Latest / Your Leo Nation / Lethal Injection: An Anesthesiologist's Perspective | Dr. Austin Quina

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Lethal Injection: An Anesthesiologist's Perspective | Dr. Austin Quina · Your Leo Nation

• Mark Garrett: So, how did Tennessee so horribly botch the execution of convicted murderer Krista Pike? Welcome to Yorle Nation, where we believe in and support the rule of law. I am the Chief Mark Garrett. Joining us today is a man who I'm sure can give us some insight to that opening question, and that is Dr. Austin Keena. Doctor, welcome to your Leo Nation. Thanks, Mark. Thanks for having me. Looking forward to having a discussion about this. Well, I'll tell you right now, I'm looking forward to getting educated on this. And I know the audience is as well. this is well, it's astounding. And it's not the first time that any of us, certainly myself, have heard of problems with lethal injection. And I really wanted to get into this and I r really wanted to get into the deep of weeds. I want to get educated in all this. And so to do that Just you know, we were talking offline about your knowledge and some research regarding the history of lethal injection. So with that said, just go ahead and educate us on that aspect of it. Okay. Yeah. You know, I I've been really excited about talking to you about this and going into into the weeds as I have a tendency to do. I'm kind of a dot the I's, you know, cross the T's kind of guy. So I I said, Well, where are we going to start? And I said, You know, I really don't know much about the history of it. It it seems like, you know, a a logical evolution of this conversation to start at the beginning. And the idea of lethal injection is actually very old. it goes back into the late eighteen hundreds. Yeah. Back in the in the the late eighteen hundreds the idea was postulated in New York. and there were some issues after some hangings. and whatnot that didn't go as as well as anticipated, from what I understand. and they brought this to I don't know if he was a an attorney or or something like that, some some politician in New York, Jerry, where the I think he was the either the son or the grandson of where the term gerrymandering came from. So he was some type of of legal person or politician and They were looking for a way not to to botch these things, in terms of hangings and whatnot. and somebody came up with the idea of, okay, let's you know, let's inject poison. And they decided for whatever reason that that that was not a great idea. And that that was when I I believe they came up with the decision to implement the electric chair. and for goodness, you know, some sixty, seventy years after that time. Lethal injection was not a thing, but it had been considered. and then sometime in the seventies in Oklahoma, there were some some more botched executions. They were, you know, I think the methods were hanging, firing squad and elect electric chair were were the three most common methods of capital punishment. Yeah. And and and it goes back to Oklahoma in the seventies. there there were a few people involved and one that was asked to review some of the protocols that were postulated was actually an anesthesiologist, which kind of intrigued me as well. by and by the way, I just let me interject here. Yeah. When I introduced you as a medical doctor, I didn't specify that you spent the better part of three decades working an anesthesiologist. Yes. So this is right R right in your wheelhouse. Right right in my wheelhouse. so there was a fella named Wiseman in Oklahoma and they they really didn't want any publicizate pub Publicized enough. Yeah, yeah. I cheated. You know, a a a lot of stuff involving, you know, the media and firing squads and things like that. So he approached the Oklahoma Medical Association for a different method. And they came up with a couple ideas and and one of the guys involved was an anesthesiologist. and the other guy was the the the medical examiner for the state, which oftentimes is a physician, sometimes that's just a a political role as well, an elected official, depending on the municipality. so they came up with a method to do this, and Pretty much the first time lethal injection was used. the initial cocktail was two drugs. one a barbituate. and basically what a barbituate does is it's a a a sedative, so to speak, that that puts you in a hypnotic state where you lose consciousness, a state of anesthesia. so to speak. We can get into the semantics of some of these and and a little deeper into the definitions as we go along. you know, so they they added that and one of the other things that they added was what's known as a non depolarizing muscle relaxant. so you have two types of muscle in your body. You've got the muscles that we all see that, you know, when you work out like like you do, Mark, you know, you're a a pretty good example of a a fit person that stays in shape, takes care of their body. You see what's known as skeletal muscle. Okay. we also have other types of muscle like your heart and your blood vessels and things. They can constrict with different types of muscle called smooth muscle. And these muscles react differently and have different types of receptors and and drugs can affect them differently. So The drug pancuronium, which is a non depolarizing muscle relaxant, was added to the mix. And basically what it does is it paralyzes all the skeletal muscle in the body. It doesn't stop your heart or any of the vital functions, but it stops your diaphragm so you can no longer breathe. And it stops all your other skeletal mu muscle functions so that you can't move. So, you know A lot of your listeners have have probably heard of horror stories involving anesthesia where people are paralyzed yet they feel everything. So the drug that they give pancuronium is one of those drugs that's very long acting. And that's what it would do if that was the only drug you were given. You would be paralyzed yet wide awake. But I just want to clarify with with that drug, you would you would you would asphyxiate as well, right? Yeah, you would. You wouldn't go to breathe. That's exactly what Which which is a horrifying way to die. It it is. So, you know, that's the reason for the the barbituate that was instituted. And the the original drug was a drug called thiopentol. and and pentathal was the trade name. And when I was in training, that was the drug that we used to put almost all of our patients to sleep with. It's it's not in common use anymore, it's not made anymore. there are different versions of the barbituate that are that are made. we mostly use a drug now called propofol, which most people are probably familiar with because of Michael Jackson, so to speak. So it it's also a a sedative hypnotic, different class, different mechanism, but the same endpoint. It it makes you unconscious, unaware, and whatnot. So those were the two drugs that were initially utilized in the recipe for lethal injection. You you've got a barbituate thiopentol, and then you had a muscle relaxant pancuronium. Shortly thereafter, a third drug was added and it it's potassium. And they're different types. I think it was potassium chloride, some version of an injectable potassium. And what potassium does is it affects the smooth muscle of the heart. And it basically makes the heart stop beating. And when patients undergo coronary artery bypass grafting and they go on bypass machine, that's what's utilized to make the heart stop beating so that the surgeon can sew the the grafts and whatnot on to bypass the obstructed coronary arteries. that's still, you know, a method that's done today. We do a lot of stuff that's called off bypass now, but you know, the general principle remains the same. The three drug cocktail was such that we're going to sedate the patient so that they're unaware and that they're asleep, so to speak. We're going to paralyze them so that they can no longer move. And we are going to stop the heart from beating as well. So that's the initial cocktail that was implemented for lethal injection. Now by the way, Doctor, this would be are we talking about the seven nineteen seventies, give or take? yeah, I think seventy seven, you know, don't quote me on that. Seventy seven may have been when it was but but in the eighties, that's when when all that came around and they really started to utilize those things. Okay. so The methods that are used now are a little bit different. a lot of states have adopted a single drug protocol, and that's what Tennessee has. And Tennessee uses a drug called pentobarbital. So you know, this is another one of the rabbit holes that we can go down in terms of how A lot of this process has been really politicized and made difficult when it doesn't have to be difficult because of people's I don't want to just say feelings, but their their their morals and their ethics. and you know, whether you, you know, you believe that capital punishment is is right or wrong, I I think is neither here nor there. it exists. in in some places. And if it's gonna exist, it seems like we should do that appropriately. Well, the the main drug that's driving all these things is a barbiturate. And it's a a really fast acting barbituate, but it's not made anymore. And that was thiopentol that we discussed. that was replaced I I can't remember what year, but a company named Hospira was pretty much the sole manufacturer of that medication. And they stopped making it for a myriad of reasons. and then that was moved overseas to another company. and they had these stipulations that the only way we're going to allow export of this medication is if you can promise us that it will not be used in executions. So eventually i they just went out of business. and I, you know, I don't have all the details of that in front of me, but but I experienced that as well. And that's how you know, propofol ended up becoming the mainstay of provision of anesthesia and induction, intravenous induction of anesthesia for virtually every surgical procedure that's performed in the United States. when I was in training, you know, the majority of the time we use thiopental. Which, you know, it's the same drug they were using for for lethal injection. so they had to find another drug. and and there's a lot of these drugs that exist. There's a there's a whole different, you know, spectrum of barbituates. and so they they they landed on pentobarbital because that's the the next fastest one, so to speak. and I'll give you a little bit of education in regards to that as well. To to understand some of the science behind it. So the reason that we used thiopentol for the induction of anesthesia was because it would act very rapidly. And very rapidly acting drugs that affect the brain are what are known as lipophilic drugs. And that means they have a high affinity to be attracted to fat. Well, your brain is full of a lot of fat, so to speak, a lot of lipids. We're all probably pretty familiar with the term lipid. So the way the drug works is it's it's a concentration gradient. So if you have a lot of something, you know, you can think of it in terms of maybe smell is is a good way to put it, you know. i if there's a scent that's coming from your stove, it's going to diffuse throughout the whole room that it's in. It goes from one spot to a next. And that's that's based on concentration gradients. Well, the same thing happens in pharmacology when you're talking about drugs and how they affect the body. And you have three different areas in your body that determine the effect of drugs. You've got what's called your vessel-rich group, which includes your brain and your vital organs. And then the next group is your muscle. and that's where things are intermediately vascularized. They they don't have as much blood flow as your brain or your vital organs do, but they have the second most. And then you have your fat stores. Okay, so that's where drugs end up in the body while they're circulating and waiting for either your liver or your kidneys to break them down or excrete them in some fashion. And that's how drug effects in general stop. You know, so if you take some type of drug or you're injected with something, it's got to get out of your body somehow. Well, you would think, well, my liver or my kidney or my other organs, that's the way I get rid of drugs. Well, that's not really the entire story. the the science of it is that it depends on the blood flow in your body. So the drug that we use, thiopental, was very highly lipophilic and attracted to the brain. So it would get there quickly, but just as quickly as it got there, within about a minute or a few minutes, it then redistributes to the muscle and the fat. And that's how the effect would go away. Even though it's a really long-acting drug that stays in your body for a significant period of time, once you're injected with it, You wake up from it fairly rapidly because the effect in the brain has subsided due to the redistribution of the drug to a different area of your body while it's being stored and waiting to be broken down. so when they took that drug away from us, that's how we went to propofol. But in terms of what we're doing for lethal injection, they had to use another drug. And this other drug, pentobarbital, is fine. It doesn't act as fast, but it lasts a significantly longer period of time because it has less affinity for fat in the body and it's stored so it can continue to recirculate and affect the brain for a longer period of time. and that has some relevance to this story. and the reason behind what we're seeing in terms of maybe what the latest updates are with tell her Christina Pike, I I believe was her name. Yeah. Krista Krista Pike. Krista Pike, yeah. So the convicted murderer. I I listen editorializing. I like to put that in the No, she's yeah, I mean that she was sentenced. She was found, you know, found guilty by a jury of her peers and sentenced and yeah, you know, and this was this was her sentence. so we've got some of the science of that. And and where we're at, we started with three drugs, but now we're down to one drug. And and the reason we're down to the one drug is because a large volume of that drug doesn't redistribute. People go to sleep and they stay asleep for an extended period of time once that drug is in your body. Unlike thiopentol, which we used to use, where the the brain effect would wear off. So the reason that I'm saying Doctor Because actually we know each other personally, so I called you Austin there. But can can you just backtrack a little bit and tell us to the best of your knowledge, why was Theo is it Theopental? Is that right? Thiopentol. Why did that go away? What was the reason behind that? It seems like it worked really well. What happened? Well, it it's it it worked well, but you know, better drugs came along. Tropophol was a better a much better drug. Okay. And You know, it wasn't a highly utilized drug any longer. And the the people that made it were, you know, they have their own moral, ethical and political reasons for not wanting to provide it, so to speak. Okay. Yeah, I was wondering if there if there was like any political reason behind it, things like that, but it seems like it was just more of a scientific and efficacy reason that it went away. Yeah. So w what I'm Seeing here in my notes, as we had discussed it. So this is back in 2011. Hospira was the pharmaceutical company and was the only US manufacturer of it. They stopped making it. Italy refused to let a plant there produce it unless Hospira could guarantee that exports of that drug would not be used in capital punishment in the United States. Well. You know, you you bring in a whole host of political issues there, exports and and ways to get around that by bringing it to other countries and ends. So they just decided not to to end they stopped making it in the US. They could no longer export it without that guarantee. So that's more or less why it went away. and they had to go to other drugs. Gotcha. And that takes us to where we are now that you were just about ready to talk about. I interrupted you. Yeah, you know, they they used some other classes of drugs, benzodiazepines and narcotics, and had some failed issues with that as well, and and just decided to go to a a large dose of a different barbiturate that was available in the United States from from my understanding. and they no longer had to use the three drug cocktail. Because this is such a long-acting drug. and to give give your listeners a little background understanding on that, there's some science behind all this. So, and it's kind of interesting. So when it comes to to death, so to speak, or unconsciousness, there there's a lot of myth out there. when it comes to execution. And you go back to, you know, France back in, you know, the the revolution and and all that and the guillotine. you know, there there are all these myths about the executioner would take the head and you know, once it was severed and show it to the body and and whatnot. And and you'll see reaction in the facial facial muscles and whatnot. and that has bearing today when it comes to anesthesia a or or any type of surgical procedure as well. Just because you're unconscious and just because you don't perceive that you're experiencing pain, your body still shows the signs and symptoms of that. And and the classic example of that is a definition in the anesthesia world. it's called MAC, MAC. And what that is is the minimum alveolar concentration, the concentration in your lungs of the drugs that we have people inhale to stay asleep once they're in sleep. So there is a number that's associated with that. And one MAC, which Is considered by definition, it's the amount of inhaled agent in one's body or lungs where they will only respond to surgical stimulus 50% of the time. So what can you imagine a response to a surgical stimulus is? Well, movement is one. So even though you're unaware, your body still has the ability to move and to respond to pain. Your heart rate goes up, your blood pressure goes up, all those things happen. so that's the reason why we use muscle relaxants a lot of the time in anesthesia to facilitate surgical procedures. you're asleep, you're unaware, but for instance, if somebody's doing eye surgery and there's a per small percentage that your head could still move. obviously you could have catastrophic results. so you want to facilitate the surgery by relaxing the muscles and preventing the ability of the patient to move. You know, and and people kind of are are probably stunned to know that, to to be aware of that, because it's an uncomfortable thought that, hey, my body can still respond. Well You know, that that's the idea behind some of those myths and things that, you know, with guotine execution and things like that, they can, you know, you're still aware, you're still conscious. Well, that's not the case. Once your cerebral perfusion pressure, the blood pressure supporting the brain goes to zero, which happens, you know, when you you sever things or you collap collapse your cardiovascular system. you probably have a maximum amount of neuronal function of about four seconds. You know, so once blood flow stops to the brain, your ability to perceive anything is is gone. It just doesn't happen. You know, so people thinking that, you know, I could still be aware you know, say firing squad and and things like that. Once once blood flow ceases like that, it it's it's seconds, literal seconds. of even the potential to have any type of awareness. So the the thing that we're trying to do when they were initially performing these lethal injections was they didn't want you know the body moving around and things like that. And that kind of ties in to the Pike issue. So basically what happened there is the the intravenous catheter was not intravenous. it it there there are basically three things that could have happened. They were in the vein and it went through the back side of it. They were in the vein, but the catheter either tore part of the wall of the vein so that a bunch of the medication that was injected leaked around it, or they were just in the subcutaneous tissue and never in the vein at all. so the the most likely scenario is that extravasation occurred. And what extravization is, is basically the leakage of what we call a vesicant into the surrounding tissues. and a vesicant is a destructive compound, whether it be a a drug, a fluid. whatever. anything that can damage the surrounding tissue is is a vesicant. so the the catheter, maybe it was in the vein and the majority of the medication leaked around it. Maybe it was through the vein and it was injected behind it, or it was never in the vein and it was just injected into the the fat and subcutaneous tissue of her arm. We can postulate that a significant amount of the drug was actually received by her because she lost the ability to stay awake. She she went unconscious somewhat. You know, she she wasn't talking. I I know there are some reports out there that, you know, th there were some eyewitnesses saying that she was wide awake and singing and this and that, but that's clearly not the case because We know by certainty, based off reliable vetted resources now in the media, that she is unconscious and having to have l life-saving measures to continue to breathe and whatnot. So she did lose consciousness at some point. And you know, as a clinician, that tells me that some of the drug was received intravenously. the other possibility is that a significant portion of the drug was eventually absorbed from the subcutaneous tissues. And you may be familiar with intramuscular injections. A lot of the vaccinations that people get are just it's a shot in the arm. It's not going into a vein. And you know, as we discussed before about how distribution of things happen in in the body, if you put something in the muscle, your muscle has blood flow. Well As the blood reaches that, it has no concentration of what's in the muscle. So anything that's in there will eventually diffuse into the vascular system and go throughout the body and affect other things. So some of the medication was definitely absorbed subcutaneously, and some of the medication was probably received intravenously. It just wasn't enough to to kill her, so to speak. Let me let me interrupt. This is this is fantastic. I mean, it's interesting. It's also disturbing to me on on a couple of levels. First of all, I just just want to clarify here. So in your opinion, the the drug that's being used now for lethal lethal injection execution, it's not a problem. In other words, the drug does what it is intended to do. Very good. The drug is fine. The drug is fine. This is really important. because it takes us to the next point here where look, I've been under the knife a number of times. And I remember one time that I think I think it was the first time, maybe second time, that I was put out, you know, right before the O before O R. And the phlebotomist, the nurse, whatever it was, I mean, and I've got veins sticking out every place, especially thirty years ago. Every place. And this person just could not get the needle in. Could not get this going. It kept rolling. Now, my my brother, who at the time, he was a he was a firefighter in Los Angeles for 30 years, and 20 of that, he was a paramedic. He started IVs all the day, all day long in Los Angeles, trust me. And he was sitting there, he was getting I mean, he was really g getting furious. He said, Hey lady, I'm a paramedic. I'll start the IV. She actually, I don't know what kind of breach this was, but she actually let him start the IB and he first stick he got it right in. Yeah, right in taped it up and he sat back down. And my question is this in other words, she knew she wasn't hitting a vein with me. My brother knew he hit it when he started it. How did these people, and I think you're probably right here, if the drug is the drug is is solid, how did they not know that they either missed vein went through it. how how do you what kind of oversight or lack there is there in this case? So we're dealing with clearly educational and training issues. And you know, I I I think to answer that question, you've got to understand the people that are doing this. And they're more often than not not They're just not well trained because the the medical societies in general don't allow clini clinicians to participate in this process. Is this a is it a HIPAA issue or something? Or not not HIPAA. I'm sorry. I didn't mean HIPAA. I said so much as once a police officer, HIPAA, HIPAA, HIPAA, HIPAA. What the what I'm talking about is the Hippocratic Oath. Is that what this is about? That that's what it comes down to. it's that and it's a it's a consent issue. So in in terms of the the medical bodies, whether it be a medical board, whether it be a board certification bodies, for so for me, I you know, I rely upon the American Board of Anesthesiology. I'm board certified by them. I have a a a medical license where I go through a state medical board. That reviews my credentials and grants me license. And then to keep up my educational requirements, I'm a member of various medical societies, in particular the American Society of Anesthesiologists. So the states not so much, but the national medical organizations and the and the board bodies have all come to the same conclusion that clinicians. should not be involved in the process of capital punishment. Interesting. And it comes down to consent. And everything that we do as clinicians to other individuals requires their consent. You know, I if you're going to come to me and have a procedure and I have to put you to sleep for that, I'm going to discuss with you all the risks. All the benefits, all the alternatives to how I think you should have it done, and let you participate and give your consent in some fashion, whether you want to go with my advice or you want to seek other alternatives. And so we develop a relationship in that regard, but I can't do anything to you without you giving me your consent. Now I'm not a lawyer or anything like that for sure, but I understand some of the basics of this. And and that's what the the the bodies that encompass, say, the American Medical Association, the American Board of Anesthesiology, they believe that since somebody that is being letally injected, they they're not giving consent. You're doing that obviously against their will. It's a sentence imposed upon them by a judge and a jury of their peers. So there's no consent, therefore the the the clinical act of providing some type of medical care is you can't do it. So that's that's where they base it upon. So how do we get around that? you know, it's it's very difficult to have any clin clinical providers involvement. Now, that doesn't mean that, say, an EMT or a paramedic or a an LPN or something like that. may be able to participate, but that's usually, you know, they have people that just aren't well qualified or well trained and do this on a day-to-day basis. They're just people that do it on occasion. And anything that you do I would say so by the way, executions. Yeah. So if if you're just doing it occasionally, you you clearly don't have the you know, you're not very fast, so you don't have good clinical skills to be able to do those things. So the margin of error goes up significantly. and that's why these things get botched a lot. Now, you know, taking it a step forward, a lot of the states have implemented anonymity and and shield laws and things like that so that they can get clinicians to do that. But if the board were to find out that you did it, they can, you know, they can just say, Hey, we're gonna revoke your board certification. Most of the licensing bodies don't do that. There needs to be some type of disciplinary thing. So there's a much lower risk, I think, of of losing a license, so to speak. But, you know, you can be taken out of the American Medical Association, your your board, your boards can be revoked so that you're no longer board certified. And that basically makes you unemployable as a clinician, you know, because if I were to go to a hospital and even though I have a a license to practice medicine, if I'm not board certified and I'm not an upstanding member of the societies that I'm involved with that keep up with my education, they're not gonna license or they're not going to credential me to practice medicine in their facility. So, you know, it really hinders, you know, no matter w what you think about, you know, the the the ethics or morals of capital punishment, They've made it such that people that can actually do this, I think, in a manner to where it's not botched, so to speak, they're they're taken out of the equation and all you have are people that just don't do it often and and basically, you know, Tennessee's requirement, they have a four-hour online course from what I've found in in some of my reading based upon their protocols of of training. But that's not hands-on training. It's but it's watching a YouTube video. Now, you know, if if you're good with your hands, you know, it's it's fine. You you can probably go on YouTube and learn how to do a lot of things. I do that all the time around my house with, you know, plumbing and electricity and things like that. I think we all do. But you know, when it comes to medicine, there's there's something different there. And they they've taken they're they're taking the the clinical providers that have the skills to this out of the equation and putting it in the hands of people that have a much higher failure rate and complication rate. So something that may have a less than 1% or a 0.1% failure rate goes up into, you know, five, 10, 15, 20% risk of failure. So that's basically what we're seeing here. And and they just don't know how to recognize it. It it it's actually very simple, the processes and things, but if you haven't been educated and and you don't know how to how to see it, there's a lot of things that can happen to make it look like you have a functioning IV when in fact you don't have a functioning IV. you know, the it based off the pictures I've seen of of this woman, you know, she's not super thin. She she probably has a bit of of fatty tissue and and loose subcutaneous tissue. And that's a prime setup to have a subcutaneous intravenous catheter, so to speak. you think it's in the vein and, you know, anybody that's ever had a surgical procedure, you know, you go in, you you, you get your IV and you look up and there's a bag of fluid connected to it and you see a little bit of a drip, you know, drip, drip, drip, drip. Well, that can happen even when it's not in a vein. if it's just separating the tissues subcutaneously, it can do that for a significant period of time before it's recognized. You know, if the patient doesn't, you know, notice it right away, maybe there's a little tingling, but eventually it swells to the point and starts to be uncomfortable where it's noticed. But the process that they use here is a is a large bolus dose of medication where You know, they they push it all in at once. and once it goes in there, yeah, they'll s you know, maybe they start to see it. But like that's kind of what leads me to to believe that this was most likely you know, an extravasation where a a portion of the drug actually was delivered to its appropriate intended target. But there was a lot of leakage around. and the other thing that can happen is, you know, under pressure, your your veins are very can be very fragile. And if somebody is put a putting a a bunch of hydrostatic pressure on the syringe or whatever to push the medication, it can rupture the vein. So so that could have easily happened as well, where you know the the first bit of it was was delivered appropriately. But because they they pressed too firmly too fast instead of taking their time to deliver it appropriately, the vein ruptured and they didn't recognize it. And that's that's easy to do. I you know, I countless times in in my career I have had these same things happen. It happens every day in every medical institution, you know, across the country. We have infiltrations, extravasations. ruptured veins, difficult IV starts. And these are, you know, with people that are trained to do this. So if if you consider that, you know, we we have a failure rate of of X percent, I don't know what that is, on a day to day basis basis with licensed clinical practitioners that do it every day, you know, people that do it on rare occasion, what's their failure rate going to be? We can only expect that the a It's gonna be higher. Much yeah. much higher. Well, this is this is really eye opening for me. really from from you know a law enforcement background and and of course for I mean listen, like you said, whether one is i in support of capital punishment or opposed to it, it's not the issue. The issue is we know that it exists. And so since the debate has been for, I guess we'll probably centuries about certainly in this country about cruel and unusual. That's what the debate has centered around. there's nothing inherently more cruel or more unusual with the proper administration of the current drug that you you talked about when it comes to lethal as opposed to firing squat and probably certainly more more more humane than hanging, but it's the administration of the drug where we get into you know these problems. It is interesting, of course, now that Tennessee has suspended all executions. Now I that's why I've read in a couple of articles that suspend all executions. I assume they only execute through l lethal injection in Tennessee. but it's maybe for you know, listen, for the purposes, you know, of politics, people who do support capital punishment, I I hope that Tennessee gets it right, certainly improves. You know, the things you laid out here ab about these people who are not trained, they're not practiced. It's it gonna be a difficult difficult one to to overcome right now. they're gonna have to train some type of change protocols here, training, oversight, you know, to get this done. Well, but you know, I guess we will see what happens and I'm gonna give you the final word, Doctor. Well, you know, that goes back to more of the the Politicization of all of this. So even if we want to do it humanely, with you know the lowest failure rate possible, that you know, that would be ideal. as a physician, I I can't even give tips. I can't educate. I can do nothing to train somebody that would perform the procedure. So not only have they they taken away the ability of, you know, clinicians to do it, they've also taken away the ability for any clinician to train or advise upon it as well. Wow. and and you know, there's a whole lot of, you know, ethics and and and moral considerations there, obviously. It it it just means that there there needs to be more discussion on it, for sure. But if you're gonna do something, why not do it to the best of your ability and use the resources to make sure that things, you know, are gonna go well. I i I don't really understand th the whole process behind a state that allows it where they can then you know, not shield their clinicians that that would want to have it performed humanely and and you know inherently block the ability. There's there's, you know, there it's a catch twenty two for sure. well it sounds like it's a s a self imposed catch twenty two because I think that where there's where there's a will, then there certainly is a a moral and legal way to to rectify the situation the situation to well To the best of one's ability to ensure something like this does not happen again. Dr. Austin Keena, it has been a pleasure as much as it's been an education. It really has been. I thank you for your time, your expertise. And as I said earlier, and you what one another another word? Go ahead. Well, I was just gonna say I I appreciate you having me on, Mark. And I you know, I I I get on on tangents and and I I wish I was a little bit better. prepared to to, you know, I I feel like I kind of got off track here and there, but hopefully, you know, there was some some good information there that that people can utilize to to educate themselves further and and whatnot. You know, I may have misspoke on a few things, but I I I really spent some time trying to to learn about this and think about it critically from my own point of view as a practicing clinician. So you did a fantastic job. Fantastic job. I really enjoyed it. And again it was eye opening. But we will see you again. I'll see you. I'll s I'm sure I'll see you around the water. sometime not in the t Yeah, looking forward to it. Looking forward to it myself. My best your lovely wife, and we will be in touch. For your Leonation, I am the chief Mark Garrett. Make sure you subscribe, tell your friends, share. We will see you next time. God bless you, God bless America.