An official report released on Thursday about a bungled execution in Oklahoma last April says that an improperly placed intravenous line in the prisoner’s groin allowed the drugs to perforate into surrounding tissue rather than to flow directly into his bloodstream.  The report was ordered by Gov. Mary Fallin after the prolonged writhing and gasping of the prisoner, Clayton D. Lockett, during the execution drew global attention to death penalty procedures and problems associated with lethal injections.  Because the groin area was covered with a sheet as the injections began — first a sedative intended to render Mr. Lockett unconscious, and then paralyzing and heart-stopping agents — the doctor and paramedic on the scene did not see the golf-ball-sized bulge indicating a procedure gone awry, said the report by Michael C. Thompson, the commissioner of public safety.  The report, which described prison officials as ill-prepared for unusual circumstances during an execution, recommended keeping injection sites visible at all times and improving the training of prison officials who inject the lethal drugs.  Mr. Lockett’s prolonged writhing and mumbling during his execution on April 29 led Oklahoma to suspend executions and intensified the national questioning about whether lethal injection can meet the constitutional standard barring cruel and unusual punishment.  To critics of the death penalty, the bungled execution of Mr. Lockett, who was convicted of shooting a 19-year-old woman and burying her alive, epitomized the growing concerns about lethal injections at a time when states are experimenting with new drugs and combinations, often purchased from secret sources, because the traditionally used barbiturates are so scarce.  Brushing aside calls to appoint an independent investigator, Governor Fallin selected Mr. Thompson, who oversees the prisons, to review what went wrong in the case of Mr. Lockett and to recommend any changes needed in the state’s execution procedures.  Defense lawyers condemned Mr. Thompson’s report as inadequate. “The state’s internal investigation raises more questions than it answers,” said Dale Baich, a federal public defender based in Phoenix who is helping to represent other prisoners on death row in Oklahoma. “The report does not address accountability.”  The report confirms for the first time that a doctor, whose assigned task was to declare the prisoner unconscious and later dead, was deeply involved in the frantic effort to insert a line into Mr. Lockett’s veins once the paramedic ran into problems. The report does not give the doctor’s name but said the doctor worked in emergency medicine and had participated in one other execution several years earlier.  The paramedic who initially tried, without success, to insert lines in Mr. Lockett’s arms, legs and feet has been licensed in emergency medical services for 40 years and was “involved in every lethal injection execution in Oklahoma, except for two,” the report said.  Once the intravenous line was placed in Mr. Lockett’s groin — a more complex procedure than using an extremity – the failure of officials to visually monitor the site appears to have been a lapse in standard medical practice.  Warden Anita Trammell, who was supervising the execution but has no medical training, told the investigators that it was common to cover a prisoner’s body with a sheet and that she had also done so “to maintain Locket’s dignity and keep his genital area covered.” But she also said that “if the IV insertion point had been viewed, the issue would have been detected earlier.”  “The physician added,” the report said, “that an IV would normally be monitored by watching the flow of the IVC line and the area around the insertion point for any signs of infiltration.”  Without such visual monitoring, and with inexpert officials pushing drugs into the injection line from behind a wall, the failure was not discovered for many minutes, until Mr. Lockett, inadequately sedated, began writhing in response to the painful second two drugs.  Executions in the state have been suspended, including that of Charles F. Warner, who was originally scheduled to die right after Mr. Lockett on April 29.  The sedative used in Mr. Lockett’s execution, midazolam, was also used in problematic executions in Ohio in January, when the prisoner gasped for 26 minutes before dying and in Arizona in July, when an execution expected to take 15 minutes dragged on for nearly two hours, with officials injecting additional doses as the prisoner gasped repeatedly.  The new report does not address the question of drug choices and sources.  On the evening of April 29, witnesses said, it took longer than expected for an attending doctor to declare Mr. Lockett unconscious during the execution at the hulking white state penitentiary in McAlester, Okla.  But once the additional injections began, he appeared to revive, bucking against his constraints and moaning in apparent agony. After several minutes, officials closed the blinds on witnesses.  More than a half-hour into what should have been a 10-minute procedure, after discovering that the drugs were not being properly delivered, the corrections director, Robert Patton, officially called off the execution. But 10 minutes after that, an attending doctor declared Mr. Lockett dead.  Mr. Patton emerged to tell reporters that Mr. Lockett’s vein had “blown,” that he had halted the execution but that Mr. Lockett had died anyway of a heart attack.  The official autopsy concluded that Mr. Lockett had died, in the end, because of the effects of the drugs, but did not describe the mechanism of his death.  Mr. Baich, the defense lawyer, accused officials of failing to try and revive Mr. Lockett once it was clear that the procedure had gone wrong.  “Why was the execution allowed to go forward when proper needles for femoral access were not readily available?” he asked. “Why did the doctor do nothing to try to revive Mr. Lockett once he determined there were not enough drugs for the execution to continue?”  “The best chance now to learn what happened will take place during discovery in the pending federal lawsuit,” Mr. Baich said, “There, the witnesses will be under oath and we will attempt to seek complete information about the manner of Clayton Lockett’s death.”
Officials at the prison also erred by covering the inmate’s groin, where the injection was made, preventing them from seeing the problem.