Nevada lethal injection protocol

The protocol that Nevada hopes to use in executing death-row inmate Scott Dozier calls for a combination of drugs, including fentanyl.

NEVADA DEPARTMENT OF CORRECTIONS

EXECUTION MANUAL
EM 103
ACQUISITION AND PREPARATION OF DRUGS FOR LETHAL
INJECTION

Effective Date: 11/07/2017
CONFIDENTIAL IN UN-REDACTED FORMAT: NO
AUTHORITY AND RESPONSIBILITY

The Director and designated Deputy Director will ensure that this manual is accurately revised
and published upon order of the Governor prior to a scheduled execution.

103.01 LETHAL INJECTION PROTOCOL

A. Lethal drugs are to be used in the execution. Although the combination of drugs and doses
listed below are lethal for most individuals, individual differences do exist. It shall be the
responsibility of the Director to consult with the Chief Medical Of?cer in order to ensure that
the selected lethal drug or combination of drugs and their dosages to be used in the execution
are suf?cient to cause death. The Director shall then select the drug, combination of drugs
and dosages to be used for the execution. This information will not be withheld ?'om the
inmate or the public.

1. The NDOC Public Information Of?cer (PIO) will prepare and produce a statement on
behalf of the Nevada Department of Corrections.

B. The Director will provide the condemned inmate With written notice of the drug or
combination of drugs that will be used for the execution after a ?nal decision has been made
and no less than seven (7) calendar days prior to the ?rst day of the week Monday), as
designated by the district court, that the judgment of death is to be executed.

1. If at any time after written notice of the drug or combination of drugs to be used for the
execution has been provided to the condemned inmate, the Director determines that it is
necessary to change the Lethal Injection Protocol identi?ed and provided in CEM
a written notice of the Director?s determination, which identi?es the necessary
changes to the Lethal Injection Protocol and an explanation as to the basis for such
changes, will be immediately provided to both the condemned inmate and the condemned
inmate?s counsel of record.

C. The drug amounts speci?ed below are designed for the execution of persons weighing 500
pounds or less. The drug amounts will be reviewed and revised, as necessary, for a
condemned inmate exceeding 500 pounds.

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103.02 ACQUIRING LETHAL DRUGS AND EQUIPMENT

A. After the Director makes the ?nal decision as to the drug or combination of drugs that will be
used for the scheduled execution, the designated Deputy Director/designated Warden will be
responsible for:

1. Con?rming that the equipment and materials necessary to properly conduct the execution
is on site, immediately available for use and functioning properly.

2. Ensuring all medical equipment, including a backup cardiac monitor is on site,
immediately available for use and functioning properly.

3. Ensuring that the drugs identi?ed are acquired, arrive at Ely State Prison (ESP) no later
than the day of execution and are properly stored. The drugs shall be stored in a secured
locked area that is temperature regulated and monitored to ensure compliance with
manufacturer speci?cations, under the direct control of the designated Warden.

103.03 PREPARATION OF LETHAL DRUGS

A. At the appropriate time, approximately two hours prior to the scheduled execution, the
designated Warden shall transfer custody of the drugs to two members of the Security Team
who have been selected by the designated Deputy Director as the Drug Administrators. The
Drug Administrators will be two individuals who, based upon their years of experience and
proven performance within the corrections industry, are uniquely trusted to perform the
sensitive and critical tasks of preperly preparing the lethal drugs for the execution, and then
injecting the lethal drugs into the condemned inmate per these instructions when so ordered.

B. The quantity of the lethal drugs may not be changed without prior approval of the Director.

C. It is the responsibility of the Drug Administrators to prepare the le?ial drugs. An Attending
Physician or other properly trained and quali?ed medical professional will observe the Drug
Administrators as they prepare the lethal drugs.

1. Both Drug Administrators shall complete detailed written reports describing the
preparation and labeling of the lethal drugs.

a. The Drug Administrators shall be responsible for preparing and labeling the assigned
syringes in a distinctive manner identifying the speci?c lethal drug contained in each
syringe by (1) lethal drug name, (2) lethal drug amount and (3) assigned number.
This information shall be preprinted on a label, with one label af?xed to each syringe
to ensure a label remains visible.

b. The syringes for each lethal drug by name will then be placed in an individual tray
marked for all the syringes of that lethal drug. The labels for each tray and each
syringe it contains will be colored to match: red in color for Diazepam, white in color
for Fentanyl and blue in color for Cis-atracurium.

c. The drugs and their doses are to be prepared and labeled as follows:

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i. Tray-1: Diazepam (labels to be red in color)

CONCENTRATION
1. #1-1 Diazepam 5mg/cc 5m] 25mg
2. #1-2 Diazepam 5mg/cc 5m] 25mg
3. #1-3 Diazepam 5mg/cc 5m] 25mg
4. #1-4 Diazepam 5mg/cc 5m] 25mg

5. In the unlikely event that it is deemed necessary (see protocol in EM 110),
additional syringes of Diazepam may be ordered by the Director, and then
prepared and injected by the Drug Administrators. If ordered, additional
syringes will be similarly labeled and numbered next in sequence, for
example the next syringe would be numbered then #1-6 and so on.

ii. Tray-2: Fentanyl (labels to be white in color)

CONCENTRATION SYRINGE
1 . #2-1 Fentanyl 50mcg/cc 1 0m] 500mcg
2. #2-2 Fentanyl 50mcg/cc 1 Oml 500mcg
3. #2-3 Fentanyl 50mcg/cc 10ml 500mcg
4. #2-4 Fentanyl 50mcg/cc 10ml 500mcg
5. #2-5 entanyl 50mcg/cc 10ml 500mcg
6. #2-6 entanyl 50mcg/cc 10ml 500mcg
7. #2-7 entanyl 50mcg/cc 10ml 500mcg
8. #2-8 entanyl 50mcg/cc 1 Oml 500mcg
9. #2-9 Fentanyl 50mcg/cc 10ml 500mcg
10. #2-10 Fentanyl 50mcg/cc 10ml 500mcg
1 1. #2-1 1 entanyl 50mcg/cc 10ml 500mcg
12. #2-12 Fentanyl 50mcg/cc 10m] 500mcg
13. #2-13 Fentanyl 50mcg/cc 10ml 500mcg
14. #2-14 entanyl 50mcg/cc 10ml 500mcg

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Administration of Drugs for Lethal Injection

15. #2-15 Fentanyl 50mcg/cc 10ml 500mcg

16. In the unlikely event that it is deemed necessary (see protocol in EM 110),
additional syringes of Fentanyl may be ordered by the Director, and then
prepared and injected by the Drug Administrators. If ordered, additional
syringes will be similarly labeled and numbered next in sequence, for
example the next syringe would be numbered #2-16, then #2-17 and so on.

Tray-3: Cis?atracurium (labels to be blue in color)

CONCENTRATION SYRINGE TOTAL
1. #3-1 Cis?atracurium 2mg/1ml 10ml 20mg
2. #3-2 Cis-atracurium 2mg/1m1 10ml 20mg
3. #3-3 Cis-atracurium 2mg/lml 10ml 20mg
4. #3?4 Cis-atracuriurn 2mg/1ml 10ml 20mg
5. #3-5 Cis-atracurium 2mg/lrnl 10ml 20mg
6. #3-6 Cis-atracurium 2mg/ 1m] 10ml 20mg
7. #3 -7 Cis-atracurium 2mg! 1 ml 1 Oml 20mg
8. #3-8 Cis?atracurium 2mg/1ml 10ml 20mg
9. #3-9 Cis-atracurium 2mg/1ml 10ml 20mg
10. #3-10 Cis-atracuriurn 2mg/1ml 10ml 20mg

11. In the unlikely event that it is deemed necessary (see protocol in EM 110),
additional syringes of Cis?atracurium may be ordered by the Director, and
then prepared and injected by the Drug Administrators. If ordered,
additional syringes will be similarly labeled and numbered next in
sequence, for example the next syringe would be numbered #3-11, then
#3-12 and so on.

2. One Drug Administrator will prepare and label the lethal drug syringes. The second Drug
Administrator will observe, verify the preparation, dosage and labeling of each syringe.
The second Drug Administrator will then place the syringes in their correct trays for use.

3. The lethal drugs shall be prepared as directed by the Chief Medical Of?cer or designee.

a. The Drug Administrators shall prepare the designated lethal drugs and syringes so
that the correct number of syringes are prepared and placed in each correctly labeled
tray.

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b. To prepare each syringe for use, the Drug Administrator will draw the appropriate
amount of supplied drug solution into each syringe so that the speci?ed dose of each
drug is made ready in each syringe.

i. Diazepam will be used at a concentration of 5 milligrams per milliliter. For this
drug, the speci?ed doses to be prepared are 25 milligrams in 5 milliliter syringes.
In order to achieve those doses, the Drug Administrator will draw ?ve (5)
milliliters of the supplied solution into each 5 milliliter syringe labeled to contain
Diazepam.

ii. Fentanyl will be used at a concentration of 50 micrograms per milliliter. For this
drug, the speci?ed doses to be prepared are 500 micrograms in each 10 milliliter
syringe. In order to achieve those doses, the Drug Administrator will draw ten
(10) milliliters of the supplied solution into each 10 milliliter syringe labeled to
contain Fentanyl.

Cis-actracurium will be used at a concentration of 2 milligrams per milliliter. For
this drug, the speci?ed doses to be prepared are 20 milligrams in each 10 milliliter
syringe. In order to achieve those doses, the Drug Administrator will draw ten
(10) milliliters of the supplied solution into each 10 milliliter syringe labeled to
contain

NO ATTACHNIENT S: SEE CEM 112 FOR ALL EXECUTION RELATED FORMS

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Effective Date: 11/07/17 Administration of Drugs for Lethal Injection