Feb 07 11 11:46a Jennifer Herndon g14-991-s645 E The anesthesfologist does/not have tlberty to practice the Induction and maintenance of anesthesla, in his deposition, the BC-AL anesthestologist M13 makes it clear that in many ways the protocol imposes restrictions on his activities that aker and limit his abity to establish dnd maintaln general anesthesia, In normal clinfcal practice M3 Issurely at liberty to customize his teehnique to best censure the establishment and maihtenance of the desired anesthetic depth. By securing the services of a BC-AL snestheslologlst the Missqur! DOC has withiv its reach the ability to provide a rdasonable assurance that the prisoner will be properly anesthetized throughout the procedure and will ba spared ‘the excruciating pain and suffering that are necessanly and caused by the needless use bf pancuronium and potassium, M3's inability to exercise his independent medical judgment represents a gratuitous and substantial risk of a cruel executlop. ‘Summary of opinions provided: lologist In 8 separate room from the prisoner crestes a gratultous anesthetic depth will be established and maintalne}l, and that the 1 The situation of the anesti ‘and substontial risk that Inadeque ‘execution will be agonizing 2 The failure of the DOC to drovide the anesthesiologist with the full sulte of mon}tors that are used for assessing depth gratultoubly end substantially hinders his abliity to reasonably bnsure that an ‘execution Is accomalished without severe pala and suffering. 3 The use of ly prison staff fo Inject thiopente’ Into the IV tubing erustes w grutuljous and substantist risk that anesthetic depth will be inedequate ond that the execution will be ¢gonizing. 4 The attending anesthestolpglst’s inability to exercise his independent medical jUdennent fimits In Important ways his abllity to reasehably ensure that the prisoner is adequately anesthetized throughout the procedure and Ht ee tnsure thatthe erection does not rey result ‘an agonizing punishment and deal | declare under penalty of perjury fhat the foregoing I true and correct to the best of mly knowledge, Hf additional Information arises or Is provided to me tha: warrants alteration ofthe abovelopinions, 1 reserve the right to amend this affidavit Executed on, (date) {elanature). Merk J, 8, Hoath, M.D, Now York Cy, NY. ‘ p Us Ke Coe i of Row York = tat Paar Ti ebmnoeantae 7 7 ‘ualtied in Now York County My Commission Expirna duly 24 ) 20/1314-831-5645 Feb 07 11 11:38a Jennifer Herndon f PREPARATION AND INJECTION OF CHEMICALS A. Execution team members 1. The execution tearh consists of con racted medical personne! and department employees. 2. A physician, nurse, or pharmacist prepares the chemicals used during the lethal injection. 3. A physician, nurse, or emergeney medical technician (EMT~intermediate or }IMT-paramedic) inserts intravenous lines, monitors the prisoner, and supervises the injection of lethal chemicals by nonmedical members of the execution team. ject the chemicals into the prisoner. 4. Two department employees B. Preparation of chemicals 1. Medical personnel prepare the lethal chemicals. The quantities of these chemi- eals may not be changed without prior approval of the department director. Fifteen (15) syringes are prepared and labeled in a distinctive manner as follows 2. Syringes 1, 2, 3, and 4 each contain 1.25 grams of thiopental (also known as 1m thiopental or sodium pentothal) in a $0 cc solution for a total of 5 grams of thiopental. 3. Syringe 5 contains 30 cc of saline solution. 4. Syringe 6 contains 60 milligrams of pancuronium bromide in a 60 cc solution, Syringe 7 contains 30 cc of saline solution. 6. Syringes 8 and 9 each contain 120 milliequivalents of potassium chloride in 60 cc of solution for a total of 240 milliequivalents of potassium chloride. 7. Sysinge 10 contains 60 cc of saline solution. Exhibit A PUNGO4 Exhibit B-- Page 1 |Feb 07 11 11:388 Jennifer Herndon 314-831-8645 8. Syringes 1A, 2A, 3A, and 4A each contain 1,25 grams of thiopental (also known 4s sodium thiopental or sodium pentothal) in a $0 ce solution fora total of 5 prams of thiopental. (These syringes are prepared in the event that additional thiopental must be administered.) 9. Syringe 5A contains 60 ce of saline solution. (This syringe is preparéd in the event that additional flush is required.) C. Intravenous lines 1. Medical personnel determine the most appropriate locations for intravenous (IV) lines. They insért both a primary IV line and a secondary 1V line unless the prisoner's physical condition makes it unduly difficult to insert more than one IV. Medical personnel may insert the primary {V line as a peripheral line or as a central venous line (¢.g., femoral, juguler, or subclavian) provided they have appropriate ‘raining, education, and experience for thal procedure. ‘The secondary IV line is a peripheral Line, 2. A sufficient quantity of saline solution is injected to confirm that the IV lines have been properly inserted and hat the ‘ines are not obstructed, D. Monitoring of prisoner J. Medical personne! attach the leads from the electrocardiograph to the prisoner's chest. Medical personnel check the electrocardiograph to eonfirm that itis function- ing properly. 2, The gurney is positioned so that medical personnel can observe the prisoner's face directly or with the aid of a mirror 3. Medical personnel monitor the electrocardiograph and the prisoner during the execution. E. Administration of chemicals 1. Upon order of the department director, the chemicals are injected into the prisoner by the execution team members under the observation of medical personne! ‘The lights in the execution support room are maintained at a sufficient level to pennit proper administration of the chemicals. RINGO-2 Tixhibit B-- Page 2Feb 07 11 11:38a Jennifer Herndon 914-831-5645 2. The thiopental is injected from syringes 1, 2, 3, and 4 (S grams). The saline solution in syringe 5 (30 cc) is injected, 3. Before the second and thitd chemicals are injected, medical petsonnel physically examine the prisoner to confirm that he is unconscious. Medical persorinel use Standard clinical techniques to assess consciousness, such as checking for movement, opened eyes, eyclash reflex, pupillary responses or diameters, and response to verbal:commands and physical stimuli. In addition to examining the prisoner, medical personnel inspect the catheter site(s), 4. In the unlikely event that the prisoner is still conscious, thiopental is injected from syringes 1A, 2A, 34, and 4A (5 grams) into the secondary IV line Approximately 30 ce of the saline solution in syringe 5A is injected. Medical personnel confirm that the prisoner is unconscious as directed in paragraph 3. When the secondary line is tised for thiopental, it is also used for the remain chemicals. : 5. After confirming that the prisoner is unconscious, the second and third chemi- cals are injected provided at least three minutes have elapsed since the execution fcam meuibers started injecting the thiopental which rendered the prisoner unconscious. 6. The pancuroniuin bromide in syringe 6 (60 milligrtims) is injected into the prisoner. ‘The saline solution in syringe 7 (30 ce) is injected. 8. The potassium chloride in syringes 8 and 9 (240 milliequivatents) is injected, 9. ‘The saline solution in syringe 10 (60 ec) is injected. 30. 1F the clectrical activity of the prisoner's heart does not cease within five minutes, additional potassium chloride is injected to cause death. |1. When all electrical activity of the heartends as shown by the electrocardiogram, medical personnel pronounce death RINGO-3 Exhibit B-- Page 3