The Dangers of Compounding Pharmacies and Texas’ Use of Lethal Injection Drugs

Texas turns to compounding pharmacies for lethal injection drugs

Texas, like many other states, faces obstacles in acquiring lethal injection drugs because of many pharmaceutical companies’ refusal to participate in executions. As a result, the state of Texas has turned to compounding pharmacies for the supply of lethal injection drugs. NPR has learned that Rite-Away Pharmacy and Medical Supply in suburban San Antonio is one such compounding pharmacy that produced injectable pentobarbital from 2019 through at least late 2023 for Texas to use in executions.

The history of safety and cleanliness violations at Rite-Away Pharmacy

Records from the Texas Department of Criminal Justice and the Federal Drug Enforcement Administration reveal that Rite-Away was cited more than a dozen times over the past decade for safety and cleanliness violations. Over the course of multiple inspections, the pharmacy repeatedly failed to maintain clean and sterile facilities and failed to keep complete and correctly labeled records and drugs in stock, among other violations. Federal authorities also alleged that another Rite-Away branch, owned by the same family, was implicated in the overdose death of a patient and “fueled and profited from the opioid epidemic.”

Questions about the state’s treatment of inmates it intends to execute

Death penalty opponents raise questions about whether the state is being cavalier in its treatment of inmates it intends to execute by relying on those who have been known to cause harm to carry out their death penalty. According to Bianca Tylek, a lawyer and the executive director of a nonprofit that advocates against exploitation of prisoners, “They’re literally relying on those who have been known to cause harm to carry out their death penalty, their execution. They are exhibiting a tremendous amount of carelessness that should never come into contact with the death penalty.”

The involvement of Rite-Away Pharmacy in the sale of injectable pentobarbital to Texas is confirmed

In an interview with NPR, Rohit Chaudhary, one of the owners of the pharmacy, confirmed Rite-Away’s involvement with the sale of injectable pentobarbital to Texas. However, officials with the Texas Department of Criminal Justice declined an interview with NPR and declined to comment.

The compounding of drugs and potential dangers

Compounding pharmacies create drugs in-house from raw ingredients. While they can be helpful in creating medicines for people who are allergic to ingredients in mass-produced drugs, the finished products are not approved by the FDA. The FDA has acknowledged that it has “observed troubling conditions during many of its inspections of compounding facilities including toaster ovens used for sterilization, pet beds near sterile compounding areas, and operators handling sterile drug products with exposed skin, which sheds particles and bacteria, among many others.” Poorly compounded drugs have led to serious patient injury and death.

The dangers of injecting drugs in poor condition into prisoners’ veins

Using compounded drugs raises issues for some prisoners and their attorneys who argue that injecting drugs in poor condition into prisoners’ veins could violate their constitutional protection against cruel or unusual punishment. Sterile injectables are harder to compound than pills as purity and sterility standards need to be high because the pharmaceutical products are inserted directly into veins.

The process of preparing pentobarbital injections in Texas

After Rite-Away agreed to make the pentobarbital injections, a state representative started hand-delivering small amounts of the active ingredient in pentobarbital, in powder form, to Rite-Away, according to the pharmacist. The powder was delivered in a bag stamped with a photocopied label that the pharmacist guessed came from the original container. The pharmacist combined the necessary ingredients inside the pharmacy’s sterile room to make the product that could be injected into prisoners.

The veterinarian’s formula used to execute prisoners

The formula itself wasn’t overly complex and consisted of four basic ingredients: sterile water, a synthetic liquid substance, alcohol, and the pentobarbital powder from Texas. The pharmacy charged the state less than $100,000 in total. “Maybe two or three hundred a bottle and we wouldn’t do more than about 10 at a time,” added the pharmacist. “I even had the guys from the DOC saying, you know, you can charge more for this.”

Potential issues with the process of preparing pentobarbital injections

The pharmacist confirmed that there was “a tech that came out of the room and went back in and didn’t de-gown or anything like that,” and the violations found recently by inspectors from the Texas State Board of Pharmacy were “faux pas for anyone trained in sterile prep.” However, the pharmacist downplayed the issues and said he made the pentobarbital injections for Texas carefully.

Controversies surrounding executions in Texas

Questions raised by death row inmates’ attorneys

Executions in Texas have not always gone according to plan. Witnesses at the 2018 execution of Texan prisoner William Rayford said that after he was injected with pentobarbital, he writhed and jerked on the gurney as he died. As they were dying, other prisoners have said they felt like the drug was burning them.

Pulmonary edema in bodies of executed inmates

A 2020 NPR review of more than 200 autopsies of people executed by lethal injection across the U. S. found that most bodies showed evidence of pulmonary edema, a condition where the lungs are filled with fluid that can cause people to feel like they’re suffocating and drowning. NPR did not analyze autopsies from Texas since the state does not conduct autopsies after executions.

Conclusion

The use of execution drugs prepared in compounding pharmacies by Texas raises concerns about whether the state is being cavalier in its treatment of inmates it intends to execute with drugs that have a history of being poorly compounded and have led to serious patient injury and death. The revelations of safety and cleanliness violations at Rite-Away Pharmacy raise further questions about whether the state is relying on those who have been known to cause harm to carry out their death penalty.

Originally Post From https://www.keranews.org/news/2024-07-10/unmarked-cars-and-secret-orders-how-a-pharmacy-prepared-drugs-for-texas-executions

Behind the Scenes of Pharmacy’s Role in Texas Executions: Unmarked Cars and Secret Orders