20! • JUL -5 p;1 I: cu I, , : l l:.1< OAVIO SO,i Cl i'.f l\'.{CEnY l.1ETHAL INJECTION EXECUTION MANUAL _____ __ _ o.r. f EXECUTION PROCEDURES FOR LETI-IAL IN"JECTION This manual co}ltains a summary of the most significant events and departmental procedures to be followed in the process of carrying out the orders of the Tennessee Supreme Court regarding the imposition of death by lethal injection. It contains a detailed listing of some of the duties and responsibilities of certain key depa1·tmenta l personnel. ln addition., the manual covers institutional perimeter security prior to, during, and subsequent to an execution. It will be used as a guideline for the Warden to assure that operational functions are properly planned with the staff who have designated responsibilities m performing a judicially ordered execution by lethal injection. SECTION VIII (PERIMETER SECURITY) IS CONFIDENTIAL AND IS NOT FOR PUBLIC RELEASE. Rev. J 11ly 5, :wrn Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 1 of 99 PageID #: 376 Attachment 4 TABLE OF CONTENTS LETHAL INJECTION I. Introduction Commissioner's Statement 6 II. Definitions Definitions 8 Diagram of Capital Punishment Unit 10 III. Duties of Management and Administrative Personnel Riverbend Maximum Security Institution Personnel 12 Warden 13 Associate Warden of Security 14 Lethal Injection Recorder 15 Death Watch Supervisor 16 Institutional Chaplain 17 Security Systems Technicians 18 Physician 19 IV Team 20 Facility Maintenance Supervisor 21 Extraction Team 22 Escort Officer(s) 23 Central Office Personnel 24 Commissioner 25 Assistant Commissioner of Prisons 26 Director of Communications and Public Relations 27 Director of Office of Investigation and Compliance 28 Director of Victim Services 29 IV. Selection ancl Training of Staff Execution Team Member Selection Criteria, Lethal Injection 31 Training of Execution Team Members 32 V. Procurement, Preparation, Introduction of the Lethal Injection Chemical, and Procedures of Accountability Chemicals Used in Lethal Injection 34 Compounded Preparations-Procurement, Storage, Accountability, and Transfer of the Chemical 35 Rev ,July 5, 2018 Page 2 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 2 of 99 PageID #: 377 Attachment 4 TABLE OF CONTENTS LETHAL INJECTION CON'T Commercially Manufactured Drugs: Procurement, Storage, Accountability, and Transfer of the Chemical 37 Lethal Injection Chemical Set-up an Preparation 39 IV Line Set-up 41 Insertion of a Catheter and Connection of IV Lines 42 Chemical Administration and IV Monitoring 44 VI. Death Watch Procedures Staff Responsibilities and Special Procedures 47 Execution Team 51 Death Watch Supervisor 53 Control Monitor 56 Floor Officer Monitor 60 Day 1 62 Day 2 62 Day 3- Execution Day 63 Day 3 - Evening Schedule 64 Post Execution 68 Contingency Issues 69 VII. Victim Services Victim Services 71 VIII. Perimeter Security - CONFIDENTIAL - Not for Public Release Perimeter Security Assignments 74 Perimeter Aerial Diagram 78 IX. Forms Notification Letter to Sheriffs Office to Witness Execution of Inmate 80 Notification Letter to Inmate's Family to Witness Execution 81 Physician's Inventory Checklist 82 IV Team Inventory Checklist 83 Chemical Preparation Time Sheet 84 Day of Execution - Lethal Injection Execution Recorder Checklist 86 RP.v. July 5, 2018 Page 3 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 3 of 99 PageID #: 378 Attachment 4 TABLE OF CONTENTS LETHAL INJECTION CON'T Lethal Injection Chemical Administration Record (Red) 89 Lethal Injection Chemical Administration Record (Blue) 90 News Release 91 Affidavit Concerning Method of Execution 92 Application for News Media Representative 93 Affidavit to Select Defense Counsel Witness to Execution 98 Form Pharmacist Contract 99 Rev.July 5, 2018 Page 4 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 4 of 99 PageID #: 379 Attachment 4 I. INTRODUCTION RIVERBEND MAXIMUM SECURITY INSTITUTION Hev. July 5, 2018 Page 5 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 5 of 99 PageID #: 380 Attachment 4 The Tennessee Department of Correction is responsible for the incarceration of convicted felons serving sentences ranging from one year to death. Individuals sentenced to death are executed at Riverbend Maximum Security Institution. Upon the exhaustion of an inmate's appeals, the execution process shall begin. In the capacity as Commissioner of the Tennessee Department of Correction, it is my duty by law to oversee the humane and constitutional execution of individuals sentenced to death by judicial authority in Tennessee. Tennessee law establishes lethal injection as the primary method for carrying out a death sentence and authorizes the Department to promulgate rules and regulations for the procedures for lethal injection. This manual explains the procedures for lethal injection. It will be reviewed annually, or as needed, by a designated panel. July 5, 201 8 Commissioner Date Hcv. Jt1ly 5. 2018 Page G Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 6 of 99 PageID #: 381 Attachment 4 II. DEFINITIONS RIVERBEND MAXIMUM SECURITY INSTITUTION R<'v. July G, 2018 Page 7 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 7 of 99 PageID #: 382 Attachment 4 DEFINITIONS The definitions listed below pertain only to the Lethal Injection Process within this manual. Catheter A thin flexible tube that is inserted into a part of the body to inject fluid. Death Watch A period of time immediately prior to an execution during which special procedures are implemented in order to ensure that the execution is carried out in a safe and orderly manner. Death Watch Area An area that includes the inmate's cell(s), contact and non-contact visitation areas, the control room, and the secured monitoring area. Drip Chamber A hollow device that provides a visual of the drip/flow. EMT Emergency Medical Technician Execution Team The Execution Team shall consist of: the Warden, Associate Warden of Security, Executioner, Extraction Team, Death Watch Team, N Team, Lethal Injection Recorder, Facility Maintenance Supervisor, ITS Security Systems Technician(s), and Escort Officer(s). Extension Line The clear tubing used to administer fluids. Extraction Team Execution Team members who are responsible for the removal, restraint, and movement of the inmate during the time of execution. Flash Chamber A device that precludes blood leakage as a needle is removed from the catheter and an IV unit is coupled to �he catheter. Gurney A wheeled stretcher for transporting. IV Intravenous Inventory Ledger Permanent record of Lethal Injection Chemicals maintained in the key control area of the armory area of Building 7 at RMSI Lethal Injection A room where the Executioner administers the lethal injection Room chemical(s) at the direction of the Warden. LIC Lethal Injection Chemical(s) Pan Tilt Zoom The camera used by the Execution Team in the T ,ethal Injection Room. Camera (PTZ) The camera monitors the condemned inmate's IV site(s). Solution Set Equipment designed to administer an IV. Ht•v. ,July 5. 2018 Page 8 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 8 of 99 PageID #: 383 Attachment 4 DEFINITIONS - CON'T Syringe A medical instrument used to inject fluids into the body or draw them from it. Tourniquet A compression device used to cut off the flow of blood to a part of the body, most often an arm or leg. It may be a special surgical instrument, a rubber tube, a strip of cloth, or any flexible material that can be tightened to exert pressure. Note: Whenever the masculine pronoun is used in this manual, it applies equally to a female. Hev. July f>, 2018 Page 9 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 9 of 99 PageID #: 384 Attachment 4 - - . .. , 'i :2011' l':q~(' 10 Ht'\' ,) lll) ' Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 10 of 99 PageID #: 385 Attachment 4 Ill. DUTIES OF MANAGEMENT AND ADMINISTRATIVE PERSONNEL RIVERBEND MAXIMUM SECURITY INSTITUTION Rev. July 5, 2018 Page 11 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 11 of 99 PageID #: 386 Attachment 4 RIVERBEND MAXIMUM SECURITY INSTITUTION PERSONNEL Rev. July 5, 2018 Page 12 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 12 of 99 PageID #: 387 Attachment 4 WARDEN Primary Role To ensure that the procedures prescribed by law and as outlined m this manual are performed, either by personal performance or by delegation. Duties: 1. To ensure that the security of the institution is maintained. 2. To ensure that condemned inmates sentenced prior to January 1, 1999, are given the opportunity to select electrocution or lethal injection as a legal means of execution at least 30 days before the execution by presenting the inmate with the Affidavit Concerning Method of Execution Form (Seep. 92). 3. To explain to the inmate the procedures and activities which will take place during Death Watch. 4. To control any contact between the condemned inmate and other persons. 5, To coordinate the notification of official witnesses of the date and time to be at the institution to witness the scheduled execution. 6. To coordinate the appointment of execution team staff member(s). 7. To select a person to serve as Executioner. 8. To set the precise hour and minute of execution, subject to approval of the Commissioner and the Department's General Counsel. 9. To arrange for the presence of a physician to carry out functions as set forth on page 19. 10. To coordinate with the Medical Examiner for disposition of the body. 11. To keep the Commissioner and Assistant Commissioner of Prisons informed of the progress towards and implementation of the execution. 12. To control activation of closed circuit TV to the victim family witness room. 13. To order the Executioner, either verbally or by gesture, to proceed with execution. 14. To cause the announcement to significant parties and the public of the fact that the sentence of execution has been carried out. Rev. J\lly 5, 2018 Page 13 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 13 of 99 PageID #: 388 Attachment 4 ASSOCIATE WARDEN OF SECURITY Primary Role Assist the Warden in performing execution procedures and substitute for the Warden if he is unable to perform his duties. Duties: 1. To ensure the security of the condemned inmate, 2. To supervise preparation of the Death Watch cell area, Execution Chamber, and the condemned inmate for execution. 3. To coordinate and/or approve, with assistance by assigned security staff, visits and phone calls permitted to the condemned inmate. 4. To provide the final inspection of restraint devices to ensure the condemned inmate is secured on the gurney prior to placing IV catheters in each arm. 5, To ensure that any blinds between the witness room and the Execution Chamber are closed prior to the witnesses entering and opened after the witnesses are seated. 6. To supervise the removal of the body from the Execution Chamber. 7. To coordinate the release of the condemned inmate's body to the authorized recipient or coordinate burial at State expense in the event no one claims the body. Rev. July 5, 2018 Pnge 14 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 14 of 99 PageID #: 389 Attachment 4 LETHAL INJECTION RECORDER Primary Role Assist the Warden in carrying out his duties. Duties: 1. To coordinate and supervise the movement of the Execution Team to and from the Execution Chamber, and aid in maintaining the team's anonymity. 2. To process applications for the selection of news media representatives to attend executions. 3. To complete the Lethal Injection and Execution Recorder Checklist. (See Section IX Forms) Rev. July 5, 2018 Page 15 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 15 of 99 PageID #: 390 Attachment 4 DEATH WATCH SUPERVISOR Primary Role To coordinate all security requirements for the inmate during the Death Watch and to supervise all correctional officers assigned any responsibilities for direct supervision of the inmate during Death Watch, including preparation of the condemned inmate. Duties: 1. To prepare a duty schedule for officers assigned this detail. 2. To review post orders for correctional officers and to become familiar with all functions of subordinates. 3. To ensure that the condemned inmate personally inventories his personal property and packs away all items he is not permitted to retain. The Death Watch Supervisor, inmate, and one witness will sign the property inventory. The sealed property will be retained in storage in the Property Room until removed by the inmate's designee. 4. To maintain a bound ledger of information related to Death Watch associated activities. This log will contain a record of all visitors, meals served, shaving, handling of mail, inmate behavior, movement, communications, etc. 5. . To permit only authorized persons to enter the Death Watch area. The Warden will provide a list of authorized personnel. 6. To maintain a sufficient amount of clothing in the inmate's size in order to provide a change of clothing each time the inmate leaves the cell. The Death Watch Officers will have custody of the clothing to be stored. 7. To ensure that cellular phones, cameras, audio, and video equipment are not taken into the Death Watch area or the Execution Chamber at any time during Death Watch or at the time of execution, unless authorized by the Warden. 8. To coordinate movement of witnesses entering and exiting witness rooms during the execution process. 9. To activate and deactivate the closed circuit TV and audio speaker systems at the prescribed times during the execution process. 10. To ensure the events pertaining to the execution are documented by the Lethal Injection Recorder on the Lethal Injection Execution Recorder Checklist. Rev July 5, 2018 Page 16 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 16 of 99 PageID #: 391 Attachment 4 INSTITUTIONAL CHAPLAIN Pl'i,nrnrv Huie To offer and deliver chaplaincy services to the condemned inmate and the inmate's family as needed. Duties: l. To ask the inmate to specify in writing the preferred funeral arrangements and the preferred recipients of personal property. If a legal will is requested, the Chaplain will coordinate with the TDOC Staff Attorney. 2. To say a brief prayer of intercession immediately prior to execution (if requested). 3. To assist in the release of the executed inmate's body to the authorized next-of-kin recipient or mortician through the State Medical Examiner. Rev . July 5, 2018 Page 17 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 17 of 99 PageID #: 392 Attachment 4 SECURITY SYSTEMS TECHNICIANS Primary, Role To ensure that the closed circuit television and the audio systems between the Execution Chamber and witness room(s) are functioning properly at the scheduled time of execution. Rev. July 5, 2018 Page 18 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 18 of 99 PageID #: 393 Attachment 4 PHYSICIAN Physician's Pthna,ry Role To pronounce death. Duties: '1. To be present at the time of execution in the capital punishment garage. 2. As an ultimate and last option, the physician may perform a venous cut-down procedure should the IV Team be unable to find a vein adequate to insert the catheter. 3. To examine the body for vital signs five minutes after the LIC has been injected. 4. To notify the Warden if the inmate is not legally dead. 5. . To pronounce death if no vital signs are detected. Rev. July 5. 2018 Page 19 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 19 of 99 PageID #: 394 Attachment 4 IV TEAM Primai.yRole To establish properly functioning IV lines for administration of the lethal injection chemical(s). Duties: 1. To prepare the IV equipment. 2. To make sure the equipment used is in working order. 3. To locate sites for intravenous use. 4. To make sure vascular access is properly established. 5. To make sure the IV lines are flowing properly. 6. To document the injection of the LIC(s) on the Lethal Injection Chemical Administration Record sheet. Rev. July 5. 2018 Page 20 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 20 of 99 PageID #: 395 Attachment 4 FACILITY MAINTENANCE SUPERVISOR Primary Role To assist with the witnesses . Rev. July 5, 2018 Page 21 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 21 of 99 PageID #: 396 Attachment 4 EXTRACTION TEAM Primary Role To escort and secure the condemned inmate during the execution process. Rev July 5, 2018 Page 22 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 22 of 99 PageID #: 397 Attachment 4 ESCORT OFFICER(S) Primary .Role , To accompany and guide witnesses during the execution process . .Hcv. July 5, 2018 Page 23 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 23 of 99 PageID #: 398 Attachment 4 CENTRAL OFFICE PERSONNEL RP.v July 5, 2018 Page 24 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 24 of 99 PageID #: 399 Attachment 4 COMMISSIONER Pi'irnary Role To oversee the administration of judicial executions in Tennessee. Duties: 1 To ensure that the chemical(s) used for lethal injection has/have been properly acquired, stored, and accounted for . 2 Approximately ten minutes prior to the time scheduled for the execution, the Commissioner will establish telephone contact with the Governor's Legal Counsel. 3 To communicate to the Warden any circumstances that could alter or delay the execution. 4 To arrange for or mandate an Employee Assistance Program (EAP) debriefing as needed. Rev. Jllly 5, 2018 Page 25 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 25 of 99 PageID #: 400 Attachment 4 ASSISTANT COMMISSIONER OF PRISONS Primary lfole To be stationed at the Command Post or location designated by the Commissioner and to work directly with the Commissioner and perform any assigned duties. Duties: 1. To serve as liaison to all support units and to conduct an operational debriefing of all security and procedural personnel after the execution. 2. To maintain telephone and/or radio contact with the Warden and other personnel. 3. To coordinate with the Metropolitan Nashville Police Department and Tennessee Highway Patrol and any additional security forces required. Rev. July 5, 2018 P;ige 26 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 26 of 99 PageID #: 401 Attachment 4 DIRECTOR OF COMMUNICATIONS AND PUBLIC RELATIONS To coordinate all media operations associated with the execution. Duties: 1. To provide assistance to the Warden m obtaining telephone communications needed by media representatives. 2. To coordinate all visits by media representatives both prior to and subsequent to an execution. 3. To notify the media of the witness lottery by faxing an advisory to the Associated Press. 4. To attend the media drawing held at RMSI and send out a notification to the Associated Press regarding who was selected. 5. To compile a press kit including guidelines, specifics of the case for which the inmate is being executed, and other related policies and statutes needed for the execution. 6. To communicate with the Governor's communication staff about who will be available to address media inquiries. 7. To coordinate with the Governor's Director of Communications any press releases and public messages. 8. To establish a contact sheet with names, assignments, and contact numbers of each Public Information Officer involved. The Warden will be issued a copy. 9. To coordinate with the Facility Maintenance Supervisor to create a staging al'ea with a podium for news briefings. 10. To establish a schedule for news briefings. Rev. July 5, 2018 Page :.!7 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 27 of 99 PageID #: 402 Attachment 4 DIRECTOR OF THE OFFICE OF INVESTIGATION AND COMPLIANCE Primary Role To coordinate all external security and tactical activities associated with the execution. Duties: 1. No less than a week before the execution, to schedule a security meeting with participating external agencies. 2. To coordinate security assignments with participating external agencies. 3. In consultatjon with the Assistant Commissioner of Prisons, to coordinate tactical activities as necessary. 4. To work with the Escort Officer(s) in accompanying witnesses. Rev July 5, 2018 PflgP. 28 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 28 of 99 PageID #: 403 Attachment 4 DIRECTOR OF VICTIM SERVICES Primm'y Role To work with victims, family members, and other interested parties involved in the execution process. Duties: 1. To confirm the list of individuals registered for notification. 2. 'l'o mail execution notification letters and packets. (See Section IX Forms) 3. To work closely with the victim liaison from the Attorney General's office. 4. To work with the Escort Officer(s) in accompanying witnesses. Rev. July f>, 2018 PAge 29 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 29 of 99 PageID #: 404 Attachment 4 IV. SELECTION AND TRAINING OF STAFF RIVERBEND MAXIMUM SECURITY INSTITUTION Rev. July 5, 2018 Page 30 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 30 of 99 PageID #: 405 Attachment 4 EXECUTION TEAM MEMBER SELECTION CRITERIA LETHAL INJECTION Certain persons are members of the Execution Team by virtue of their official position (i.e. Warden, Associate Warden of Security). The Warden selects the remaining team and considers at a minimum the following general criteria for other members: 1. Length of service. 2. Ability to maintain confidentiality. 3. Maturity. 4. Willingness to participate. 5. Satisfactory work performance. 6. Professionalism. 7, Staff recommendations to the Warden. 8. Review of personnel files by the Warden prior to selection. The following positions on the Execution Team are specialized and have specific requirements: 1. Three (3) EMTs - Paramedic Certified Emergency Medical Technician 2. Three (3) Correctional Staff Received IV training through the Tennessee Correction Academy by qualified medical professionals. 3. Facility Maintenance Supervisor A person knowledgeable of the institution's physical plant and equipment. 4. Security Systems Technician(s) Must be an Electronic Security Systems Specialist l or above with audio/visual experience. Rev. July 5, 2018 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 31 of 99 PageID #: 406 Attachment 4 TRAINING OF EXECUTION TEAM MEMBERS Execution Team The Execution Team shall consist of: the Warden, Associate Warden of Security, Executioner, IV Team, Extraction Team, Death Watch Team, Lethal Injection Recorder, Facility Maintenance Supervisor, ITS Security Systems Technician(s), and Escort Officers. r:J.'raining 1. All Execution Team members must read the Lethal Injection Execution Manual when they become members of the Execution Team. Additionally, the Warden or designee holds a class during which the manual is reviewed and clearly understood by all participants. At least annually, the Warden or designee holds an Execution Manual review class for all members of the Execution Team. 2. The Execution Team simulates Day 3 (Execution Day) of the Death Watch Procedures and the steps outlined in Section 4 for at least one (1) hour each month. Additjonal training is held within two weeks before a scheduled execution. A training record is maintained to document all staff members who participate in the training. The simulation includes all steps of the execution process with the following exceptions: A. Volunteers play the roles of the condemned inmate and physician. B. Saline solution is substituted for the lethal chemicals. C. A body is not placed in the body bag. 3. All training that occurs is documented. The documentation includes the times and dates of the training, the participants, and the training content. Executioner The Executioner receives initial and periodic instruction from a qualified medical professional. Rev. July 5, ~018 Page :12 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 32 of 99 PageID #: 407 Attachment 4 V. PROCUREMENT, PREPARATION, INTRODUCTION OF THE LETHAL INJECTION CHEMICAL, AND PROCEDURES OF ACCOUNTABILITY RIVERBEND MAXIMUM SECURITY INSTITUTION Rev. ,July 5, 2018 P:ig~ 33 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 33 of 99 PageID #: 408 Attachment 4 CHEMICALS USED IN LETHAL INJECTION The Department will use the following protocol for carrying out executions by lethal injection: Midazolam 100 ml of a 5mg/ml solution (a total of 500 mg) Vecuronium 100 ml of a lmg/ml solution (a total of 100 mg) Bromide Potassium 120 ml of a 2 mEq/ml solution (a total of 240 mEq) Chloride Chemicals used in lethal injection executions will either be FDA-approved commercially manufactured drugs; or, shall be compounded preparations prepared in compliance with pharmaceutical standards consistent with the United States Pharmacopeia guidelines and accreditation Departments, and in accordance with applicable licensing regulations. Rev. ,July 5, 2018 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 34 of 99 PageID #: 409 Attachment 4 COMPOUNDED PREPARATIONS: PROCUREMENT, STORAGE, ACCOUNTABILITY, AND TRANSFER OF THE CHEMICAL Procurement Upon receipt of an order setting an execution date, the Commissioner or his designee shall contact a physician to obtain a physician's order for the LIC. The Commissioner or his designee shall submit the physician's order to a licensed pharmacy or pharmacist to be filled. The Pharmacist shall compound alll drugs in a clean sterile environment in compliance with pharmaceutical standards for identity, st1·ength, quality, and purity of the compounded drug that are consistent with United States Pharmacopoeia guidelines and accreditation Departments and in accordance with applicable licensing regulations pertaining to pharmacies compounding sterile preparations. (See pp. 99-104) The Pharmacist shall arrange for independent testing of the compound for potency, sterility, and endotoxins. Compounded preparations shall be transferred, stored and maintained in accordance with the directions of the Pharmacy with which the Department has a Pharmacy Services Agreement which shall be in compliance with pharmaceutical standards and consistent with United States Pharmacopeia guidelines. Storage of LIC I. When the LIC is received, a member of the Execution Team and the Warden take the LIC to the armory area of Building darrell09@example.org. The LIC is not stored in the weapon area of the armory due to the occasional employee traffic but rather in the key control section of the armory where there is the least employee need for access. The LIC is placed in an unmovable heavy gauge steel container with security grade locks. 2. All locking devices and storage containers are designed to prevent access to anyone without the proper keys or result in such destruction that entry into the container is unmistakable. There is only one key to access the storage container. That key is issued permanently to the Warden of RMSI. 'T'he Warden also has the pattern key to the container in his possession. There are no other duplicates produced. The Warden surrenders the key to no one other than the one member of the Execution Team designated for inventorying the LIC and only for the duration of the count and expiration checking of the LIC. Only the Warden or designee is allowed to access the storage container. 3 The LIC on hand is monitored for expiration dates. All of the LIC boxes/bottles have an expiration date, and all are in tamper-proof containers. As the LIC reac.h es its expiration date, it shall be disposed of by hazardous waste pick-up. Rev July 5, 2018 Pngc :-lf> Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 35 of 99 PageID #: 410 Attachment 4 Accountability of LIC 1. A permanently bound ledger is maintained in the armory/key control area where all employees, including the armory/key control officer(s), sign each time they enter the area. The armory/key control officer performs a visual inspection of each container upon arrival at his workstation to ens_ure the proper band is in place and that the container has not been compromised in any way. 2. A permanently bound ledger is maintained in the storage area that contains a record of the LIC. Any LIC removed for use, disposal due to expiration, or for any other reason is deducted from the inventory. Any LIC received into the storage container is added to the inventory. 3. The storage container has a numbered security band that is broken prior to opening the container. The number of the band is recorded in the ledger. When the storage container is opened for any reason, the band is broken and the justification for entry is recorded in the ledger adjacent to the band number. When the storage container is secured and a new band is placed on the container, a new number is recorded in the ledger. 4. Upon receipt of the LIC, the Warden or designee proceeds to the armory storage area, secures the LIC, and adjusts the inventory appropriately. Prior to the LIC being placed in storage, the expiration date and lot number or other identifying marking is recorded to ensure that the LIC is properly disposed of at the time of expiration. 5. The Warden and the designee jointly verify the inventory of LIC on a semi-annual basis (January/July), at a minimum, and subsequent to each execution. The Warden and the designee make appropriate entries in the ledger with their full signatures that verify the correctness of the LIC count. Transfer of Location 1. After the LIC is signed out on the appropriate ledger in the armory for execution purposes, the LIC is placed in an inconspicuous container for transport to the Execution Chamber. The Warden's designee is responsible for the delivery of the LIC to the appropriate individuals in the Execution Chamber. 2. If the LIC is not used and not compromised in any way, the LIC is returned to the armory, re-entered on the perpetual inventory ledger, and secured in the refrigerator. The LIC is used only for the execution of the inmate for whom it was ordered. Hev. July 5, 2018 Page 36 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 36 of 99 PageID #: 411 Attachment 4 COMMERCIALLY MANUFACTURED DRUGS: PROCUREMENT, STORAGE, ACCOUNTABILITY, AND TRANSFER OF THE CHEMICALS Procurement Upon direction from the Commissioner or his designee, a member of the Execution Team checks the supply of chemicals and expiration dates. If it is determined that additional chemicals are needed, the member contacts the Procurement Officer at RMS!. The RMSI Procurement Officer contacts the Procurement Officer at De Berry Special Needs Facility (DSNF) to order the needed chemicals. When the chemicals are delivered, the Procurement Officer at DSNF contacts the Procurement darrell09@example.org. One of the members of the Execution 'l'eam picks up the chemicals at either the DSNF or RMSI warehouse. A. member of the Execution Team checks the supply of the chemicals, the concentration, a nd expiration dates. The Commissioner or his designee ensures that there are enough lethul injection chemicals kept in inventory at RMSI to carry out three executions. Storir~e of LTC 1. The member of the Execution Team and the Warden take the chemicals to the armory area of Building darrell09@example.org. The lethal injections chemicals (LICs) are not stored in the weapon area of the armory due to the occasional employee traffic but rather in the key control section of the armory where there is the least employee need for access. The chemicals are placed in unmovable heavy gauge steel containers with security grade locks. 2. AU locking devices and storage containers are designed to prevent access to anyone without the proper keys or result in such destruction that entry into the container is unmistakable. There is only one key to access each storage container. That key is issued permanently to the Warden of RMSI. The Warden also has the pattern key to the container in his possession. There are no other duplicates produced. The Warden surrenders the key to no one other than the one member of the Execution Team designated for inventorying the LICs and only for the duration of the count and expiration checking of the LICs. Only the Warden or designee is allowed to access the storage containers. 3 The chemicals on hand are monitored for expiration dates. All of the chemical boxes and bottles have an expiration date, and all chemicals are in tamper-proof bottles or containers. As the chemicals reach their expiration dates, they are disposed of by hazardous waste pick-up . Rev. July 5, 2018 Page 37 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 37 of 99 PageID #: 412 Attachment 4 Accountability of lJCs L A permanently bound ledger is maintained in the armory/key control area where all employees, including the armory/key control officer(s), sig·n each time they enter the area. The armory/key control officer performs a visual inspection of each container upon arrival at his workstation to ensure the proper band is in place and that the container has not been compromised in any way. 2. A permanently bound ledger is maintained in the storage area that contains a record of each LIC . Any LICs removed for use, disposal due to expiration, or for any other reason are deducted from the inventory. Any LICs received into the storage container are added to the inventory . 3. Each storage container has a numbered security band that is broken prior to opening the container. The number of each band is recorded in the ledger. When the container is opened for any reason, the band is broken and the justification for entry is recorded in the ledger adjacent to the band number. When the container is secured and a new band is placed on the container, a new number is recorded in the ledger. 4. Upon receipt of the LICs, the Warden or designee proceeds to the armory storage area, secures the LICs, and adjusts the inventory appropriately. Prior to the LICs being placed in storage, the expiration date and lot number or other identifying marking is recorded to ensure that the LIC is properly disposed of at the time of expiration. 5. The Warden and the designee jointly verify the inventory of LI Cs on a semi-annual basis (January/July), at a minimum, and subsequent to each execution. The Warden and the designee make appropriate entries in the ledger with their full signatures that verify the correctness of the LIC count. Transfer of Location 1. After the LICs are signed out on the appropriate ledger in the armory for execution purposes, the LICs are placed in an inconspicuous container for transport to the Execution Chamber. The Warden's designee is responsible for the delivery of the LICs to the appropriate individuals in the Execution Chamber. 2. In the event the LICs are not used and not compromised in any way, the LICs are returned to the armory, re-entered on the perpetual inventory ledger, and secured in the appropriate container. Rev. J11ly f, , 2018 PagE.' 38 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 38 of 99 PageID #: 413 Attachment 4 LETHAL INJECTION CHEMICAL SET-UP AND PREPARATION 1. Prior to an execution, a minimum of two members of the Execution Team bring the LICs from the armory area directly to the Lethal Injection Room. The amount of chemicals and saline is sufficient to make two complete sets of nine (9) syringes each. One set is color coded red and the back-up set is color coded blue. Each syringe is numbered in the order it is to be administered and labeled with the name of its contents. Only the Warden and one member of the Execution Team have a key to the Lethal Injection Room. 2. The LICs are drawn into syringes by one member of the Execution Team. Another member of the Execution Team observes and verifies that the procedure has been carried out correctly. 3. Only one syringe is prepared at a time. As they are prepared, the two sets of syringes are positioned in specific holding places in two separate ti-ays color coded red and blue. The syringes are numbered, labeled, and placed in the order they will be administered. One member of the Execution Team will perform this procedure while another member of the Execution Team observes and verifies that the procedure has been carried out correctly. The Chemical Preparation Time Sheet will document the preparation of the LIC . (See Section IX Forms) 4. Preparation in accordance with the directions of the Pharmacy with which the Department has a Pharmacy Services Agreement to create of one set of syringes as follows: a. Midazolam: The member of the execution team draws 50 cc of a 5 mg/ml solution of Midazolam in each of two syringes, for a total of 500 mg of Midazolam. These syringes are labeled Midazolam with numbers one (1) and two (2), respectively. b. Saline: The member of the Execution Team draws 50 cc of saline solution from the IV bag into a syringe, which is labeled Saline with the number three (3) . c. Vecuronium Bromide: The Vecuronium is in powder form and must be reconstituted with bacteriostatic water. The Vecuronium comes in 10mg vials each of which need to be reconstituted with 10 mL of bacteriostatic water. A total of JO vials is required to produce 100 mg of the chemical. The member of the execution team draws 50 cc of Vecuronium (I mg/mL solution) in each of two syringes, for a total of 100 mg of Vecuronium. These syringes are labeled Vecuronium with numbers four (4) and five (5), respectively. Rev. July 5, 2018 PagC' 39 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 39 of 99 PageID #: 414 Attachment 4 d. Saline: The member of the Execution Team draws 50 cc of saline solution from the IV bag into a syringe, which is labeled Saline with the number six (6) . e. Potassium Chloride: The member of the execution team draws 60 cc of a 2 mEq/ml solution of Potassium Chloride in each of two syringes for a total of 240 mEq/mL of Potassium Chloride. These syringes are labeled Potassium Chloride with numbers seven (7) and eight (8), respectively. f. Saline: The member of the Execution Team draws 50 cc of saline solution from the IV bag into a syringe, which is labeled Saline with the number nine (9). 5. The tray is placed on the workstation in the Lethal Injection Room. 6. THIS PROCESS WILL BE REPEATED FOR THE SECOND SET OF SYRINGES 7. When the execution is complete, all sy;ringes and any of the prepared but unused LIC are sent to the Medical Examiner's office with the body. Rev Jnly 5, 2018 Page 40 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 40 of 99 PageID #: 415 Attachment 4 IV LINE SETUP REQUIRED ITEMS: 2 BAGS OF 0.9% SODIUM CHLORIDE 2 SOLUTION SETS 2 HEMOSTATS EXTENSION SETS TAPE 1. Two (2) bags of 0.9% Sodium Chloride Injection USP are hung in the injection room. The expiration dates must be checked. 2. A Solution Set spike is inserted into each bag with the clamp turned to the off position. The drip chamber is compressed until it is approximately 1/3 filled. The Solution Sets are 85 inches long. The length of the Solution Set may be purchased longer or shorter just as long as there is a port near the spiked end. 3. The port nearest the spiked end is opened. This may be done by tearing the plastic and rubber off leaving an open hole. 4. Once the port is opened, an extension is inserted. Extensions can be purchased in different lengths. The extension into the first port should be 18 to 24 inches in length. Extensions are added to each end of the Solution Set until it reaches the desired length. The ends should reach from head to toe of the condemned inmate. 5. Once the desired length is obtained, the lines should be filled with Sodium Chloride. The clamp is opened, allowing the port to fill. When it is filled it is clamped and capped off. The line that goes to the body continues to fill. The clamp is turned off and the line is capped. 6. The line is taped to the port (where the syringe is inserted) in place. The remainder of the line is placed out of the ports in the window. It should be taped in place to keep it from being pinched closed. 7. The Sodium Chloride bag and line on the left goes to the left side of the condemned inmate. The left side of the condemned inmate is nearest the wall / window and requires fewer extensions. Repeat #5 and #6. IV lines are ready. Rev. July 5, 2018 Page 41 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 41 of 99 PageID #: 416 Attachment 4 INSERTION OF A CATHETER AND CONNECTION OF IV LINES Strap Down and Location of the Vein 1. The Extraction Team straps the inmate to the gurney in the Death Watch Area. 2. The Extraction Team moves the gurney into place in the Execution Chamber and straps it to the floor. Members of the team place arm supports on the gurney and restrain the condemned inmate's arms securely to the gurney. The restraints are secure but not tight enough to slow or stop blood circulation. 3. The Extraction Team exits the Execution Chamber after the condemned inmate is in place and secure. 4. The IV Team enters the Execution Chamber with an instrument cart. One member of the IV team remains in the Lethal Injection Room. 5. The member of the IV Team in the Lethal Injection Room signals the IV team to insert IV lines. 6. Size, location, and resilience of veins affect their desirability for infusion purposes. The EMT inserts the first catheter into a vein on the right side of the inmate in the antecubital fossa area. If a catheter cannot be successfully inserted into the antecubital area, the EMT examines other locations for insertion in the following order: a. Forearm b. Wrist c. Back of the hand d. Top of the foot e. Ankle, lower leg, or other appropriate locations as determined by the EMTs 7. In the unlikely event that none of these veins are usable, the physician is called into the Execution Chamber to perform a cut-down procedure. Ve:rtipi:m.c ture llnd lV Li11es 1. The EMT(s): a . Place a tissue towel under the limb or body part to be used to start an IV. b. Place a tourniquet around the limb or body pal't 6-8 inches above the vein to be used. c. Find the best vein to use according to the succession outlined. d . Swab the area with an alcohol pad. e. Determine the size of the catheter to be used which is determined by the size of the vein, 18 gauge being the largest. f. Insert a catheter into the vein bevel side up at a shallow angle, feeding the plastic catheter sleeve into the vein. Rev. July 5, 2018 Page 42 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 42 of 99 PageID #: 417 Attachment 4 The flash chamber of the catheter fills with blood, which is the first indicator the catheter is inside a vein. 2. i\n IV Team member attaches the Solution Set line from the right Sodium Chloride bag to the catheter. This is a friction coupling and requires the line to be pushed into the catheter and twisted to secure the connection. 3. An IV Tea1.11 member in the Execution Chamber signals the IV Team member in the Lethal Injection Room to open the clamp on the right bag of Sodium Chloride, near the spike, to allow a flow of Sodium Chloride into the vein. 4. Members of the IV Team observe the IV for indication of a well-functioning line. The first indicator is that when the clamp is opened, there is a steady flow/drip inside the drip chamber. The second indicator is that the flash chamber becomes clear of blood as the Sodium Chloride begins to flow. When the IV Team is confident that there is a well-functioning line, the IV Team member in the Lethal Injection Room signals the IV team that there is a successful IV line. 5. A member of the IV Team places the Tegaderm transparent dressing over the catheter and secures the line in place with tape. 6. The second IV is then started on the left side of the condemned inmate and Steps 1- 5 are repeated, using the left bag of Sodium Chloride. l{rv. July 5, 2018 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 43 of 99 PageID #: 418 Attachment 4 CHEMICAL ADMINISTRATION AND IV MONITORING 1. All members of the IV Team monitor both catheters to ensure that there 1s no swelling around the catheter that could indicate that the catheter is not sufficiently inside the vein. The IV Team member in the Lethal Injection Room monitors the catheters by watching the monitor in his room, which displays the exact location of the catheter(s) by means of a pan-tilt zoom camera. The IV Team Members observe the drip chambers in both lines to ensure a steady flow/drip into each Solution Set line . 2. Next, an IV Team member tapes both hands, palms up, to the arm support to prevent movement. The palms will be down should the back of the hand be used for the catheter. 3. When the hands are taped in place, the members of the IV Team leave the Execution Chamber. 4. Designated members of the IV Team enter the Lethal Injection Room and assume their pre-assigned stations. a. One IV Team member observes the process, monitoring the catheter sites for swelling or discoloration, and enters the times of the LIC and Saline administration on the Chemical Administration Record sheet. (See Section IX Forms) b. One IV Team member observes the process and hands the labeled/numbered/colored syringes to the Executioner in the prescribed order. 5. The Executioner selects either the left or right Solution Set line based on the flow/drip inside the drip chamber. If both lines are equal, the left line nearest the Executioner is used. 6. When the Warden gives the signal to proceed with the execution, the Executioner clamps the line near the spike. The Executioner receives the first syringe from the member of the IV Team and inserts and twists it into the extension line. #_ _ DB,UG- SJi; Ql)Ji;N IN I ~N'l'I F rER LABEL VOLUME MIDAZOLAM '" [DRUG NAME, RED #1] 50 cc 1. 2. MIDAZOLAM [DRUG NAME, RED #2] 50 cc 3. SALINE FLUSH [DRUG NAME, RED #3] 50 cc 4_ VE CURO NI UM [DRUG NAME, RED #4J 50 cc BROMIDE Rev Jilly 5, 2018 Page 411 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 44 of 99 PageID #: 419 Attachment 4 5. VECURONlUM [DRUG NAME, RED #5] 50 cc BROMIDE 6. SALINE FLUSH [DRUG NAME, RED #6] 50 cc 7. POTASSIUM CHLORIDE [DRUG NAME, RED #7) 60 cc 8. POTASSIUM CHLORIDE [DRUG NAME, RED #8) 60 cc 9. SALINE FLUSH [DRUG NAME, RED #9] 50 cc 7. The Executioner pushes on the plunger of the #1 syringe (red) with a slow, steady pressure. Should there be or appear to be swelling around the catheter or if there is resistance to the pressure being applied to the plunger, the Executioner pulls the plunger back. If the extension line starts to fill with blood, the execution may proceed. If there is no blood, the Executioner discontinues with this line. He starts the process on the other line with the back-up set of syringes starting with syringe #l(blue) and following all of Step 6. 8. An IV Team Member hands the syringes to the Executioner and both IV Team Members observe the correct order of the syringes as the Executioner injects the LIC and saline solution. 9. After the last syringe has ·been injected, the Executioner closes the extension line with a clamp and opens the line below the spike to allow a drop of 1-2 drops per second in the drip chamber. 10. The Executioner signals the Warden that all of the LIC and saline solution have been administered. Rev. July 5. 2018 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 45 of 99 PageID #: 420 Attachment 4 VI. DEATH WATCH PROCEDURES LETHAL INJECTION RIVERBEND MAXIMUM SECURITY INSTITUTION Rev. July 5, 2018 Page 46 Case 3:18-cv-01234 Document 1-5 Filed 11/02/18 Page 46 of 99 PageID #: 421 Attachment 4 STAFF RESPONSIBILITIES AND SPECIAL PROCEDURES FOR INMATES ON DEATH WATCH Purpose: The purpose of this operating procedure is to designate staff responsibilities and establish uniform property, privileges, and institutional guidelines for condemned inmates with sjgned court orders for execution. Application: All inmates who have exhausted all appeals available to them and have an execution date within the next four days. 1. Housing and Security Assignments A. The inmate is transferred to Building 8 (Capital Punishment) three (3) days prior to the scheduled execution. B. Correctional officers are assigned to the housing area in a manner consistent with TDOC Policy #506 .16.2, which sets forth the guidelines for the Death Watch Supervisor. 2. Middle Tennessee ln s t it,Lttion al Notification a n d Advisem ent of Law En for e - rne.nt Ag nciies Upon determination of the execution date and time, the Commissioner, Director of Communications and Community Relations, Assistant Commissioner of Operational Support, Assistant Commissioner of Prisons, Correctional Administrator, Correctional Program Director, Wardens of Tenn essee Prison for Women, Deberry Special Needs Facility, and Turney Center may be advised by Riverbe nd's Warden or his designee . Should circumstances devel op which necessita te it, tactical activities are coordinated by the Director of Investi gation a nd CompJi,an ce a fter conl'erring with the Assistant Commissioner of Prisons. F ormulation of secur ity personn el is a t, the discretion of the Assistant Commissioner of Prisons. 3. S t.at .- lss uc <l Pl' p r ty a n 11 os1-1es~ion Li mit The inmate is allowed only the items listed below. Any other item is considered contraband and confiscated in accordance with institutional policy. A. Standard issue of outer clothing B. One bed C. One mattress, pillow, and standard issue of linens D. One toothbrush E, One tube of toothpaste F. One bar of soap G. One electric razor (to be issued and used under direct supervision on,ly) H. Two towels, one washcloth I. Two
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