacist who took exception to Flynt's Hustler magazine showing photo spreads of interracial sex, shot Flynt and a lawyer in Georgia. Flynt and the American Civil Liberties Union sued to find out which medical personnel were participating in executing Missouri's condemned.

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