IN THE UNITED STATES DISTRICT COURT WESTERN DISTRICT OF MISSOURI 

CENTRAL DIVISION  MICHAEL ANTHONY TAYLOR,    ) 

) Plaintiff,         ) 

) v.            ) 

) LARRY CRAWFORD,        )   Director,          )  No. 05‐4173‐CV‐C‐SOW   Department of Corrections;    )               ) JAMES D. PURKETT,        )   Superintendent,        )   Eastern Reception Diagnostic  )   Correctional Center; and    )  JURY TRIAL DEMANDED               ) JOHN DOES 1‐666,        )   Anonymous Executioners,    ) 

) Defendants.        ) 

 VERIFIED 

COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF 

COMES NOW the plaintiff, Michael Anthony Taylor, by and through 

appointed counsel, John William Simon, and—as authorized by 42 U.S.C. 

§ 1983—prays the Court for its declaratory judgment holding that the 

existing procedure for lethal injection that the State of Missouri and its 

officials, officers, and employees, acting under color of state law, use in 

‐ 2 ‐ 

executions violates the Eighth, Thirteenth, and Fourteenth Amendments, 

because it would inflict on him cruel and unusual punishment, which 

would thereby deprive him of life, liberty, or property without due process 

of law, and would inflict on him a badge of slavery, in that the defendants’ 

selection of a three‐chemical sequence—itself unnecessary to bring about 

the statutory goal of his death—as a means of applying their chosen 

method of execution (lethal injection) creates a foreseeable risk of the 

infliction of gratuitous pain, i.e., a specific form of an otherwise lawful 

method of execution which is more painful than necessary to accomplish 

the statutory purpose of bringing about the “mere extinguishment of life.”1 

 In an exhibit submitted with this complaint, the plaintiff shows that a peer‐

reviewed study of autopsy and toxicology data from executions in the four 

jurisdictions which did the tests, kept the results, and agreed to make them 

available to scholarly researchers would indicate this foreseeable risk to be 

at least 43% likely to occur. 

Plaintiff does not in this action dispute whether the State of Missouri 

can kill him, but rather demonstrates that the way its agents have chosen to 

do so is unconstitutional.  Plaintiff prays the Court for its preliminary 

                                           1In re Kemmler, 136 U.S. 436, 447 (1890). 

‐ 3 ‐ 

injunction to prevent the defendants from executing him at all, however, 

until he has had an opportunity to present his case after discovery and in 

open court and to receive an adjudication on the merits, and thereafter for 

its permanent injunction to prevent the defendants from using this form of 

lethal injection on the plaintiff; for its order granting the plaintiff 

reasonable attorneys’ fees and costs; and for such other relief as the Court 

finds appropriate. 

I. Summary 

As set forth in detail in the declarations of anesthesiology professors 

Mark J.S. Heath, M.D. (Exhibit 1), and David A. Lubarsky, M.D. (Exhibit 2) 

which are attached to this complaint, the use of a specific succession of 

chemicals in judicial executions by lethal injection—which the defendants 

or their predecessors in office have admitted they use—creates a 

foreseeable risk of the gratuitous infliction of pain and suffering, in that the 

first of the three chemicals is used by health‐care professionals specifically 

because it wears off when the patient experiences stimuli which produce 

pain; the second chemical paralyzes the prisoner such that he cannot 

breathe and he suffers from suffocation, but the prisoner cannot cry out or 

even flinch, because of the paralysis; the third chemical burns as it works 

‐ 4 ‐ 

its way through his veins to the heart, killing him with a heart attack—

which to a conscious person is painful.  The co‐authors of a peer‐reviewed 

study published April 16, 2005, in the world‐renowned medical journal 

THE LANCET found that in 43% of the executions for which four states 

provided information, the levels of anesthesia were inadequate to render 

the prisoner unconscious at the time of his death; and those executions 

were in jurisdictions which (unlike Missouri) were careful enough to keep 

records and confident of the humanness of their several practices to share 

these data with the co‐authors.  None of the three chemicals are required by 

Missouri statute; neither any one of them nor the combination of them is 

necessary to bring about the death of the plaintiff.  Defendants could bring 

about the death of the prisoner by the administration of a single, lethal 

dose of a single anesthetic, pentobarbital, as their veterinarians would do if 

they had a pet which they decided to have euthanized.  The Eighth 

Amendment forbids the gratuitous infliction of pain and suffering, and the 

Fourteenth Amendment applies this guaranty against the states.  The 

Thirteenth Amendment abolishes slavery, of which not only the 

contemporary infliction of the death penalty but more specifically the use 

of a form of execution more painful than necessary to bring about the death 

‐ 5 ‐ 

of the prisoner is a relic, a vestige, and a badge.  Plaintiff is entitled to the 

relief he seeks. 

II. Statement of Exhibits 

1. Declaration of Mark J.S. Heath, M.D. with curriculum vitae 

attached as “Heath Exhibit 1” 

2. Declaration of David A. Lubarsky, M.B.A., M.D., with 

curriculum vitae and LANCET article attached as “Lubarsky Exhibits” 1 & 2 

respectively 

3. Johnston v. Kempker, No. 4:04‐CV‐1975‐DJS, Defendant Gary 

Kempker’s Answers and Objections to Plaintiff’s First Set of Interrogatories 

(E.D. Mo. Dec. 22, 2004) 

4. Johnston v. Kempker, No. 4:04‐CV‐1975‐DJS, Defendants’ 

Memorandum of Law in Support of Motion to Dismiss (E.D. Mo. Nov. 15, 

2004) 

5. Johnston v. Kempker, No. 4:04‐CV‐1975‐DJS, Exhibit 1 to 

Plaintiff’s Response to Defendants’ Motion to Dismiss (E.D. Mo. Dec. 6, 

2004) 

6. Johnston v. Kempker, No. 4:04‐CV‐1975‐DJS, Defendant’s Reply 

to Plaintiff’s Response to Motion to Dismiss (E.D. Mo. Dec. 20, 2004) 

‐ 6 ‐ 

7. Jones v. Crawford, No. 4:05‐CV‐653‐RWS, Transcript of 

Temporary Restaining Order Hearing (E.D. Mo. April 25, 2005) 

8. Informal Resolution Request with Cover Affidavit by Vernon 

Brown, executed May 6, 2005 

9. Affidavit of Stanley D. Payne with Informal Resolution Request 

and equivocal unsigned statement by staff attached 

10. Declaration of Michael Lenza, Ph.D., with curriculum vitae 

(Exhibit 1) 

11. M. LENZA, POLITICS OF DEATH: A STATISTICAL, THEORETICAL, AND 

HISTORICAL EXAMINATION OF THE DEATH PENALTY IN MISSOURI, University of 

Missouri–Columbia, 2005 (hitherto unpublished Ph.D. dissertation) 

12. John F. Galliher, et al., REPORT TO THE OFFICE OF THE MISSOURI 

PUBLIC DEFENDER ON PROPORTIONALITY OF SENTENCING IN DEATH‐ELIGIBLE 

CASES, filed by Missouri State Public Defender System in, inter alia, State v. 

Parker2 

                                           2886 S.W.2d 908 (Mo. 1994) (en banc), cert. denied, 514 U.S. 1098 (1995), 

citing In re Estate of Danforth, 705 S.W.2d 609, 610 (Mo. Ct. App., S.D. 1986) (providing for judicial notice of the record resulting in an opinion to determine grounds on which opinion is based).  A published work coming after the original Galliher study but before the Lenza et al. study is J.R. SORENSEN AND D.H. WALLACE, Capital Punishment in Missouri:  Examining the Issue of Racial Disparity, 13 BEHAVIORAL SCIENCES AND THE LAW 61, 75 

‐ 7 ‐ 

13. M. Lenza et al., THE PREVAILING INJUSTICES IN THE APPLICATION 

OF THE DEATH PENALTY IN MISSOURI (1978‐1996) (2002), available May 18, 

2004, at 

http://www.umsl.edu/divisions/artscience/forlanglit/mbp/Lenza1.html 

14. Denise Lieberman, Legal Director, American Civil Liberties 

Union of Eastern Missouri, PROSECUTORS:  THE FIRST LINE OF OFFENSE—

PROSECUTORIAL DISCRETION AND ARBITRARINESS IN ADMINISTRATION OF THE 

DEATH PENALTY, http://www.umsl.edu/~phillips/dp/ACLUDenise.html 

(2001) 

15. J. SOSS ET AL., Why Do White Americans Support the Death Penalty? 

65 J. OF POLITICS 397, 409 (2003), 

http://www.polisci.wisc.edu/~soss/Research/Articles/JOP_2003.pdf 

16. Affidavit of Michael Anthony Taylor executed May 27, 2005, 

with Informal Resolution Request attached 

17. Missouri Department of Corrections, Department Manual, D5‐

3.2, Offender Grievance 

18. Brown v. Crawford, No. 4:05‐CV‐746, Transcript of Hearing on 

Motion for Temporary Restraining Order (E.D. Mo. May 13, 2005) 

                                                                                                                                        (1995). 

‐ 8 ‐ 

III. Parties 

1. Plaintiff, Michael Anthony Taylor, CP‐89, is a citizen of the 

United States and a resident of the State of Missouri. 

2. Plaintiff is a person within the jurisdiction of the State of 

Missouri. 

3. Plaintiff was sentenced to death in the Circuit Court of Jackson 

County (the Hon. Alvin G. Randall, Circuit Judge; on remand, the late Hon. 

Michael Coburn) for the kidnapping, rape, and murder of a minor child, 

A.H., while acting together with Roderick Nunley. 

4. Plaintiff is attacking the conviction and sentence of the Circuit 

Court of Jackson County in at least one pending action before the Missouri 

Supreme Court, a motion to recall the mandate filed on or about March 25, 

2005, in its Appeal No. 85235, but not in this complaint. 

5. Plaintiff is incarcerated at the Potosi Correctional Center, 11593 

State Highway O, Mineral Point, Washington County, Missouri  63660. 

6. The State of Missouri conducts its executions at the Eastern 

Missouri Reception, Diagnostic & Correctional Center, 2727 Highway K, 

Bonne Terre, St. Francois County, Missouri 63628. 

‐ 9 ‐ 

7. Defendant Larry Crawford is Director of the Department of 

Corrections of the State of Missouri. 

8. Defendant Crawford is specifically authorized and directed by 

state statute to prescribe and direct the means by which the Department of 

Corrections carries out executions within the statutorily specified methods 

of lethal gas or lethal injection.3  Plaintiff does not in this complaint contend 

that lethal injection is per se unconstitutional. 

9. Defendant Crawford is sued in his individual and official 

capacity for the purpose of obtaining prospective declaratory and 

injunctive relief. 

10. At all times and in all respects referred to in this complaint, 

defendant Crawford acted and will act under color of state law. 

11. Defendant Crawford’s office is at 2729 Plaza Drive, Jefferson 

City, Cole County, Missouri  65109. 

                                           3Mo. Rev. Stat. § 546.720:  “The manner of inflicting the punishment 

of death shall be by the administration of lethal gas or by means of the administration of lethal injection.  And for such purpose the director of the department of corrections is hereby authorized and directed to provide a suitable and efficient room or place, enclosed from public view, within the walls of a correctional facility of the department of corrections, and the necessary appliances for carrying into execution the death penalty by means of the administration of lethal gas or by means of the administration of lethal injection.” 

‐ 10 ‐ 

12. Defendant Crawford is a resident of the Central Division of the 

Western Federal Judicial District of Missouri. 

13. Defendant James D. Purkett is Superintendent of the Eastern 

Reception, Diagnostic & Correctional Center (ERDCC), in Bonne Terre, St. 

Francois County, Missouri. 

14. Defendant Purkett is “warden” or chief executive officer of 

ERDCC, and is therefore charged with the management of ERDCC. 

15. Defendant Purkett’s principal place of business is the Eastern 

Reception, Diagnostic & Correctional Center (ERDCC), 2727 Highway K, 

Bonne Terre, St. Francois County, Missouri 63628. 

16. Defendant Purkett is a resident of the Eastern District of 

Missouri. 

17. ERDCC is where the State of Missouri began conducting its 

executions on April 27, 2005. 

18. By virtue of his authority over the staff of ERDCC, defendant 

Purkett is responsible for the way in which executions are conducted in 

Missouri. 

19. Defendant Purkett is sued in his individual and official capacity 

for the purpose of obtaining declaratory and injunctive relief. 

‐ 11 ‐ 

20. At all times and in all respects referred to in this complaint, 

defendant Purkett acted and will act under color of law. 

21. Defendants John Does 1‐666 are officials, officers, employees, 

agents, and servants of the State of Missouri who, by virtue of their 

employment or other status (including independent contractors and 

volunteers under the supervision of the defendants and their designees), 

participate in the planning of, purchasing and preparation for, carrying out 

of, and covering up of details about executions in the State of Missouri. 

22. Plaintiff cannot provide the Court the natural names of these 

individuals because the State of Missouri and its officials, officers, and 

employees have thus far kept them secret. 

23. John Does 1‐666 are sued in their individual and official 

capacities for the purpose of obtaining declaratory and injunctive relief. 

24. Defendants Does 1‐666 reside in the Eastern and Western 

Districts of Missouri. 

25. At all times and in all respects referred to in this complaint, 

defendants Does 1‐666 acted and will act under color of law. 

26. Each and all of the foregoing defendants Crawford, Purkett, 

and Does 1‐666 at all times relevant to this complaint were acting in their 

‐ 12 ‐ 

official capacities with respect to all acts and omissions described in this 

complaint, and were in each instance acting under color of state law. 

27. Unless permanently enjoined against doing so, the defendants 

and each of them intend to act in their respective official capacities and 

under color of state law to execute the plaintiff by lethal injection in the 

manner set forth in this complaint. 

IV. Jurisdiction 

28. Plaintiff brings this action to enforce and protect his rights 

under the Eighth Amendment to the United States Constitution, as applied 

against the states by the Fourteenth Amendment, and also to enforce and 

protect his rights under the Thirteenth Amendment. 

29. This Court has jurisdiction over this cause under 28 U.S.C. 

§ 1331, in that it arises under the Constitution of the United States; under 28 

U.S.C. § 1343(a)(3), in that it is brought to redress deprivations, under color 

of state law, of rights, privileges, and immunities secured by the United 

States Constitution; under 28 U.S.C. § 1343(a)(4), in that it seeks to secure 

equitable relief under an Act of Congress, i.e., 42 U.S.C. § 1983, which 

provides a cause of action for the protection of rights, privileges, or 

immunities secured by the Constitution and laws of the United States; 

‐ 13 ‐ 

under 28 U.S.C. § 2201(a), in that one purpose of his action is to secure 

declaratory relief; and under 28 U.S.C. § 2202, in that one purpose of his 

action is to secure permanent injunctive relief. 

30. In addition to the foregoing, this Court has jurisdiction by virtue 

of the United Nations Convention Against Torture and Other Cruel, 

Inhuman or Degrading Treatment, or Punishment. 

31. Article 1, ¶ 1 of the Convention defines “torture” as “any act by 

which severe pain or suffering, whether physical or mental, is intentionally 

inflicted on a person for such purposes as obtaining from him or a third 

person information or a confession, punishing him for an act he or a third 

person has committed or is suspected of having committed, or intimidating 

or coercing him or a third person, or for any reason based on 

discrimination of any kind, when such pain or suffering is inflicted by or at 

the instigation of or with the consent or acquiescence of a public official or 

other person acting in an official capacity.”  (Emphasis supplied.) 

32. Article 2, ¶ 1, provides that “Each State Party shall take effective 

legislative, administrative, judicial or other measures to prevent acts of 

torture in any territory under its jurisdiction.” 

‐ 14 ‐ 

33. Article 1, ¶ 1 adds that torture “does not include pain or suffering 

arising only from, inherent in or incidental to lawful sanctions.”  Because 

the plaintiff invokes the treaty as providing a remedial structure rather 

than as a source of substantive law, it would be begging the question or 

beside the point for the defendants to argue that the pain from their 

specific method of lethal injection is part of a “lawful” sanction.  The Eighth 

Amendment controls on the question whether such an execution is lawful. 

34. Consequently, because this Court’s jurisdiction does not depend 

on a federal statute, 42 U.S.C. § 1997e would not bar relief even if the 

selection of a garrote rather than lethal injection were a “prison condition.” 

V. Venue 

35. Venue is proper in this federal judicial district under 28 U.S.C. 

§ 1391(b)(1)‐(3) in that (1) defendant Crawford resides in its territorial 

jurisdiction; (2) defendant Crawford’s decisions regarding the specific 

means of using lethal injection are made in its territorial jurisdiction, and 

(3) defendant Crawford may be found in its territorial jurisdiction. 

VI. Facts 

36. Plaintiff restates and realleges the contents of each preceding 

paragraph as if fully set forth again. 

‐ 15 ‐ 

37. Defendants intend to execute the plaintiff by lethal injection 

using a succession of three chemicals:  sodium pentothal, pancuronium 

bromide, and potassium chloride. 

38. As set forth in greater detail in the declarations of 

anesthesiologists, Mark J.S. Heath, M.D. (Exhibit 1), and David A. 

Lubarsky, M.D. (Exhibit 2), the use of this succession of chemicals in 

judicial executions by lethal injection creates a foreseeable risk of the 

gratuitous infliction of pain and suffering.  The use of this succession of 

chemicals, or of any one or more of them, is absolutely unnecessary to 

bring about the death of the plaintiff.  (E.g., Exhibit 1, ¶¶ 25, 36, 41 & 45.) 

39. Specifically, sodium pentothal, also known as thiopental, is a 

ultra‐short acting substance which produces shallow anesthesia.  Health‐

care professionals use it as an initial anesthetic in preparation for surgery 

while they set up a breathing tube in the patient and use different drugs to 

bring to patient to a “surgical plane” of anesthesia that will last through 

the operation and will block the stimuli of surgery which would otherwise 

cause pain.  Sodium pentothal is intended to be defeasible by stimuli 

associated with errors in setting up the breathing tube and initiating the 

‐ 16 ‐ 

long‐run, deep anesthesia; the patient is supposed to be able to wake up 

and signal the staff that something is wrong.  (Exhibit 1 ¶¶ 20‐22.) 

40. Sodium pentothal is unstable in liquid form.  To be effective as 

an anesthetic, it must be mixed up and administered by a person with the 

qualifications of a licensed health‐care professional.  Licensed health‐care 

professionals cannot by law and professional ethics participate in 

executions.  (Exhibit 1, ¶ 26.) 

41. Therefore, on information and belief, the sodium penthothal 

which the defendants administer to condemned persons in Missouri has 

not been prepared and administered by one who is qualified under 

Missouri law to do so in the therapeutic environment.  This fact increases 

the risk—if not guarantees the result—that the sodium pentothal will not 

have the intended anesthetic effect on the condemned person. 

42. The second chemical the defendants use in lethal injections is 

pancuronium bromide, sometimes referred to simply as pancuronium.  It is 

not an anesthetic.  It is a paralytic agent, which prevents any of the 

voluntary muscles of the body from moving, including those which control 

breathing, and effectively stops the lungs from functioning.  It has two 

contradictory effects:  first, it causes the person to whom it is applied to 

‐ 17 ‐ 

suffer suffocation when the lungs stop moving; second, it prevents the 

person from manifesting this suffering, or any other sensation, by facial 

expression, hand movement, or speech.  (Exhibit 1, ¶¶ 27‐30.) 

43. When sodium pentothal is exposed to pancuronium bromide, it 

precipitates, i.e., returns to the solid condition it was in before the 

executioner of unknown qualifications or lack thereof mixed it up in 

preparation for the execution.  Once it returns to its solid condition, the 

sodium pentothal is no longer active as an anesthetic.  Any one of a 

number of mistakes—the type of mistakes that one would expect to occur 

when sodium pentothal is prepared and administered by a non‐licensed 

person—or simply bad luck, can cause this abatement of the anesthetic 

effect toward the beginning of the lethal injection.  In the absence of the 

assurance that the executioners have the same skills as anesthesiologists, 

nurse‐anesthetists, or even veterinarians or their staff, the likelihood is 

substantial that this will happens in any given execution by lethal injection 

performed in the State of Missouri. 

44. Pancuronium bromide is unnecessary to bring about the death 

of a person being executed by lethal injection.  It has the unconscionable 

effect of creating the possibility that the sodium pentothal will become 

‐ 18 ‐ 

ineffective when the prisoner begins to suffer suffocation from the 

pancuronium bromide.  Its only relevant function is to prevent the media 

and the conscientious staff from knowing when the sodium pentothal has 

worn off and the prisoner is suffering from suffocation or from the 

administration of the third chemical.  (Exhibit 1, ¶ 41.) 

45. That third chemical is potassium chloride, which is the 

substance that causes the death of the prisoner.  It burns intensely as it goes 

through the veins toward the heart.  Because the veins are running back to 

the heart after the arteries have carried it to the extremities, the blood runs 

more slowly than it does in the arteries.  This prolongs the pain the 

prisoner suffers when the sodium pentothal wears off, as it is selected by 

surgical anesthetists because it does.  (Exhibit 1, ¶¶ 43‐44.) 

46. When the potassium chloride reaches the heart, it causes a heart 

attack.  If the sodium pentothal has worn off by the time the potassium 

chloride reaches the heart (as it foreseeably would, given the shallow 

nature of the anesthesia sodium pentothal is supposed to produce, from the 

potassium chloride burning its way through the veins), the prisoner feels 

the pain of a heart attack, but no one but the prisoner can tell, because the 

pancuronium bromide has paralyzed his face, his arms, and his entire body 

‐ 19 ‐ 

so that he cannot express himself either verbally or otherwise.  (Exhibit 1, 

¶¶ 43‐46.) 

47. Veterinarians would not use any of these three chemicals in 

euthanizing animals, because the veterinary profession knows that the first 

is short‐acting and that the second and third are cruel means of bringing 

about the death of a sentient being; for these reasons it would be illegal to 

use either of the latter two chemicals in euthanizing a pet.  (Exhibit 1, 

¶¶ 25, 37‐40 & 47‐50.)  They cause pain and suffering far in excess of what 

is necessary to bring about the mere extinguishment of life. 

48. Veterinarians are forbidden to use these chemicals even though 

they may personally participate in euthanasia and may also recruit and 

retain the most qualified available personnel to assist them.  By contrast, 

physicians are forbidden by the Hippocratic Oath and by positive law from 

participating in executions.  (Exhibit 1, ¶¶ 55‐58.) 

49. A veterinarian would use a lethal dose of pentobarbital, a long‐

acting anesthetic, to perform euthanasia consistently with professional 

regulations, positive law, and the values of humaneness which the latter 

norms reflect.  This substance is an alternative to the three‐chemical 

formula the defendants use on other people.  Although the plaintiff is 

‐ 20 ‐ 

challenging the outstanding sentence of death against him by other judicial 

means (not in this civil action), and has applied for executive clemency, and 

is not advocating his own death, he points out pentobarbital as a specific 

alternative to the three‐chemical sequence, with the amount, concentration, 

and timing, and the qualifications of staff performing and monitoring the 

execution, to be determined in the course of discovery. 

50. On April 16, 2005—the day after the Missouri Supreme Court 

set the execution date in the Vernon Brown case—Dr. David A. Lubarsky 

and three co‐authors published in the world‐renowned medical journal 

THE LANCET the results of their research on the effects of these chemicals in 

lethal injections in the few states which bothered to conduct autopsies and 

prepare toxicology reports, and which did not refuse to produce these data 

for these scholars. 

51. This publication is Exhibit 2 to Exhibit 2, the declaration of the 

plaintiff’s expert witness Dr. Lubarsky. 

52. The LANCET team found that in 43% of the lethal injections they 

studied, the prisoner had an inadequate amount of sodium pentothal in his 

bloodstream to provide anesthesia.  (Exhibit 2, ¶ 16.)  In other words, in 

close to half of the cases, the prisoner felt the suffering of suffocation from 

‐ 21 ‐ 

pancuronium bromide, and the burning through the veins followed by the 

heart attack caused by the potassium chloride. 

53. Another Missouri prisoner under sentence of death, Timothy 

Johnston, has filed an action before the United States District Court for the 

Eastern District of Missouri under 42 U.S.C. § 1983 raising a claim which 

substantially overlaps with the claim that this plaintiff is raising.  Johnston 

v. Kempker, No. 4:04‐CV‐01075‐DJS (E.D. Mo. Mar. 31, 2005) (memorandum 

in support of motion to compel answers filed by plaintiff Johnston’s 

counsel). 

54. Represented by the Office of the Attorney General, specifically 

Assistant Attorneys General Denise G. McElvein and Stephen David 

Hawke, the defendants in the Johnston case—including the predecessor in 

office of defendant Crawford and also defendant Purkett—have resisted 

virtually every syllable of discover promulgated by Mr. Johnston’s counsel, 

but have admitted, by their response to interrogatories to defendant 

Crawford’s predecessor in office (Exhibit 3 at 4), that the defendants use 

the three chemicals identified in this complaint, though the defendants 

have refused to disclose the amounts or the timing of their injection into 

the person. 

‐ 22 ‐ 

55. Although a Missouri statute specifies that death sentences will 

be carried out by lethal gas or lethal injection, it does not prescribe any 

given chemical to be used in either process, but leaves these decisions up to 

defendant Crawford.4 

56. In Johnston v. Kempker, the defendants have refused to disclose 

the training or lack thereof which the actual executioners have had.  Only 

blind faith would lead this Court to find that the personnel they have been 

able to recruit to participate in this activity have the skills of licensed 

medical and veterinary professionals which would be necessary to 

administer the chemicals in a minimally competent manner.  (Exhibit 1, 

¶¶ 55‐58; Exhibit 2, ¶¶ 19.f & 21.) 

57. One of the defenses the Johnston defendants asserted was 

nonexhaustion of administrative remedies.  (Exhibit 4 at 12‐13.)  Mr. 

Johnston’s counsel filed an Informal Resolution Request (IRR) in which Mr. 

Johnston had sought to raise the grievance in his complaint, Mr. Jones’s, 

and Mr. Brown’s, but the Department of Corrections had not processed the 

grievance beyond noting in writing that it raised “a non‐grievable issue.”  

(Exhibit 5.)  Although the Johnston defendants’ counsel, Ms. McElvein and 

                                           4Mo. Rev. Stat. § 546.720. 

‐ 23 ‐ 

Mr. Hawke, filed a reply to the response to which this IRR was an exhibit, 

they did not dispute the plaintiff’s showing that because the issue was non‐

grievable according to the agency which promulgated the grievance policy 

on which the defense of nonexhaustion relied, the defense was unavailing.  

(Exhibit 6 at 5 (digitally signed “/s/Denise G. McElwein”). 

58. On January 21, 2005, the undersigned counsel, while 

representing Vernon Brown, CP‐75, filed a pleading in the Missouri 

Supreme Court in response to its order to show cause why it should not set 

an execution date in Mr. Brown’s case, raising the grievance with the use of 

the three‐chemical sequence described in the attached declarations, and 

also arguing that the Missouri Supreme Court should not set an execution 

date while the defendants’ motion to dismiss was pending before the sister 

district court in Mr. Johnston’s case. 

59. On April 15, 2005, the Missouri Supreme Court set an execution 

date on Mr. Brown notwithstanding his pleading as aforesaid, which it had 

duly filed and to which the Office of the Attorney General (specifically 

counsel of record for the state, Assistant Attorney General Stephen D. 

Hawke) filed no response. 

‐ 24 ‐ 

60. On April 16, 2005, Dr. Lubarsky (whose declaration is attached 

to this complaint) and his co‐authors published in the world‐renowned 

medical journal THE LANCET the article attached to Dr. Lubarsky’s 

declaration (Exhibit 2) as Exhibit 2. 

61. This article confirmed, through the analysis of empirical after‐

the‐fact data, that the scientific critique of the use of sodium pentothal, 

pancuronium bromide, and potassium chloride creates a foreseeable risk of 

the gratuitous infliction of pain on a person being executed. 

62. On April 21, 2005, Mr. Brown filed a petition for a writ of 

habeas corpus under Mo. S. Ct. R. 91 before the Missouri Supreme Court, 

renewing the grievance Mr. Brown had set forth on January 21, 2005, but 

with the additional authority of the LANCET article by Dr. Lubarsky and his 

co‐authors. 

63. On the same day that Mr. Brown filed his state habeas corpus 

petition challenging this three‐chemical sequence on the new basis of the 

LANCET article, so did Donald Jones, CP‐110, represented by the 

undersigned court‐appointed counsel. 

64. The Missouri Supreme Court denied Mr. Jones’s petition the 

next day. 

‐ 25 ‐ 

65. Represented by Michael A. Gross—his lead appointed counsel 

in the federal courts—Mr. Jones filed an action under 42 U.S.C. § 1983 on 

Monday, April 25, 2005, less than forty‐eight hours before his scheduled 

execution using this sequence of three chemicals. 

66. The same day, the Court (the Hon. Rodney W. Sippel, District 

Judge) held a proceeding at which Mr. Jones was represented by Mr. Gross, 

and the defendants (including defendants Crawford and Purkett here) 

were represented by Assistant Attorneys General Denise McElwein, in 

person, and Andrew W. Hassell, by telephone.  (Exhibit 7 is a true and 

correct copy of the transcript of proceedings in the Jones section 1983 

action.) 

67. Before Judge Sippel, Ms. McElwein (who had signed a pleading 

in the Johnston case recognizing by silence that the issue before Judge 

Sippel was non‐grievable) re‐raised the defense of nonexhaustion of 

administrative remedies: 

 . . . even if you look at this as a Section 1983 action, then it is barred under the Prison Litigation Reform Act because the plaintiff has failed to allege that he has exhausted his administrative remedies as required by the PLRA. 

And I think the PLRA is pretty clear that no action—it says:  “No action shall be brought with 

‐ 26 ‐ 

respect to prison conditions under Section 1983 until such administrative remedies as are available are exhausted.” 

And according to this circuit in McAlphin v. Morgan, 216 F.3d. 680, which is a 2000 Eighth Circuit opinion, states that dismissal is appropriate in the absence of proof of exhaustion.5 

68. Immediately before retiring to deliberate, Judge Sippel sought 

to probe the facts regarding prisoners’ having raised the issue in Mr. 

Jones’s section 1983 action, in a way that would have disclosed the 

unavailability of an administrative remedy for Mr. Jones to have pursued: 

THE COURT:  Do you all know?  I mean, it would be a matter of some significance if there was a claim that the dosage, if you will, was wrong and that the State should re‐examine the three‐drug treatment and use of the three drugs in what order and how much, strikes me that’s something you might know about if that had been an issue. 

MS. MCELVEIN:  Oh, you mean if he had filed a grievance? 

THE COURT:  As an officer of the court, can you tell me if you have any knowledge about a grievance to that effect? 

MS. MCELVEIN:  No, Your Honor, I do not. 

THE COURT:  Mr. Hassell? 

MR. HASSELL:  I have no knowledge, Your Honor. 

                                           5Exhibit 7 at 22‐23. 

‐ 27 ‐ 

THE COURT:  It strikes me that they might have told you about it if that was becoming a big issue in the facility. 

MR. HASSELL:  I would expect so, Your Honor, but I just donʹt know. 

THE COURT:  Okay.  All right.  Iʹm going to take a short recess and give you a sense of where weʹre going.  One way or the other, I suspect you might be in another court tomorrow some way, some how.6 

69. Judge Sippel went back to chambers with Ms. McElvein’s 

silence in his ears.  She knew that Mr. Johnston had filed an IRR, and her 

clients had held it “non‐grievable.”  We do not presently have evidence 

that Mr. Hassell knew about it until the undersigned faxed him to that 

effect while the 1983 was still before the Eighth Circuit; we do have 

evidence that Ms. McElvein did. 

70. After retiring to deliberate under these circumstances, Judge 

Sippel returned to the courtroom and announced that he was relying on 

Ms. McElwein’s nonexhaustion defense as his first and basic reason for 

denying relief:  “the basis of my judgment will be that the complaint fails to 

state a cause of action under Section 1983 for failure to exhaust 

administrative remedies.”  (Exhibit 7 at 30‐31.) 

                                           6Id. at 28‐29 (emphasis supplied). 

‐ 28 ‐ 

71. Over a vote of five to two for commutation by the Board of 

Probation & Parole, the Governor denied executive clemency, and the 

defendants executed Mr. Jones on April 27, 2005, at or about 12:01 a.m. 

72. Later the same morning (after the fact of the execution was 

public knowledge), the district court (the Hon. Carol E. Jackson) granted 

Vernon Brown’s motion—filed before the Missouri Supreme Court had set 

an execution date in his case—for leave to proceed ex parte to request 

funding for expert and investigative services.  Thereafter and thereby, Mr. 

Brown’s counsel were able to obtain the services, inter alia, of the senior co‐

author of the LANCET article published the day after the Missouri Supreme 

Court set Mr. Brown’s execution date. 

73. After the sister district court allowed Vernon Brown’s counsel 

to seek funding for expert and investigative services without disclosing 

their mental impressions to opposing counsel, the Missouri Supreme Court 

summarily denied Mr. Brown’s habeas corpus action raising this issue, 

with explanation and without ordering the respondents to show cause or 

otherwise respond. 

74. Vernon Brown filed an Informal Resolution Request seeking to 

raise the issue of the lethal injection chemicals (Exhibit 8), but received a 

‐ 29 ‐ 

response different from the one which previous prisoners had received, 

with the special response in his case suggesting that there were multiple 

levels he would need to go through in order to exhaust his administrative 

remedies (Exhibit 9). 

75. Counsel filed a verified complaint and accompanying papers 

on behalf of Mr. Brown as soon as counsel received the attached 

declarations prepared by the LANCET team (through Dr. Lubarsky) and by 

Dr. Mark Heath, the leading expert on the underlying mechanism under 

which the defendants’ three‐chemical sequence creates a foreseeable risk of 

inflicting gratuitous pain. 

76. Unless the defendants answer several questions that the 

LANCET team has expressed through Dr. Lubarsky’s declaration (Exhibit 2, 

¶¶ 19‐21), and which are reflected in the plaintiff’s discovery, the petitioner 

is entitled to the inference that because the defendants’ practices are 

substantially similar to those of the lethal‐injection jurisdictions which 

conducted autopsies and toxicology reports, which kept records of them, 

and which disclosed them to the LANCET scholars, there is at least the same 

risk (43%) as in those jurisdictions that he will not be anesthetized at the 

time of his death.  (Exhibit 2, ¶¶ 22‐23.) 

‐ 30 ‐ 

77. In Mr. Brown’s case as aforesaid, counsel learned after filing the 

complaint in the United States District Court for the Eastern District of 

Missouri that the lead co‐author of a study he had already cited before the 

Missouri Supreme Court had completed his Ph.D. dissertation and that it 

included evidence bearing on the claim concerning the lethal‐injection 

chemicals and their administration. 

78. By leave of court, counsel filed an amendment by interlineation 

with memorandum in support raising this additional claim. 

79. Likewise in this action, the plaintiff relies on certain facts set forth 

in the Ph.D. dissertation of Michael Lenza, and in his declaration 

accompanying this memorandum, which is incorporated herein and 

marked as “Exhibit 10”; his curriculum vitae is attached to, incorporated in 

his declaration, and marked as “Declaration Exhibit 1.” 

80. Plaintiff tendered Dr. Lenza as a witness at the hearing of May 13, 

2005, on the motion for temporary restraining order in Vernon Brown’s 

case.  Defendants were represented by Assistant Attorneys General Hawke 

and McElwein, and did not object when the district court declined the 

plaintiff’s offer to present live testimony from Dr. Lenza. 

‐ 31 ‐ 

81. Dr. Lenza’s Ph.D. dissertation is entitled POLITICS OF DEATH: A 

STATISTICAL, THEORETICAL, AND HISTORICAL EXAMINATION OF THE DEATH 

PENALTY IN MISSOURI, University of Missouri–Columbia (2005).  It is 

attached hereto, incorporated herein, and marked as “Exhibit 11.” 

82. Its central finding is that in the customs and practices of the State 

of Missouri, there is a strong historical association between the presence of 

black slavery, the incidence of lynching, and a disproportionate number of 

death sentences after Furman v. Georgia7 and Gregg v. Georgia.8  It bears not 

only on the absence of a lawful capital punishment régime—which is 

beyond the scope of this action—but also on the defendants’ selection of 

lethal‐injection chemicals that have an elevated likelihood of inflicting 

gratuitous pain, when they could use at least one (pentobarbital) which 

would—as they advertise their current practice, in contradiction to 

veterinary law and practice—be like putting a dog to sleep. 

83. In the research for his dissertation, Dr. Lenza discovered that there 

is a strong historical association in fact within Missouri between counties 

that had the heaviest levels of black slavery until the Civil War, the 

                                           7408 U.S. 238 (1972). 8428 U.S. 153 (1976). 

‐ 32 ‐ 

incidence of lynching, and an elevated rate of death sentences after Furman 

v. Georgia and Gregg v. Georgia.  (Exhibit 10.)  In the judicial circuits falling 

into the slave and Southern cultural regions as Dr. Lenza defines them, a 

homicide case is 286% more likely to be prosecuted as a capital case and 

taken to trial as such than in the circuits he categories as urban.  (Exhibit 11 

at 232.)  Such a case was 71% more likely to result in a death sentence.  (Id. 

at 233.)  Whether a case arose in the slave and Southern cultural regions 

was the most important variable in predicting death sentences even when 

compared such other reliable predictors to the color of the accused versus 

the color of the decedent, whether the accused was a stranger to the 

decedent, whether the homicide was performed with a knife (producing 

better gruesome photographs to inflame the jury), and whether the accused 

had prior convictions and was represented by a public defender (both of 

which are surrogates for lower socio‐economic status of the accused).  (Id. 

at 233‐35.)  These data are not samples, but the universe of cases; there is a 

92% certainty that the associations Dr. Lenza found did not happen by 

chance fluctuation in the data.  (Id. at 235.) 

84. Just as 89% of executions occur in states which used to have 

slavery (Exhibit 11 at 3‐5), the practice of the death penalty in Missouri 

‐ 33 ‐ 

today is a reflection of the attitudes towards one’s fellow human beings 

which allowed slavery to exist and thrive until put down by force of arms. 

85. An underlying explanatory principle is that slavery “vested white 

citizens with the power of the State to utilize extra‐legal violence to 

maintain the social order,” i.e., the supremacy of whites over African‐

Americans.  (Exhibit 11 at viii.)  Like all Ph.D. theses, this one finds that 

more research is called for, but also suggests that the results are consistent 

with the proposition that the death penalty is “an institutionalized social 

artifact of slavery, maintaining the racialized social order through violence, 

carried forth into our present by our social institutions.”  (Exhibit 11 at 244.) 

86. One of the subsidiary themes of Dr. Lenza’s dissertation is that 

greater pain was imposed on slaves and their descendents who were 

executed—officially or unofficially—than on members of the master race 

who were executed:  this frequently took the form of burning alive (Exhibit 

11 at 7, 63, 82, 108, 160‐62 & 174‐76), for which potassium chloride is as 

close as the defendants can get away with in the court of public opinion.  

See Exhibit 10, ¶¶ 8‐11. 

87. Plaintiff does not here contend that the death penalty in Missouri 

is unlawful because despite the color‐neutral statutes, it discriminates 

‐ 34 ‐ 

against men of color and on other arbitrary or independently unlawful 

bases.  Plaintiff does, however, plead—as in an intermediate premise in his 

claim for relief under the Thirteenth Amendment—that the death penalty 

in Missouri falls disproportionately on African‐American residents.  

Plaintiff pleads this premise in the course of establishing that the specific 

method of lethal injection the defendants have chosen is a badge of slavery. 

88. In support of the intermediate premise regarding disparate impact 

of the death penalty, the plaintiff relies on four additional attachments, 

including one which was chiefly co‐authored by Dr. Lenza before he 

completed his dissertation.  Because the plaintiff does not advance this 

premise as a freestanding ground for relief, this Court need not consider 

whether McCleskey v. Kemp9 need be overruled. 

89. In other death‐sentenced persons’ cases before the Missouri 

Supreme Court, the Missouri State Public Defender System presented a 

study by University of Missouri–Columbia Professor John F. Galliher of the 

reports from Missouri circuit judges that the Missouri Supreme Court itself 

collected as the statute on proportionality review mandated.  The Missouri 

State Public Defender System filed this study with the Missouri Supreme 

                                           9481 U.S. 279 (1987). 

‐ 35 ‐ 

Court in State v. Parker.10  Plaintiff presents it here as Exhibit 12.  There is 

also available on the Internet a subsequent report based on later and more 

inclusive data prepared by Professor Galliher’s original co‐author, 

Professor David Keys, and others, headed by Dr. Michael Lenza.11  Plaintiff 

presents it as Exhibit 13. 

90. The original Galliher report was based entirely on the reports of 

Missouri trial judges in homicide cases that the Missouri Supreme Court 

gathered in response to Mo. Rev. Stat. § 565.035.6.  The report showed that 

out of 439 death‐eligible cases during the period it covered, the prosecutors 

had waived the death penalty in 212, or 52%.  (Exhibit 12 at 1.)  The 

remainder of the report showed that aggravating and mitigating factors 

played virtually no role in determining whether a person actually got the 

death penalty for a homicide.  (Id. at 2‐8.)  For example, in respect to eight 

of the fourteen statutory aggravating factors, sentencers were more likely 

                                           10886 S.W.2d 908 (Mo. 1994) (en banc), cert. denied, 514 U.S. 1098 

(1995), citing In re Estate of Danforth, 705 S.W.2d 609, 610 (Mo. Ct. App., S.D. 1986) (providing for judicial notice of the record resulting in an opinion to determine grounds on which opinion is based). 

11M. LENZA ET AL., THE PREVAILING INJUSTICES IN THE APPLICATION OF THE DEATH PENALTY IN MISSOURI (1978‐1996) (2002), available May 18, 2004, at http://www.umsl.edu/divisions/artscience/forlanglit/mbp/Lenza1.html.  (Exhibit 13.) 

‐ 36 ‐ 

to impose life without parole than death if they found that factor;12 in cases 

where accused citizens received life without parole, the sentencer found an 

average of 2.17 statutory mitigating factors, whereas in cases where the 

accused received a death sentence, the sentencer found 2.2.13  Whereas the 

relationship between the total number of aggravating factors and a 

sentence of death is positive, it is only slightly so.  (Id. at 2‐3.) 

91. By contrast, the clearest, strongest predictor of whether a 

prosecutor would seek the death penalty was whether the accused was a 

black person and the decedent was a white person.  In 89% of the cases in 

which prosecutors waived the death penalty, the accused and the decedent 

were the same color, and prosecutors rarely charged whites for killing 

blacks.  (Id. at 11.)  Prosecutors were radically less likely to waive the death 

penalty in cases where they charged blacks with killing whites than in any 

other class of death‐eligible cases: 

For black offenders 44 percent of those receiving the death penalty killed a white victim, 44 percent of black offenders sentenced by a jury to life in prison killed a white victim, but only 18 percent of black offenders where the death penalty was waived killed a white victim.  These figures indicate that in 

                                           12Id. at 4‐5. 13Id. at 6. 

‐ 37 ‐ 

Missouri the race of the victim makes little difference for the legal outcome of white offenders, but for black offenders killing a white victim severely reduces the chances of having the death penalty waived by the prosecution—a reduction from 97 percent of white offenders who had killed white victims to 78 percent of black offenders who had killed white victims.14 

92. The Galliher study examined the influence of youth on charging 

and sentencing decisions, because it is a statutory mitigating factor.  The 

data from the circuit judges collected by the Missouri Supreme Court 

showed that youth was a mitigating factor for white accused citizens but 

not for black ones: 

Among cases where the prosecution waived the death penalty 14 percent of defendants were 18 years old or less, and 32 percent were 21 or less with a mean age of 28.2 years.  In cases where a jury handed down a life sentence 9 percent were 18 or less, and 25 percent were 21 or less with a mean age of 28.2 years—exactly the same average age as for cases in which the prosecutor waived the death penalty.  Those receiving the death penalty were slightly older than others.  Prosecutors perhaps correctly perceive the common bias of jurors against imposing the death penalty against the very young. 

 . . .  

The mean age of black offenders sentenced to death is 27.7 years, and for whites the mean age is 35 

                                           14Id. at 11 (emphasis supplied). 

‐ 38 ‐ 

years.  Twenty‐two percent of black defendants under the age of 21 were sentenced to death, while this was true of only 14 percent of white offenders under 21.15 

The authors concluded that “young black defendants are in greater 

jeopardy of a death sentence than are white offenders.”16 

93. Another factor that the Galliher study explored was the reputation 

of the decedent as a mitigating factor.  The data from the circuit judges, as 

collected by the Missouri Supreme Court, showed that the reputation of the 

decedent made a difference only if the decedent was white: 

While killing a white person with a bad reputation nearly always saved a defendant from death, it is much less likely to operate in the same fashion in the case of black victims.  Perhaps this is true because all black victims were devalued whether or not they were noted to have a bad reputation.17 

94. Prosecutors waived the death penalty as a rule if the accused was 

a woman, as long as she was white: 

Prosecutors seem less likely to seek the death penalty against female defendants than juries are to sentence females to death.  The application of this apparent chivalry is, however, differentially distributed across races.  Among death waived 

                                           15Id. at 8. 16Id. at 17. 17Id. at 13. 

‐ 39 ‐ 

cases 20 percent of white offenders and only 3 percent of black offenders were females.  In other words, white females were proportionately nearly seven times as likely to benefit from a waived death penalty as were black females.18 

95. Dr. Lenza’s study included data into 1996, and was not available 

until 2002.  Whereas the Galliher study observed that the reports from the 

trial judges in the Missouri Supreme Court’s database were incomplete, 

and listed 189 names of persons in the Department of Corrections for 

death‐eligible offenses at the relevant time that were missing from the 

database,19 the authors of the Lenza et al. study used FBI Supplemental 

Homicide Reports to enhance their coverage.20  They divided capital cases 

into three stages:  (1) the prosecutor’s decision whether to charge a death‐

eligible offense, (2) the prosecutor’s decision whether to seek the death 

penalty for a death‐eligible offense, and (3) the result of a penalty phase 

once the prosecutor had decided to seek death.21  The first stage accounts 

for most of the decision‐making, as prosecutors charged only 5.8% of 

homicides (574 out of 9857) as death‐eligible cases; the second stage 

                                           18Id. at 16. 19Id. at 18 & attached memorandum. 20Exhibit 13:4 21Id. at 4‐5. 

‐ 40 ‐ 

accounts for the next largest number of decisions, as prosecutors waived 

the death penalty in 49% of the cases they had charged as death‐eligible 

(270 out of 551).22  Of the remaining cases, circuit courts sentenced 54% of 

the accused (152 out of 281) to death.23 

96. At the first stage, in which the prosecutor decides whether to 

charge a homicide as “capital murder” or “first‐degree murder” 

(depending on the statutory classification of death‐eligible homicide at the 

time of the case), Missouri prosecutors were almost twice as likely to 

charge a black who killed a white with death‐eligible homicide as they 

were to charge a white who killed a black:24 

                                           22Id. at 4‐5.  The authors dropped 23 cases due to insufficient data. 23Id. at 5. 24Id. at 8. 

‐ 41 ‐ 

Accused/Decedent  Capital  Total  Percent 

White/Black  274  2945  8.39% 

White/White  12  254  4.72% 

Black/Black  188  6045  3.11% 

Black/White  88  599  14.69% 

Missing Cases  12  14  N/A 

Totals  574  9857  5.8% 

The authors explained that these data confirmed previous studies: 

The percentages of all Missouri homicides charged with capital murder by offender/victim racial characteristics indicates blacks killing whites are 5 times more likely to be charged with capital murder than blacks killing blacks.  Whites with black victims are half as likely to be charged with capital murder than whites killing other whites. . . . this pattern confirms the suspicion that whiteness is valued over non‐whiteness, predicting that the severest punishment would be visited on cases where the non‐white offender kills a Caucasian (‐/+) 14.69%, followed by a descending hierarchical structuring of the proportion of cases charged with capital murder based on racial characteristics: whites killing whites (+/+) 8.39%, whites killing blacks (+/‐) 4.72%, to the lowest, blacks killing blacks (‐/‐) 3.11%.25 

                                           25Id. at 14 (emphasis supplied). 

‐ 42 ‐ 

97. At the next stage of a capital case—the prosecutor’s decision 

whether to waive the death penalty for a death‐eligible homicide—the 

Lenza study found that the color of the accused and the color of the 

decedent played a strong explanatory role: 

Compared to whites killing whites (W/W) one sees that blacks with black victims (B/B) are 59% less likely to be taken forward to trial, while blacks killing whites (B/W) are 56% more likely than (W/W) to be taken to trial.  In the few cases where whites have killed a black victim and were charged with capital murder, they were 115% more likely to be taken to trial than whites taking the lives of other whites.  The last category, whites killing blacks (W/B), represents the only 12 cases in Missouri over 18 years in which white defendants were charged with capital murder for killing an African‐American, a mere 2% of the total cases.26 

98. In contrast to the decisions made by prosecutors, the Lenza et al. 

study found, the decisions made by judges and juries in the third stage of a 

capital case—the actual sentence—did not reflect bias according to the 

color of the accused or the color of the decedent.27  The Lenza et al. study 

found other factors—such as low socio‐economic status of the accused and 

the availability of gruesome photographs to inflame the jury—that were 

                                           26Id. at 15. 27Id. at 15‐16. 

‐ 43 ‐ 

associated with prosecutorial decisions to seek death.28  For example, 

whereas juries and sentencing judges did not in fact respond measurably 

differently to cases involving the use of firearms as opposed to knives, 

prosecutors were 133% more likely to seek the death penalty in knife cases, 

such as the instant case, because they produce more gruesome photographs 

they could use to inflame the jury, as this prosecutor did, regardless of the 

relative moral blameworthiness of the offense.29  The conclusions of the 

Lenza study pointed to prosecutorial discretion as the main cause of racial 

disparity in the use of the death penalty in Missouri: 

the seat of prosecutorial discretion is also the location of and the mechanism responsible for the greatest racial disproportionality in capital sentencing [in] Missouri.  It is those elements of the process, in the hands of prosecutors, who are charged with selecting offenders and crimes for eventual capital consideration and sentencing, that put in place factors which proportionate sentencing has sought to avoid.30 

99. In 2001, the Executive Director of the ACLU of Eastern Missouri 

presented data on Missouri death sentences both from the time the state 

created a central execution process in 1937 until 1965, when the pre‐Furman 

                                           28Id. at 17‐19 & 20‐22. 29Id. at 17‐18. 30Id. at 22. 

‐ 44 ‐ 

moratorium took effect, and then from the post‐Gregg reinstitution of the 

death penalty until the date the paper was written in October 2001.31  This 

study, which was obviously not available at the time of the plaintiff’s 

consolidated appeal, complements the data the Missouri State Public 

Defender System had provided the Missouri Supreme Court in State v. 

Parker.  Initially this paper emphasizes the variation among counties in the 

state:  several sizable counties had no one under sentence of death, 

regardless of their homicide rate.32 

100. From the creation of a centralized state death penalty to the 

pre‐Furman moratorium, the split between black and white persons that 

Missouri executed was 23 to 16 over almost thirty years.33  The split after 

Gregg was 21 to 30 to one Native American over about eleven years.34  The 

                                           31DENISE LIEBERMAN, Legal Director, American Civil Liberties Union 

of Eastern Missouri, PROSECUTORS:  THE FIRST LINE OF OFFENSE—PROSECUTORIAL DISCRETION AND ARBITRARINESS IN ADMINISTRATION OF THE DEATH PENALTY, http://www.umsl.edu/~phillips/dp/ACLUDenise.html (2001)  (Exhibit 14.) 

32Id. at 5‐10. 33Id. at 1‐2. 34Id. at 11. 

‐ 45 ‐ 

state achieved this leveling of racial impact by increasing the executions 

per year by about 300%, and killing more white men:35 

Period  Black  White  Native American 

Total  Years  Annual Rate 

1937‐65  23  16  0  39  28  1.4 1989‐2001 

21  30  1  52  12  4.3 

Totals  47  43  1  91  40  2.3  

101. Although this state is executing more white men, its death 

penalty continues to fall on black men convicted of killing whites far out of 

proportion to any other combination of homicide convicts and their 

decedents.  While the death penalty continues to target black men out of 

proportion to their numbers, it has added white men to the pie of persons 

executed and has thereby decreased the proportion of blacks. 

102. A 2003 article—which is not limited to Missouri data—shows 

that support for the death penalty among white people tends to vary 

strongly according to a combination of racial prejudice and the proximity 

of black residents to the person surveyed:36 

                                           35Id. at 11‐12. 36J. SOSS ET AL., Why Do White Americans Support the Death Penalty? 65 

J. OF POLITICS 397, 409 (2003).  (Exhibit 15.) 

‐ 46 ‐ 

as the black percentage of a county’s population rises, racial prejudice becomes a much more powerful predictor of whether a white person will strongly favor state executions.  Indeed, the effect of context on the relationship between prejudice and white support is dramatic.  Among white people who live in all‐white counties, the largest possible increase in prejudice (from 0 to 100) produces only a 34‐point increase in the probability of strong death penalty support (from .52 to .86).  By contrast, when the black percentage of the county population stands just below 20%, the same increase in prejudice raises the probability of strong support from fairly unlikely (.29) to a virtual certainty (.95).  Thus, the interplay of racial beliefs and racial proximity go far to explain strong white preferences for state executions—but neither factor can be adequately understood in isolation from the other.37 

103. The case against this plaintiff arose in Jackson County, one with 

a high proportion of African‐American citizens, yet one in which they are a 

distinct minority.  This is exactly the kind of jurisdiction in which the 

foregoing article would predict a high correlation between racist attitudes 

and support for the death penalty. 

104. As elected officers who retain their positions at the will of the 

electorate, Missouri prosecutors are presumptively aware of and 

responsive to the level of support for the death penalty.  In its current form, 

the prosecutorial discretion created by Missouri statutes leads to racial 

                                           37Id. at 411. 

‐ 47 ‐ 

discrimination in the imposition of the death penalty.  The longitudinal 

data in the latter two articles cited in this response raise the question 

whether after Furman and Gregg have addressed various aspects of fairness 

at the jury and trial‐judge level, it is possible in any case for there to be a 

death‐charging decision which is free from impermissible attention—one 

way or the other—to the color of the accused and the color of the decedent. 

105. Because the death penalty as practiced in Missouri both before 

and after Furman and Gregg is disproportionately applied against African‐

American men like Stanley Hall, Donald Jones, and Vernon Brown—and 

this plaintiff—the fact that it is more tortuous than it need be is consistent 

with the behavior Dr. Lenza found beginning with the introduction of 

slavery into the Missouri Territory. 

106. The use of a gratuitously painful form of suffocation, followed 

by the burning through the veins and the heart attack caused by potassium 

chloride, instead of a single, lethal dose of an otherwise legitimate 

medication such as pentobarbital is evidence that the state keeps the death 

penalty around primarily for “them.” 

107. The proposition that the death penalty itself bears more heavily 

against blacks than whites is not before this Court as a claim for relief.  In 

‐ 48 ‐ 

light of this fact, however, the additional fact that the defendants use a 

special form of lethal injection which creates a foreseeable, completely 

unnecessary, risk of inflicting gratuitous pain and suffering, when the 

executions of slaves and their descendants have historically been more 

painful than the execution of others in a slave jurisdiction such as Missouri, 

 is a badge or vestige of slavery over and above the existence of the death 

penalty in the abstract and over and above the judicial decision to impose 

the death penalty in a given case. 

VII. Claims for Relief 

108. Plaintiff restates and realleges the contents of each preceding 

paragraph as if fully set forth again. 

Claim I 

109. Unless this Court stops them, the defendants, acting 

individually and under color of state law, will violate the plaintiff’s right to 

be free of cruel and unusual punishments secured to him by the Eighth 

Amendment to the Constitution of the United States as applied against the 

states by section 1 of the Fourteenth Amendment by executing him using 

the sequence of three chemicals (sodium pentothal a/k/a thiopental, 

pancuronium bromide, and potassium chloride) which they have admitted 

‐ 49 ‐ 

to be their practice in their discovery responses in Johnston v. Kempker as 

aforesaid, which is unnecessary as a means of employing lethal injection 

and not required by the statute creating this form of execution in the State 

of Missouri, and which creates a foreseeable risk of inflicting gratuitous 

pain and suffering. 

Claim II 

110. Defendants’ chosen use of a specific form of lethal injection 

which is more painful than necessary to bring about the statutory objective 

of killing the condemned person is a vestige and badge of slavery, and 

therefore violates the Thirteenth Amendment as well as the Eighth and 

Fourteenth, and impinges on the vertical‐equity (color and socio‐economic 

status of accused) and horizontal‐equity (irrationality of who among the 

mass of homicide defendants gets the death penalty, even irrespective of 

color and SES) prongs of Eighth Amendment analysis (applied against the 

states through the Fourteenth) as well as the severity prong, the latter of 

which is the focus of Count I. 

VIII. Exhaustion of Administrative Remedies 

111. Plaintiff has exhausted any available administrative remedy for 

the issues contained in this complaint, because the selection of chemicals 

‐ 50 ‐ 

for lethal injection is not a grievable issue within the meaning of the 

administrative grievance procedure as adopted and applied by the 

defendants’ actual penological agents as distinguished from the 

Department’s outside counsel in the Attorney General’s Office, and these 

agents have so informed him in response to his attempt to seek 

administrative remedies.  (Exhibit 16.) 

112. As noted, in the Johnston, Jones, and Brown litigation, the 

defendants initially asserted that the plaintiff had failed to exhaust 

administrative remedies. 

113. In Johnston, the defendants’ clients in the Department of 

Corrections had admitted, by signed notation on Mr. Johnston’s IRR, that 

the issue of which chemicals the executioners use is “non‐grievable.”  

(Exhibit 5). 

114. Counsel for the defendants in Johnston (who were also counsel 

for the defendants in Jones and Brown) recognized this fact by dropping the 

nonexhaustion point in the reply to Mr. Johnston’s response to which the 

IRR was attached as an exhibit.  (Exhibit 6.) 

115. The same counsel raised the same defense in Jones, knowing 

that this issue was not grievable according to the Department of 

‐ 51 ‐ 

Corrections, in whose favor the exhaustion requirement of 42 U.S.C. 

§ 1997e is supposed to run; the Court relied on her representations; Mr. 

Jones was executed by the use of the specific chemical sequence which Mr. 

Johnston’s pleadings and Mr. Jones’s pleadings showed to create a 

foreseeable risk of inflicting gratuitous pain and suffering in violation of 

the Eighth and Fourteenth Amendments. 

116. As of the time this claim manifested itself beyond cavil with the 

publication of the LANCET article, Vernon Brown was not only aware of 

what happened to Mr. Johnston’s grievance but had also heard that when 

other prisoners have attempted to file IRR’s on this issue, the staff of the 

Department of Corrections have actually refused to give them IRR forms 

because of the Department’s position that the issue was not grievable.  

(Exhibit 8.) 

117. Nonetheless, on the advice of counsel, Mr. Brown filed an IRR, 

and this plaintiff, Michael Taylor, submits a true and correct copy of it with 

the above‐referenced affidavit by Mr. Brown as Exhibit 8.  This filing was 

expressly made in an abundance of caution and not by way of admission 

that the issue is grievable notwithstanding the well‐established position of 

the Department of Corrections, reflected both to the federal courts through 

‐ 52 ‐ 

counsel and to the prisoners affected by the issue by the staff of the 

Department. 

118. Because the issue which chemicals the state uses in lethal 

injections is not within the scope of the Department of Corrections 

grievance policy, this complaint is not subject to the requirement of 42 

U.S.C. § 1997e. 

119. Parties in privity with the State of Missouri, such as these 

defendants, are estopped to assert the nonexhaustion of administrative 

remedies because the Department of Corrections does not consider this 

issue grievable (and their attorneys know it). 

120. In Mr. Brown’s case, the staff who responded to Mr. Brown’s 

IRR changed the response from what it had been in Johnston and what Mr. 

Brown had heard it had been to other prisoners under sentence of death, 

and asserted that Mr. Brown—whose execution date had already been 

set—had to pursue multiple levels of review in order to exhaust 

administrative remedies on the issue.  (Exhibit 9.) 

121. In Mr. Brown’s case, the district court relied on these 

representations to deny a temporary restraining order.  A divided United 

States Court of Appeals for the Eighth Circuit denied a stay of execution, as 

‐ 53 ‐ 

did the United States Supreme Court over the dissenting votes of four 

Justices, and Mr. Brown was executed on May 18, 2005. 

122. This plaintiff, Michael Taylor, filed an Informal Resolution 

Request, and the staff returned it to him with the explanation that he could 

not file it because the subject‐matter of the issue was not grievable but was 

involved in litigation.  (Exhibit 16.)  Defendants’ counsel are estopped to 

contradict their clients’ correct interpretation of their own administrative 

regulations in order to avoid this issue once more. 

123. After counsel had prepared and circulated a complete draft of 

this complaint, he received a telephone call from the plaintiff, Mr. Taylor, 

indicating that the staff had told the plaintiff he could, after all, file an IRR, 

but that there was no guaranty the result would be any different.  Plaintiff 

is proceeding with the re‐filing of an IRR. 

124. Pendency of this new IRR need not delay the filing of this 

complaint.  Selection of a specific means of lethal injection is not a “prison 

condition” within the meaning of 42 U.S.C. § 1997e(a), the source of the 

requirement of exhaustion of administrative remedies.  Selection of a 

specific means of lethal injection is not a matter of “institutional life” within 

the meaning of the administrative remedy the Department of Corrections 

‐ 54 ‐ 

adopted to take advantage of section 1997e.  (Exhibit 17 at 2, ¶ D5‐3.2, II.J.)  

Defendants’ agents have admitted the inapplicability of the grievance 

procedure in Johnston.  (Exhibits 5‐6.) 

125. This Court should not allow the defendants to avoid 

accountability for their actions by invoking section 1997e.  Their shift of 

ground in the Vernon Brown case was belied by their attorneys’ admissions 

in the hearing on Mr. Brown’s motion for a temporary restraining order.  

During the hearing, the issue of exhaustion of administrative remedies was 

discussed at some length.  Defendants represented the complete exhaustion 

of administrative remedies requires three steps:  (1) the filing of an IRR, (2) 

the filing of a grievance, and (3) the filing of a grievance appeal.  (Exhibit 18 

at 60.)  Defendants further represented the grievance is filed with the 

superintendent of the institution where the prisoner is incarcerated, and 

the grievance appeal is addressed by “central office,” which counsel for the 

defendants elided with defendant Crawford, the Director of the 

Department of Corrections.  (Id. at 61‐62.) 

126. In Vernon Brown’s case, the defendants—who were the same as 

the defendants in Johnston and Jones, and one of whom was opposing 

counsel on this plaintiff’s federal habeas corpus petition and on his motion 

‐ 55 ‐ 

to recall the mandate of the Missouri Supreme Court—conceded that the 

corrections classification worker who would address the initial IRR has no 

authority to change the lethal injection protocol; they further conceded the 

superintendent of the institution where the prisoner is incarcerated has no 

authority to change the protocol for the lethal injection.  (Id. at 61.)  They 

admitted the only person with authority to change the protocol would be 

defendant Crawford.  When asked whether an inmate had the ability to 

bring an initial grievance before the Director, they conceded there was no 

procedure for that: 

THE COURT:  Okay. Could Mr. [Brown] have bypassed the IRR procedure and the grievance?  Since it is clear that no one at the institution had authority to make any changes, could he have bypassed the institutional officials and gone directly to the director with his complaint? 

MS. McElvein:  No, your Honor.  Not that I am aware of.  [Id. at 62‐63.] 

127. There is therefore no administrative process available to the 

plaintiff to grieve this claim.  By the defendants’ admissions in open court, 

the Director’s role in the normal administrative process is to function as an 

appellate decisionmaker, reviewing the disposition of the grievance filed 

with the superintendent of the institution where the prisoner is 

‐ 56 ‐ 

incarcerated.  In this case, the defendants concede that the superintendent 

of an institution, even of the institution where the executions occur, has no 

authority—no jurisdiction—to change the protocol for lethal injections.  

Thus, as the appellate decisionmaker reviewing any decision made by the 

superintendent, the only role the Director would serve would be to 

determine whether the superintendent correctly determined the 

superintendent had no authority to change the chemicals which other 

personnel use in lethal injections.  The Director’s appellate role in the 

administrative grievance process is not the same as his role as the initial 

decisionmaker.  Here, the defendants have conceded there was no 

administrative grievance procedure available to seek to change the 

Director’s position as the initial decisionmaker, rather than in the role of an 

appellate decisionmaker reviewing the question whether the 

superintendent had the authority to determine which chemicals to use, 

which they concede he does not. 

128. It is therefore irrelevant whether the staff of the Department of 

Corrections adhere to their correct position that the issue in this plaintiff’s 

IRR is not grievable, or attempt to manipulate this Court as they did a sister 

court in Vernon Brown’s case by moving the goalposts. 

‐ 57 ‐ 

129. Missouri does not provide an administrative grievance process 

for presenting this issue, and therefore section 1997e would not apply even 

if the method of execution were a “prison condition,” even if “institutional 

death” equaled “institutional life,” and even if the United Nations 

Convention Against Torture were not part of “the supreme law of the 

land” requiring the United States to afford the plaintiff a forum for raising 

this issue. 

IX. Prayer for Relief 

130. Initially, the plaintiff seeks a preliminary injunction to prevent 

the defendants from executing him until the defendants have responded to 

his discovery (including what appears to be the inevitable time it will take 

to litigate motions to compel as Mr. Johnson has had to do) and until this 

Court has adjudicated his underlying claim for relief on the merits 

(including the time it would take for any appeal from the disposition). 

131. Second, the plaintiff seeks a declaratory judgment holding that 

the defendants’ current means, methods, practices, procedures, and 

customs regarding execution by lethal injection violate the Eighth, 

Thirteenth, and Fourteenth Amendments. 

‐ 58 ‐ 

132. Plaintiff seeks a permanent injunction preventing the 

defendants from using their current means, methods, practice, procedures, 

and customs regarding execution by lethal injection. 

133. Finally, the plaintiff seeks an order granting him reasonable 

attorney fees under 42 U.S.C. § 1988 and the laws of the United States; for 

his costs of suit; and for such other and further relief as the Court deems 

appropriate. 

WHEREFORE, the plaintiff prays the Court for its orders as 

aforesaid. 

Respectfully submitted,  

JOHN WILLIAM SIMON, J.D., PH.D.  /s/ John William Simon  

Of Counsel            2683 South Big Bend Boulevard, # 12 Sindel, Sindel & Noble, P.C.      St. Louis, Missouri  63143‐2100 

    (314) 645‐1776    FAX (314) 645‐2125 

 Attorney for Plaintiff 

 

- 59 -

- 60 -

‐ 61 ‐ 

Declaration of Verification 

COMES NOW the declarant, John William Simon, and as authorized 

by 28 U.S.C. § 1746, states and declares under penalty of perjury all as 

follows: 

1. My name is John William Simon. 

2. I live in Richmond Heights, Missouri. 

3. I am a member of the Missouri Bar (Enrollment No. 34535), and 

of the bars of the Supreme Court of the United States, the United States 

Court of Appeals for the Seventh and Eighth Circuits, and of the United 

States District Courts for the Eastern and Western Districts of Missouri. 

4. I hold an A.B. summa cum laude, Phi Beta Kappa, with 

distinction in Philosophy and Political Science from Boston University; an 

A.M. and a Ph.D. in Political Science from Harvard University; and a J.D. 

from the Yale Law School. 

5. I taught constitutional law and other subjects in the discipline 

of political science for eight and one‐half years. 

6. I have practiced law full‐time since my admission to the bar in 

1985, having worked as a summer clerk or law clerk from my first summer 

of law school until my admission. 

7. I have handled capital cases in federal habeas corpus and in

state court from both sides since 1991, first for the State of Missouri and its

privies, and thereafter for persons accused of capital crimes or sentenced to

death by the federal government or the State of Missouri.

8. I have personally prepared the foregoing pleading.

9. Insofar as I am a witness to the transactions and occurrences set

forth in the foregoing pleading, such as pleadings filed, representations

made, and responses and orders received in the cases of Donald Jones and

Vernon Brown, the statements in the pleading are true and correct

according to my personal knowledge and belief.

10. The documents I have attached to this pleading are true and

correct copies of the masters or originals in my possession, custody, and

control.

Further, the declarant saith naught.

I declare under penalty of perjury that the foregoing is true and

correct.

IAM SIMON

‐ 63 ‐ 

Certificate of Service 

I hereby certify a true and correct copy of the foregoing was 

forwarded for transmission via Electronic Case Filing (ECF) or otherwise e‐

mailed this third day of June, 2005, to the offices of: 

Stephen David Hawke, Esq. Assistant Attorney General P.O. Box 899 Jefferson City, Missouri  65102 stephen.hawke@ago.mo.gov 

 /s/ John William Simon Attorney for Plaintiff 

IN THE UNITED STATES DISTRICT COURT WESTERN DISTRICT OF MISSOURI 

CENTRAL DIVISION  

MICHAEL ANTHONY TAYLOR,    ) ) 

Plaintiff,        ) ) 

v.            ) )   No. 05‐4173‐CV‐C‐SOW ) 

LARRY CRAWFORD, et al.,      ) ) 

Defendants.       )   

NOTICE OF FILING OF EXHIBIT OR EXHIBITS 

COMES NOW the plaintiff, Michael Anthony Taylor, by and through 

counsel, John William Simon, and gives notice of his filing of the attached 

exhibit or exhibits to the pending verified complaint, allocated so as not to 

have one filing greater than two megabytes. 

‐ 2 ‐ 

Respectfully submitted,  

JOHN WILLIAM SIMON, J.D., PH.D.  s/John William Simon 

Of Counsel            2683 South Big Bend Boulevard, # 12 Sindel, Sindel & Noble, P.C.      St. Louis, Missouri  63143‐2100 

    (314) 645‐1776    FAX (314) 645‐2125 

 Attorney for Plaintiff 

 Certificate of Service 

I hereby certify a true and correct copy of the foregoing was 

forwarded for transmission via Electronic Case Filing (ECF) or otherwise e‐

mailed this third day of June, 2005, to the offices of: 

Stephen David Hawke, Esq. Assistant Attorney General P.O. Box 899 Jefferson City, Missouri  65102 stephen.hawke@ago.mo.gov 

 /s/ John William Simon Attorney for Plaintiff 

DECLARATION OF MARK J.S. HEATH, M.D. 

COMES NOW the declarant, Mark J.S. Heath, M.D., as authorized by 

28 U.S.C. § 1746, and states and declares all as follows: 

I. Foundation 

1. My name is Mark J.S. Heath. 

2. I live in New York City. 

3. I earned a B.A. in Biology, magna cum laude, from Harvard 

University, and an M.D. from the University of North Carolina at Chapel 

Hill. 

4. I am licensed to practice medicine in the State of New York. 

5. I am diplomate of the American Board of Anesthesiology, i.e., I 

am a board‐certified anesthesiologist. 

6. I have taught anesthesiology since 1993. 

7. I serve as an Assistant Professor of Clinical Anesthesiology at 

Columbia University. 

8. My work consists of approximately equal parts of performing 

clinical anesthesiology, teaching residents, fellows and medical students, 

and managing an NIH‐funded neuroscience laboratory. 

‐ 2 ‐ 

9. Additional credentials, including 27 publications, are listed on 

my curriculum vitae, which is attached hereto, incorporated herein, and 

marked as Heath Exhibit 1. 

10. As a result of my training, practice, and research as an 

anesthesiologist, I am familiar and proficient with the basic science 

involved in producing and reversing unconsciousness in human beings 

and other mammals by means of chemicals, and also in the applied science 

of carrying out this objective through the use of equipment, medications, 

and techniques. 

11. This knowledge of basic and applied science includes the the 

pharmacology of the chemicals, involved in lethal injections as they have 

been conducted from the late 1970’s through the present. 

12. I have performed several hundred hours of research into the 

techniques that are used in lethal injections.  This research has included the 

parallel and related subject of veterinary euthanasia. 

13. I have been admitted as a medical or scientific expert witness in 

courts in Georgia, Tennessee, Kentucky, Pennsylvania, Virginia, and 

Louisiana.  I have provided affidavits that have been reviewed by courts in 

the above jurisdictions and also in Kentucky, New York, Alabama, 

‐ 3 ‐ 

Maryland, North Carolina, South Carolina, Connecticut, Ohio, Oklahoma, 

Tennessee, Texas, California, and also in the United States Supreme Court. 

14. During court proceedings, I have listened to testimony from 

prison officials who are responsible for conducting executions by lethal 

injection.  I have reviewed protocols and/or lethal injection legislation from 

Missouri and from multiple additional states. 

15. I have testified by invitation before the Pennsylvania Senate 

Judiciary Committee regarding proposed legislation to remove 

pancuronium bromide from Pennsylvania’s lethal injection protocol.  I 

have testified before the Nebraska Senate Judiciary Committee regarding 

proposed legislation to adopt lethal injection as a method of execution.  I 

have testified before the New Jersey Department of Corrections regarding 

proposed regulatory amendments to the lethal injection protocol.  I have 

delivered multiple lectures on the subject of anesthesia during lethal 

injection. 

16. My research regarding lethal injection has involved both 

extensive conversations with recognized experts in the field and personal 

correspondence with the individuals responsible for introducing lethal 

injection as a method of execution in Oklahoma (the first state to formulate 

the procedure) and the federal government. 

‐ 4 ‐ 

17. Based on my training, experience, research, and analysis as 

aforesaid, I express the opinions set forth in the affidavit to a reasonable 

degree of medical certainty.  The fact that this standard is expressly cited in 

connection with any specific premise in this document is not intended to 

imply that any other premises are not set forth to the same standard. 

18. I have reviewed the discovery responses which the defendants 

in Timothy Johnston v. Gary B. Kempker, No. 4:04‐CV‐01075‐DJS, an action 

under 42 U.S.C. § 1983 before the United States Court of Appeals for the 

Eastern District of Missouri challenging Missouri’s practice of lethal 

injection. 

II. Chemicals Used in Missouri Lethal Injections 

A. Thiopental (Sodium Pentothal) 

19. On page 4 of defendant Kempker’s response to interrogatories, 

he says that the State of Missouri uses sodium pentothal, pancuronium 

bromide, and potassium chloride. 

20. Sodium thiopental (also known as “pentothal”, and commonly 

shortened by practitioners to “thiopental”) is a member of the group of 

drugs known as barbiturates.  This group is subdivided on the basis of 

duration of action into the “long acting,” the “intermediate acting,” the 

‐ 5 ‐ 

“short acting,” and the “ultra‐short acting” barbiturates.  Sodium 

thiopental belongs to the class of ultra‐short acting barbiturates. 

21. The medical utility of thiopental is that because of its ultra‐

short duration of action it can be used to render a patient unconscious for 

brief periods of time, in the range of a few seconds to a few minutes, and 

that because it “wears off” quickly patients regain consciousness rapidly.  

The ultra‐short duration of thiopental is medically important to 

anesthesiologists because sometimes during the induction of general 

anesthesia it is not possible to establish an airway for the patient, and the 

only recourse is to allow the anesthetic to wear off before the patient 

succumbs to suffocation.  Procedures for administering general anesthetics 

and achieving a deeper, more sustained “surgical plane” of anesthesia 

commonly involve “intubation,” or the placement of a tube in the patient’s 

trachea, in order to facilitate mechanical ventilation.   

22. Once the “induction” phase of a general anesthetic is 

completed, the “maintenance” phase is instituted.  Typically during this 

phase mechanical ventilation is used to deliver a continuous dose of 

volatile anesthetic gasses (inhaled anesthetics).  

23. If a prisoner being executed is given a sufficiently low dose of 

thiopental he will be similarly rendered unconscious for a period of time as 

‐ 6 ‐ 

short as a few seconds.  He would then regain consciousness only to find 

himself paralyzed by pancuronium bromide; he would next experience the 

pain from an intravenous concentrated potassium chloride injection 

coursing through his veins and causing cardiac arrest. 

24. Using an ultra‐short acting barbiturate, which produces more 

transient anesthesia than longer acting barbiturates, needlessly increases 

the risk that the prisoner will regain consciousness, and therefore will 

suffer extreme pain prior to and during his death by cardiac arrest from 

potassium chloride.  Injection of concentrated potassium chloride is well‐

documented to cause excruciating pain in humans and animals. 

25. Although veterinarians often use barbiturates for euthanasia of 

household pets, they rarely if ever use ultra‐short acting barbiturates.  Most 

commonly veterinarians use pentobarbital, an intermediate‐acting 

barbiturate with a half‐life of many hours.  This ensures that the animal 

cannot regain consciousness once the animal has been anesthetized for the 

purpose of euthanasia.  When given in the high doses used by 

veterinarians for achieving euthanasia, pentobarbital produces the rapid 

and painless onset of unconsciousness without the known attributes of 

thiopental such as short duration of anesthesia. 

‐ 7 ‐ 

26. Thiopental has a short “shelf life” in liquid form.  Sodium 

pentothal is therefore distributed in powder form to increase its shelf life; it 

must be properly mixed into a liquid solution before it can be injected.  

Proper mixing requires appropriate training, experience, and proficiency 

on the part of the responsible individual.  For example, the package insert 

supplied with Pentothal, a brand of thiopental, states that only individuals 

with experience in the administration of intravenous anesthetics should 

administer this drug.  Notably, the great majority of physicians, nurses, 

emergency responders, phlebotomists, and other health care professionals 

have no experience with the administration of intravenous anesthetics. 

B. Pancuronium Bromide 

27. The second chemical the Johnston defendants state they use in 

lethal injections, pancuronium bromide (sometimes referred to simply as 

“pancuronium” or “Pavulon”), paralyzes all voluntary muscles, but does 

not affect sensation, consciousness, cognition, or the ability to feel pain and 

suffocation. 

28. Pancuronium bromide is a member of a group of drugs called 

neuromuscular blockers.  These drugs block the transmission of the signals 

that pass from nerve endings to voluntary muscles.  Pancuronium has no 

‐ 8 ‐ 

significant effect on the brain or on nerves that carry sensory information.  

The effect of pancuronium is to render a person or animal completely 

paralyzed, so that no voluntary movement of any kind can be achieved. 

29. Pancuronium has no anesthetic or sedative properties, and 

therefore an individual who is paralyzed by pancuronium is fully 

conscious and able to feel, hear, see, and smell.  Because the muscles that 

enable breathing are paralyzed by pancuronium, such an individual would 

immediately on its administration begin to suffocate, but would be unable 

to cry out or express that he was conscious and suffering. 

30. Conscious paralysis is not a theoretical construct but is a real 

and much‐feared complication of general anesthesia.  In this context it is 

sometimes referred to as “intraoperative awareness.”  When this occurs, 

patients are conscious, paralyzed, feeling the pain of surgery, and unable to 

communicate with the personnel in the operating room.  Because of the risk 

of intraoperative awareness, anesthesiologists receive extensive training in 

the use of monitoring equipment and diagnostic techniques to ensure to 

the greatest extent possible that their patients are not awake while 

paralyzed during surgery. 

31. In Johnston v. Kempker, the defendants’ discovery responses fail 

to prove or even assert that the executioners (or indeed any participant in 

‐ 9 ‐ 

the procedure) have been trained in the detection and prevention of 

conscious paralysis or intraoperative awareness, or that they are even 

aware that such a possibility exists. 

32. The Johnston defendants’ discovery responses do not assert a 

reason why they administer pancuronium bromide.  They do not assert 

that it is a lethal dose. 

33. Individuals who are paralyzed by pancuronium appear 

tranquil, relaxed, and serene, regardless of whether they are conscious or 

unconscious.  Pancuronium places a “chemical veil” over the execution, 

and makes it impossible for any witnesses to make a meaningful 

determination about whether the execution they observe is being 

conducted without the infliction of gratuitous pain. 

34. Because the defendants use pancuronium bromide, regardless 

of whether the prisoner is awake or anesthetized, and regardless of 

whether the execution is humane or cruel, the execution will appear 

humane to the media and to any other witnesses. 

35. The inclusion of pancuronium in the chemicals the defendants 

disclosed in their Johnston discovery responses compounds the needless 

risk arising from their choice to use a short‐acting, shallow anesthetic 

(thiopental) and the risk of an administration error caused by non‐

‐ 10 ‐ 

professional execution personnel that the prisoner will be conscious during 

the procedure and will experience conscious paralysis, suffocation, and the 

effects of the injection of the third chemical state they are using, 

concentrated potassium chloride. 

36. If the sodium pentothal and potassium chloride are given in 

doses sufficient to cause death, there would be no rational or medically 

justifiable place for pancuronium bromide in a lethal injection protocol. 

Because it simultaneously suffocates a sentient being and prevents the 

sentient being from communicating the suffering to anyone else, the use of 

pancuronium bromide violates professional, legal, and ethical norms for 

the euthanasia of animals. 

37. Missouri’s legal regulation of veterinarians, 2 CSR 30‐

9.020(F)(5), provides:  “All euthanasia of animals shall be accomplished by 

a method approved by the 2000 edition, or later revisions, of the American 

Veterinary Medical Association’s Panel on Euthanasia, as incorporated by 

reference in this rule.”  The “American Veterinary Medical Association” is 

often referred to by the abbreviation “AVMA”. 

38. The AVMA periodically convenes a panel of veterinary experts 

to review, refine, and update a set of recommendations about the conduct 

of euthanasia.  The purpose of this periodic review is to ensure, as much as 

‐ 11 ‐ 

is reasonably possible, that the recommendations of the AVMA regarding 

euthanasia have taken into account advances and developments in the 

veterinary field and in the sub‐field of veterinary euthanasia.  The most 

recent panel released the report entitled “2000 Report of the AVMA Panel 

on Euthanasia”; a copy of this report is available under the internet 

address: http://www.avma.org/resources/euthanasia.pdf. 

39. The “2000 Report of the AVMA Panel on Euthanasia” discusses 

the use of barbiturates and neuromuscular blockers in euthanasia.  At the 

bottom of page 680 a separate paragraph emphasizes that “a combination 

of pentobarbital with a neuromuscular blocker is not an acceptable 

euthanasia agent.”  While this statement refers specifically to pentobarbital 

it is clearly intended to be generalized to all barbiturates, because earlier on 

this pagethere is a discussion of the use of “all barbituric acid derivatives”.  

Consistent with the veterinary practice set forth at the top of page 680 the 

AVMA recommends the use of pentobarbital (not thiopental) on animals in 

part because it is long‐acting (in contrast to the ultra‐short acting thiopental 

which the defendants use on condemned prisoners).  Indeed, the use of 

thiopental in combination with a neuromuscular blocker would certainly 

be considered by the AVMA to be even more unacceptable than the use of 

pentobarbital with a neuromuscular blocker, because of the increased 

‐ 12 ‐ 

chance (compared with pentobarbital) that the animal would regain 

consciousness. 

40. The selection of chemicals to which the Johnston defendants 

admit fails to comply with the professional and legally‐recognized 

standards for euthanizing animals which the AVMA Panel Report on 

Euthanasia promulgates.  These veterinary norms reflect the high level of 

attention that is directed towards preventing and eliminating the 

possibility of conscious suffocation due to chemical paralysis. 

41. Defendants’ choice to use the combination of a barbiturate with 

a neuromuscular blocker is completely unnecessary to bring about the 

statutory object of causing the death of the prisoner.  It compounds the risk 

of causing gratuitous pain which results from the defendants’ use of an 

ultra‐short acting barbiturate in the first place, their declining to reveal the 

quantity to be used, the likelihood of administration errors caused by their 

use of executioners whose ability to monitor anesthetic depth is unknown, 

the needless use of pancuronium bromide (compounded by the use of the 

painful agent potassium chloride, the next chemical to be discussed), and 

the failure to verify anesthetic depth before intravenously administering 

the concentrated potassium chloride. 

‐ 13 ‐ 

42. If administered alone, a lethal dose of pancuronium bromide 

would not immediately cause a human being to lose consciousness.  It 

would totally immobilize him by paralyzing all voluntary muscles and the 

diaphragm, causing him to suffocate to death while experiencing an 

intense, conscious desire to inhale.  Ultimately the condemned inmate 

would lose consciousness, but it would not be as an immediate and direct 

result of the pancuronium bromide.  Rather, the loss of consciousness 

would be due to suffocation, and would be preceded by the torment and 

agony caused by suffocation. 

C. Potassium Chloride 

43. Potassium chloride (KCl) is a common salt composed of 

potassium and chlorine.  Potassium is vital in the human body, and oral 

potassium chloride is the common means to replenish it, although it can 

also be administered intravenously if highly diluted.  Medically it is used 

in the treatment of hypokalemia (low concentration of potassium in the 

blood).  When administered rapidly by intravenous route, potassium 

chloride travels via the venous system to the heart and interferes with the 

normal electrical activity of the heart, causing the heart to stop pumping 

blood (“cardiac arrest”) and death. 

‐ 14 ‐ 

44. The intravenous administration of concentrated potassium 

chloride is extremely painful.  In clinical settings, potassium chloride is 

used in much lower concentrations in part so as to avoid this excruciating 

pain.  Veins are richly supplied with sensory nerve endings that can signal 

extremely high levels of pain.  Concentrated potassium strongly activates 

these fibers, and causes an excruciating searing or burning sensation that is 

likened to that of boiling oil or branding with a red hot iron. 

45. There are many possible alternative drugs or chemical agents 

that are equally effective in causing and maintaining cardiac arrest but that 

do not cause pain.  Such non‐painful drugs are used by veterinarians to 

produce and maintain cardiac arrest during euthanasia of animals. 

46. The inclusion of potassium chloride by the Johnston defendants’ 

admission compounds the risk presented by the needless selection of an 

ultrashort‐acting barbiturate, the defendants’ declining to reveal the doses 

of drugs to be used, the likelihood of administration errors caused by 

executioners whose credentials or lack thereof the Johnson defendants have 

not revealed, and the needless use of pancuronium, that the prisoner will 

be conscious during the procedure and will experience the excruciating 

torments of conscious paralysis and intravenous concentrated potassium. 

‐ 15 ‐ 

47. Page 680 of the AVMA report states that “although 

unacceptable and condemned when used in unanaesthetized animals, the 

use of a supersaturated solution of potassium chloride injected 

intravenously or intracardially is an acceptable method to produce cardiac 

arrest and death.”  This statement firmly establishes the utter 

unacceptability of administering potassium chloride to an animal that is 

not anesthetized. 

48. On page 681 the AVMA report goes on to state that “[i]t is of 

utmost importance that personnel performing this technique are trained 

and knowledgeable in anesthetic techniques, and are competent in 

assessing anesthetic depth appropriate for administration of potassium 

chloride intravenously.”  The Johnston defendants have declined to provide 

any information about presence or absence of training, competency, or 

proficiency of the executioners in the assessment of anesthetic depth.  The 

Johnston defendants have placed in doubt the proposition that anyone 

involved in conceiving or reviewing the entire lethal injection rite in 

Missouri has the requisite training in anesthetic techniques to assess 

anesthetic depth as required by the AVMA prior to the administration of 

potassium on an animal.  

‐ 16 ‐ 

49. On page 681 the AVMA report also states that “administration 

of potassium chloride intravenously requires animals to be in a surgical 

plane of anesthesia characterized by a loss of consciousness, loss of reflex 

muscle response, and loss of response to noxious stimuli.”  The information 

the Johnston defendants have chosen to provide in response to discovery 

does not indicate the existence of attempts to conduct any such testing, let 

alone the presence among the executioners of persons qualified to do so. 

50. The use of pancuronium greatly increases the difficulty of 

making the assessment of anesthetic depth as described and required by 

the AVMA report.  For example, a common way in which veterinarians 

assess anesthetic depth is to use a surgical clamp to pinch the tail or paw.  

If the animal is not adequately anesthetized it will withdraw the pinched 

appendage, and may possible exhibit generalized escape or withdrawal 

responses, and may even vocalize.  By contrast, if an animal is adequately 

anesthetized it will not exhibit any of these responses.  Of course, if the 

animal has been administered a neuromuscular blocker such as 

pancuronium, this pinch test cannot be used, because the animal will not 

be able to exhibit such reflexive withdrawal responses because it is 

paralyzed.  If the animal is not properly anesthetized it will feel the 

extreme pain caused by the clamping of its tail or paw, but will be unable 

‐ 17 ‐ 

to withdraw, struggle, or vocalize because of the entombing effect of 

pancuronium.  If the veterinarian is not closely monitoring subtle 

indicators of anesthetic depth such as pupil size, heart rate, and blood 

pressure, they would have no knowledge that the animal is in fact feeling 

the pain but unable to respond. 

51. Although the Johnston defendants do not claim that there is any 

attempt to assess or verify anesthetic depth prior to the administration of 

potassium chloride, any hypothetical attempt to assess anesthetic depth 

would be made much more challenging and subject to error by their 

needless administration of pancuronium.  Further, such hypothetical 

attempts to ascertain anesthetic depth prior to the administration of 

potassium would be thwarted if monitoring equipment such as an EKG 

and blood pressure cuff is not present, in use, and under the supervision of 

an individual who is trained to use them to assess anesthetic depth. 

52. The failure of the defendants/respondents to comply with the 

AVMA Panel Report on Euthanasia by specifying the assessment and 

verification of anesthetic depth prior to the administration of potassium 

chloride compounds the risk presented by the relatively low dose of 

thiopental, and compounds the risk presented by the use of an ultra‐short 

acting barbiturate, and compounds the risk of an administration error 

‐ 18 ‐ 

caused by inadequately proficient execution personnel, and compounds 

the risk engendered by the needless use of pancuronium, and compounds 

with the use of the painful agent potassium chloride, that the inmate will 

be conscious during the procedure and will experience the excruciating 

torments of conscious paralysis and intravenous concentrated potassium 

chloride. 

53. If the individuals conducting an execution by lethal injection do 

not properly mix and inject thiopental (sodium pentothal), in a dose 

sufficient to cause death or at least the loss of consciousness for the 

duration of the plaintiff or petitioner’s execution, then it is my opinion to a 

reasonable degree of medical certainty that the use of pancuronium 

bromide places the plaintiff or petitioner at undue and unnecessary risk of 

consciously experiencing paralysis, suffocation, and the excruciating pain 

of the intravenous injection of the respondent’s high dose of the third 

chemical, potassium chloride.  Based on the information the Johnston 

defendants have chosen to release, it is my opinion to a reasonable degree 

of medical certainty that the defendants’ lethal injection practices create a 

foreseeable risk that the plaintiff/petitioner will not be anesthetized to the 

point of being unconscious and unaware of the pain for the duration of the 

execution procedure, when this risk is absolutely unnecessary to the 

‐ 19 ‐ 

statutory purpose of bringing about the death of the plaintiff/petitioner.  If 

the condemned prisoner is not first anesthetized, it is my opinion to a 

reasonable degree of medical certainty that the pancuronium bromide will 

paralyze all voluntary muscles and mask external, physical indications of 

the excruciating pain being experienced by the prisoner during the process 

of suffocating (caused by the pancuronium bromide) and intravenous 

potassium administration. 

54. Defendants/respondents’ execution protocol requires the 

presence of media witnesses to the execution, and permits the presence of 

witnesses chosen by the condemned prisoner and witnesses chosen by the 

homicide decedent’s surviving family members.  The use of pancuronium 

bromide effectively nullifies the ability of witnesses to discern whether or 

not the condemned prisoner is experiencing a peaceful death or an 

agonizing death.  Regardless of the experience of the condemned prisoner 

(i.e. whether he is deeply unconscious or experiencing the excruciation of 

suffocation, paralysis, and potassium chloride injection) he will appear to 

witnesses to be serene and peaceful due to the defendants/respondents’ 

choice to use pancuronium to institute paralysis.  It is unconscionable that 

the lethal injection protocol would specify the use of a superfluous drug 

that thwarts the ability of the witnesses to ascertain whether or not the 

‐ 20 ‐ 

procedure is humane.  If the witness cannot ascertain whether the 

procedure is humane, then there is no means by which the citizens of 

Missouri or the Court can know whether or not the procedure is humane. 

III. Qualifications and Training of Executioners 

55. The information about their lethal injection practices which the 

Johnston defendants have chosen to reveal do not include procedures 

designed to ensure the proper preparation of the chemicals used.  They 

have declined to provide any of the facts regarding the credentials, 

certification, experience, or proficiency of the personnel who are 

responsible for the mixing of the drugs, or for the drawing up of the drugs 

into syringes. 

56. Preparation of drugs, particularly for intravenous use, is a 

technical task requiring significant training in pharmaceutical concepts and 

calculations.  It is my opinion based on a reasonable degree of medical 

certainty, and based on my review of lethal injection procedures in various 

jurisdictions, that there exist many risks associated with drug preparation 

which, if not properly accounted for, further elevate the risk that a prisoner 

will consciously experience excruciating pain during the lethal injection. 

‐ 21 ‐ 

57. The information the Johnston defendants have chosen to make 

available provides inadequate data regarding the training, credentials, 

certification, experience, and proficiency of any prison employee or 

contractor who performs the execution procedure.  Their declining to 

supply such information—let alone the ultimate details of their licensure 

and work history—raises critical questions about the degree to which the 

condemned prisoners are at risk of excruciating pain during their 

executions.  It is my opinion based on a reasonable degree of medical 

certainty that the correct and safe management of intravenous drug and 

fluid administration requires a significant level of professional acumen, 

and cannot be adequately performed by personnel lacking the requisite 

training and experience.  If a person had invested the time and other 

resources into acquiring this proficiency, it would be my experience in the 

practice of medicine that they would obtain a license and practice in their 

area of health care rather than being an executioner. 

58. The great majority of nurses are not trained in the use of ultra‐

short acting barbiturates; indeed, this class of drugs is essentially only used 

by nurses who have significant experience in intensive care units and as 

nurse anesthetists.  Very few paramedics or ex‐military corpsmen are 

trained or experienced in the use of ultra‐short acting barbiturates, such as 

‐ 22 ‐ 

thiopental (sodium pentothal).  Based on my medical training and 

experience, and based upon his research of lethal injection procedures and 

practices, inadequacies in these areas elevate the risk that the lethal 

injection procedure will cause the prisoner to suffer excruciating pain 

during the execution. 

59. Based on my research into methods of lethal injection used by 

various states and the federal government, and based on my training and 

experience as a medical doctor specializing in anesthesiology, it is my 

opinion based on a reasonable degree of medical certainty that, given the 

apparent absence of a central role for a properly trained medical or even 

veterinary professional in the defendants/respondents’ execution 

procedure in Missouri, it can and should be presumed that the lethal 

injection procedure which the defendants/respondents use creates 

foreseeable risks of inflicting excruciating pain and suffering on the 

prisoner during the lethal injection procedure when to do so is unnecessary 

to bring about the death of the prisoner. 

Further, the declarant sayeth naught. 

I declare under penalty of perjury that the foregoing is true and 

correct. 

Executed:  ___May 9, 2005________________ 

‐ 23 ‐ 

 

_____________________________ MARK J.S. HEATH, M.D. Assistant Professor of Clinical   Anesthesiology College of Physicians & Surgeons Columbia University New York, New York  10024 

Curriculum Vitae

1) Date of preparation: December 19, 2004 2) Name: Mark J. S. Heath

Birth date: March 28, 1960 Birthplace: New York, NY Citizenship: United States, United Kingdom

3) Academic Training: Harvard University B.A., Biology, 1983

University of North Carolina, Chapel Hill M.D., 1987 Medical License New York: 177101-1

4) Traineeship: 1987 – 1988 Internship, Internal Medicine, George Washington University Hospital, Washington, DC.

1988 – 1991 Residency, Anesthesiology, Columbia College of Physicians and Surgeons, New York, NY

1991 – 1993 Fellowship, Anesthesiology, Columbia College of Physicians and

Surgeons, New York, NY 5) Board Qualification: Diplomate, American Board of Anesthesiology, October 1991. Testamur, Examination of Special Competence in Perioperative Transesophageal Echocardiography (PTEeXAM), 2001. 6) Military Service: None 7) Professional Organizations: American Society of Anesthesiologists International Anesthesia Research Society Society of Cardiovascular Anesthesiology 8) Academic Appointments:

1993 – 2002 Assistant Professor of Anesthesiology, Columbia University, New York, NY

2002 - present Assistant Professor of Clinical Anesthesiology,

Columbia University, New York, NY

9) Hospital/Clinical Appointments:

1993 – present Assistant Attending Anesthesiologist, Presbyterian Hospital, New York, NY.

10) Honors: Magna cum laude, Harvard University Alpha Omega Alpha, University of North Carolina at Chapel Hill

First Prize, New York State Society of Anesthesiologists Resident Presentations, 1991

11) Fellowship and Grant Support:

Foundation for Anesthesia Education and Research, Research Starter Grant Award, Principal Investigator, funding 7/92 - 7/93, $15,000.

Foundation for Anesthesia Education and Research Young Investigator Award, Principal Investigator, funding 7/93 - 7/96, $70,000.

NIH KO8 "Inducible knockout of the NK1 receptor" Principal Investigator, KO8 funding 12/98 - 11/02, $431,947 over three years (no-cost extension to continue through 11/30/2002)

NIH RO1 "Tachykinin regulation of anxiety and stress responses"

Principal Investigator, funding 9/1/2002 – 8/30/2007 $1,287,000 over 5 years

12) Departmental and University Committees: Research Allocation Panel (1996 – 2001)

Institutional Review Board (Alternate Boards 1-2, full member Board 3) (2003 - present)

13) Teaching:

Lecturer and clinical teacher: Anesthesiology Residency Program, Columbia University and Presbyterian Hospital, New York, NY Advanced Cardiac Life Support Training

Anesthetic considerations of LVAD implantation. Recurrent lecture at Columbia University LVAD implantation course.

Invited Lecturer:

NK1 receptor functions in pain and neural development, Cornell University December 1994

Anxiety, stress, and the NK1 receptor, University of Chicago, Department of Anesthesia and Critical Care, July 2000

Anesthetic Considerations of LVAD Implantation, University of

Chicago, Department of Anesthesia and Critical Care, July 2000 NK1 receptor function in stress and anxiety, St. John’s University

Department of Medicinal Chemistry, March 2002 Making a brave mouse (and making a mouse brave), Mt.Sinai

School of Medicine, May 2002 Problems with anesthesia during lethal injection procedures,

Geneva, Switzerland. Duke University School of Law Conference, “International Law, Human Rights, and the Death Penalty: Towards an International Understanding of the Fundamental Principles of Just Punishment”, July 2002.

NK1 receptor function in stress and anxiety, Visiting Professor,

NYU School of Medicine, New York, New York. October 2002. Anesthetic Depth, Paralysis, and other medical problems with

lethal injecton protocols: evidence and concerns, Federal Capital Habeas Unit Annual Conference, Jacksonville, Florida. May 2004.

Medical Scrutinyof Lethal Injection Procedures. National

Association for the Advancement of Colored People Capital Defender Conference, Airlie Conference Center, Warrenton, Virginia. July 2004.

Anesthetic considerations of LVAD implantation. Recurrent

lecture at Columbia University LVAD implantation course.

14) Grant Review Committees: None

15) Publications: Original peer reviewed articles * Santarelli, L., Gobbi, G., Debs, P.C., Sibille, E. L., Blier, P., Hen, R., Heath, M.J.S. (2001). Genetic and pharmacological disruption of neurokinin 1 receptor function decreases anxiety-related behaviors and increases serotonergic function. Proc. Nat. Acad. Sci., 98(4), 1912 – 1917. * King, T.E. δ, Heath M. J. Sδ., Debs, P, Davis, MB, Hen, R, Barr, G. (2000). The development of nociceptive responses in neurokinin-1 receptor knockout mice. Neuroreport.;11(3), 587-91 δ authors contributed equally to this work * Heath, M. J. S., Lints, T., Lee, C. J., Dodd, J. (1995). Functional expression of the tachykinin NK1 receptor by floor plate cells in the embryonic rat spinal cord and brainstem. Journal of Physiology 486.1, 139 -148. * Heath, M. J. S., Womack M. D., MacDermott, A. B. (1994). Subsance P elevates intracellular calcium in both neurons and glial cells from the dorsal horn of the spinal cord. Journal of Neurophysiology 72(3), 1192 - 1197. McGehee, D. S., Heath, M. J. S., Gelber, S., DeVay, P., Role, L.W. (1995) Nicotine enhancement of fast excitatory synaptic transmission in the CNS by presynaptic receptors. Science 269, 1692 - 1696. Morales D, Madigan J, Cullinane S, Chen J, Heath, M. J. S., Oz M, Oliver JA, Landry DW. (1999). Reversal by vasopressin of intractable hypotension in the late phase of hemorrhagic shock. Circulation. Jul 20;100(3):226-9. LoTurco, J. J., Owens, D. F., Heath, M. J. S., Davis, M. B. E., Krigstein, A. R. (1995). GABA and glutamate depolarize cortical progenitor cells and inhibit DNA synthesis. Neuron 15, 1287 - 1298. Kyrozis A., Goldstein P. A., Heath, M. J. S., MacDermott, A. B. (1995). Calcium entry through a subpopulation of AMPA receptors desensitized neighboring NMDA receptors in rat dorsal horn neurons. Journal of Physiology 485.2, 373 - 381. McGehee, D.S., Aldersberg, M. , Liu, K.-P., Hsuing, S., Heath, M.J.S. , Tamir, H. (1997). Mechanism of extracellular Ca2+-receptor stimulated hormone release from sheep thyroid parafolicular cells. Journal of Physiology: 502,1, 31 - 44. Kao, J., Houck, K., Fan, Y., Haehnel, I., Ligutti, S. K., Kayton, M. L., Grikscheit, T., Chabot, J., Nowygrod, R., Greenberg, S., Kuang, W.J., Leung, D. W., Hayward, J. R., Kisiel, W., Heath, M. J. S., Brett, J., Stern, D. (1994). Characterization of a novel tumor-derived cytokine. Journal of Biological Chemistry 269, 25106 - 25119. Dodd, J., Jahr, C.E., Hamilton, P.N., Heath, M.J.S., Matthew, W.D., Jessell, T.M. (1983). Cytochemical and physiological properties of sensory and dorsal horn neurons that transmit cutaneous sensation. Cold Spring Harbor Symposia of Quantitative Biology 48, 685 -695.

Pinsky, D.J., Naka, Y., Liao, H., Oz, M. O., Wagner, D. D., Mayadas, T. N., Johnson, R. C., Hynes, R. O., Heath, M.J.S., Lawson, C.A., Stern, D.M. Hypoxia-induced exocytosis of endothelial cell Weibel-Palade bodies. Journal of Clinical Investigation 97(2), 493 - 500. Case reports none Review, chapters, editorials * Heath, M. J. S., Dickstein, M. L. (2000). Perioperative management of the left ventricular assist device recipient. Prog Cardiovasc Dis.;43(1):47-54. * Dickstein, M.L., Mets B, Heath M.J.S. (2000). Anesthetic considerations during left ventricular assist device implantation. Cardiac Assist Devices pp 63 – 74. * Heath, M. J. S. and Hen, R. (1995). Genetic insights into serotonin function. Current Biology 5.9, 997 -999. * Heath, M.J.S., Mathews D. (1990). Care of the Organ Donor. Anesthesiology Report 3, 344-348. * Heath, M. J. S., Basic physiology and pharmacology of the central synapse. (1998) Anesthesiology Clinics of North America 15(3), 473 - 485. Abstracts Heath, M.J.S., Davis, M., Santarelli L., Hen H. (2002). Gene targeting of the NK1 receptor blocks stress-evoked induction of c-Fos in the murine locus coeruleus. IARS American-Japan Congress A-15. Heath, M.J.S., Davis, M., Santarelli L., Hen H. (2002). Gene targeting of the NK1 receptor blocks stress-evoked induction of c-Fos in the murine locus coeruleus. Anesthesiology 95:A-811. Heath, M.J.S., Davis, M., Santarelli L., Hen H. (2002). Expression of Substance P and NK1 Receptor in the Murine Locus Coeruleus and Dorsal Raphe Nucleus. Anesthesia and Analgesia 93; S-212 Heath, M.J.S., Davis, M., Santarelli L., Hen H. (2002). Expression of Substance P and NK1 Receptor in the Murine Locus Coeruleus and Dorsal Raphe Nucleus. Anesthesia and Analgesia 93; S-212. Heath, M.J.S., Santarelli L, Hen H. (2001) The NK1 receptor is necessary for the stress-evoked expression of c-Fos in the paraventricular nucleus of the hypothalamus. Anesthesia and Analgesia 92; S233. Heath, M.J.S., Santarelli L, Debs P, Hen H. (2000). Reduced anxiety and stress responses in mice lacking the NK1 receptor. Anesthesiology 93: 3A A-755.

Heath, M.J.S., King, T., Debs, P.C., Davis M., Hen R., Barr G. (2000). NK1 receptor gene disruption alters the development of nociception. Anesthesia and Analgesia; 90; S315. Heath, M.J.S., Lee, J.H., Debs, P.C., Davis, M. (1997). Delineation of spinal cord glial subpopulations expressing the NK1 receptor. Anesthesiology; 87; 3A; A639. Heath, M.J.S., MacDermott A.B. (1992). Substance P elevates intracellular calcium in dorsal horn cells with neuronal and glial properties. Society for Neuroscience Abstracts; 18; 123.1. Heath, M.J.S., Lee C.J., Dodd J. (1994). Ontogeny of NK1 receptor-like immunoreactivity in the rat spinal cord. Society for Neuroscience Abstracts; 20; 115.16. Heath, M.J.S., Berman M.F. (1991) Isoflurane modulation of calcium channel currents in spinal cord dorsal horn neurons. Anesthesiology 75; 3A; A1037.

DECLARATION OF DR. DAVID A. LUBARSKY 

COMES NOW the declarant, David A. Lubarky, M.B.A., M.D., and as 

authorized by 28 U.S.C. § 1746, states and declares under penalty of perjury 

all as follows: 

1. My name is David A. Lubarsky. 

2. I live in Miami, Florida. 

3. I graduated from Washington University with a B.A. in 1980 and 

an M.D. in 1984. 

4. I also hold an M.B.A. from Duke University (1999). 

5. I am licensed to practice medicine in the States of New York 

(1985), North Carolina (1988) and Florida (2002).  I moved from North 

Carolina to Florida, and while applying for a full license, in 2001 and early 

2002, held a Florida Board of Medicine Medical Faculty Certificate. 

6. I am board‐certified by the National Board of Medical Examiners, 

the American Board of Anesthesiology (placing in the 99th percentile on 

Part I of its examination), recently completed the American Board of 

Anesthesiology Maintenance of Certification Exam (2004) and am certified 

by the American Academy of Pain Management. 

7. I serve as the Emanuel M. Papper Professor and Chairman, 

Department of Anesthesiology, University of Miami School of Medicine, 

‐ 2 ‐ 

with a secondary academic appointment as Professor, Department of 

Management, University of Miami School of Business. 

8. I have published, as author or co‐author, 127 books, chapters, 

monographs, journal articles, and other publications or abstracts, primarily 

in the area of anesthesiology.  I have also made video presentations and 

other private‐sector publications, contributed to conference proceedings 

and newsletters, and created electronic, World Wide Web, and/or Internet 

publications related to my work. 

9. I have lectured, appeared on panels, and served as a visiting 

professor throughout the United States and in, Paris, Hong Kong, and 

Japan. 

10. I have been retained as an expert witness in approximately 50 

malpractice cases and given about 20 depositions. 

11. My credentials are set forth in greater detail in the curriculum 

vitae, a true and correct copy of which is attached hereto, incorporated 

herein, and marked as Lubarsky Exhibit 1. 

12. Together with Leonidas Koniaris, M.D., Teresa A. Zimmers, Ph.D., 

and Jonathan P. Sheldon, J.D., I conducted the research and reported the 

findings contained in “Inadequate anesthesia in lethal injection for 

execution” in THE LANCET, volume 365, pages 1412‐14, published on April 

‐ 3 ‐ 

16, 2005, a true and correct copy of which is attached hereto, incorporated 

herein, and marked as Lubarsky Exhibit 2. 

13. THE LANCET is one of the most prestigious medical journals in the 

world.  All publications go through a rigorous process of review for both 

pertinence and scientific method.  Usually at least two reviewers eminent 

in the field being investigated provide input to an editor in charge of the 

section in which the paper will be published.  Among the methods 

evaluated are how data were collected, and statistical analysis of that data.  

Furthermore, conclusions are carefully monitored for faithfulness to the 

data described in the paper.   

14. Our research dealt with the process of injecting a person sentenced 

to death with a succession of three chemicals:  thiopental (also known as 

sodium pentothal), pancuronium bromide, and potassium chloride, and 

raised the question whether the levels of thiopental in the bloodstream of 

the person being executed were high enough to produce unconsciousness 

throughout the execution and whether the protocols provided by Texas 

and Virginia would absolutely produce a foolproof method of humane 

execution. 

15. Each of the propositions of fact set forth in the LANCET article as 

aforesaid reflects my opinion to a reasonable degree of scientific certainty. 

‐ 4 ‐ 

16. Based on our research, the article concludes that toxicology reports 

from the four lethal‐injection jurisdictions which provided them showed 

that post‐mortem concentrations of thiopental (sodium pentothal) in the 

blood of persons who had been executed were lower than that required for 

surgery in 43 of 49 cases reported (88%), and 21 (43%) inmates had 

concentrations consistent with awareness.  This conclusion reflects my 

opinion to a reasonable degree of scientific certainty. 

17. My LANCET co‐authors and I have reviewed the discovery 

responses which the Missouri defendants have thus far provided in 

Timothy Johnston v. Gary B. Kempker, et al., 4:04‐CV‐1075‐DJS (U.S. Dist. Ct. 

E.D. Mo.), as forwarded to us by counsel for Vernon Brown. 

18. On the basis of the data which these representatives of the State of 

Missouri have provided, and from the fact that according to these data, the 

procedure in Missouri is not substantially dissimilar to the procedure in the 

states which kept and provided toxicology data, I draw the inference, to a 

reasonable degree of scientific certainty, that the levels of thiopental 

(sodium pentothal) in the bloodstreams of persons executed by lethal 

injection in Missouri are, at best, similar to those levels executed in the four 

states which kept and provided toxicology data. 

‐ 5 ‐ 

19. In order for us to reject the inference that because the basic 

procedure in Missouri is the same as in the states for which we have 

toxicology data, the results are the same in Missouri as in those states, 

representatives of the State of Missouri would have to provide the 

following data: 

a. Documented blood levels of thiopental, showing 

adequate anesthesia at the time of death, of each person 

executed; 

b. Documented post‐mortem blood levels showing adequate 

levels of anesthesia post‐mortem of each person executed,  

c. The time from administration of each of the three 

chemicals to the time of death of each person executed; 

d. The quantity of each of the three chemicals administered 

to each person executed; 

e. The protocol of execution; 

f. The training of each individual performing each 

execution; 

‐ 6 ‐ 

20. In order to render a prospective evaluation about an execution 

that the State of Missouri intends to carry out in the future, based on its 

having carried them out in the past, my co‐authors and I would need the 

following information: 

a. Any and all post‐mortem reports on the persons executed 

by lethal injection in Missouri, including autopsy reports, 

Medical Examiner investigative reports, all post‐mortem 

toxicology including blood, vitreous and other fluids, 

exact identification of all blood sampling sites, and the 

timing of all samples drawn, and the timing of all tests 

run, and the method of storage of samples between 

sampling and testing.  Toxicology reports alone are often 

incomplete, lacking sample collection time, site of 

collection, so reviewing the complete autopsy and 

toxicology original study is necessary.   

b. In order to rule out the foreseeable risk of the gratuitous 

infliction of pain in a future lethal injection, we would 

need to have access to the standard operating procedures 

‐ 7 ‐ 

for the autopsy procedures themselves.  As North 

Carolina performed toxicology analysis without a full 

autopsy, we would specifically need the results from all 

post‐mortem investigative procedures, not only 

autopsies.  To the extent these procedures fell short of 

professional norms for a full autopsy, they may be 

inadequate to rule out the foreseeable risk of the 

gratuitous infliction of pain. 

c. We would need the most complete available description 

of the protocol itself, including identity and training of 

executioners, number of intravenous (IV) lines, 

preparation of the drugs, the dosages, the order of 

administration, rate of administration, backup plan, etc.  

Is there monitoring for depth of anesthesia?  Are heart 

rate monitors are used strictly to determine death? 

d. In order to render certain other data reliable, we would 

need to know the protocol for determining death.  In 

North Carolina, staff claim to watch the monitor flat‐line 

‐ 8 ‐ 

for five minutes, and then call a doctor in to pronounce 

death, but there is reason to think this is not always the 

procedure.  Any fact tending to draw in question the 

timing of death would undermine our confidence that the 

anesthesia level at the time of death was adequate to 

produce unconsciousness. 

e. Time from injection of first drug to declaration of death. 

We generally have to rely on published eyewitness 

accounts or press releases from the various jurisdictions 

for this information. 

21. In addition to needing the foregoing data about all past Missouri 

executions by lethal injection, we would need to know the plans of the 

executions in the future execution concerning which our opinion is sought, 

for example: 

• identity and training of executioners 

• number of intravenous (IV) lines 

• preparation of the chemicals 

• dosages of the chemicals 

‐ 9 ‐ 

• the order of administration 

• rate of administration 

• backup plan 

• plan, or lack of plan, for monitoring for depth of 

anesthesia 

• any other fact on which the State relies in contending that 

its plans for carrying out the lethal injection in question 

does not create the foreseeable risk of gratuitous pain. 

22. Each and every one of the foregoing expressions of need for 

certain data in order to rule out the foreseeable risk of gratuitous pain in a 

Missouri execution by lethal injection is set forth to a reasonable degree of 

scientific certainty. 

23. In the absence of all of the foregoing information, I am left with

the conclusion to a reasonable degree of scientific certainty that the

infliction of death by lethal injection on Vernon Brown on May 18,2005, by

officials, officers, and employees of the State of Missouri would create the

foreseeable risk of gratuitous pain for the reasons set forth in "Inadequate

anesthesia in lethal injection for execution" in THE LANCET, as aforesaid.

Further, the declarant saith naught.

I declare under penalty of pe jury that the foregoing is true and

correct. -<,/p .s/ Executed:

Department of ~ n e s t h e s i o l o ~ ~ School of Medicine University of Miami P.O. Box 016370 Miami, Florida 33101

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

1

UNIVERSITY OF MIAMI CURRICULUM VITAE

Date: February 2005 PERSONAL Name: David Alan Lubarsky, M.D., M.B.A. Office phone: (305) 585-7037 Office address: Jackson Health System 1611 NW 12th Avenue, C301 Miami, Florida 33136 Date of birth: August 2, 1959 Place of birth: New York, NY Present academic rank and title: Primary academic appointment: Emanuel M. Papper Professor and Chairman Department of Anesthesiology Professor of Anesthesiology, with tenure

University of Miami School of Medicine

Secondary academic appointment: Professor Department of Management University of Miami School of Business Citizenship: U.S.A. HIGHER EDUCATION Washington University, St. Louis, MO, May, 1980, B.A. Washington University School of Medicine, St. Louis, MO, May, 1984, M.D. Fuqua School of Business, Duke University, Durham, NC, August, 1999, M.B.A. Medical licensure: November, 2002 – Florida State License #ME86449 December, 2001-Florida Board of Medicine Medical Faculty Certificate-Number: 1457 July, 1988–North Carolina State License #32774 July, 1985–New York State License #162663-1 Certification: National Board of Medical Examiners–July, 1985 Part I American Board of Anesthesiology (99th%) –July, 1987 Part II Board Certification–October, 1988 American Academy of Pain Management–1991

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

2

Previous Academic Appointments

Professor (with tenure) and Vice-Chairman, Chief Division of General, Vascular and Transplant Anesthesia and Surgical Intensive Care

Department of Anesthesiology, Duke University Medical Center July 1988 – November 2001 Adjunct Professor, Fuqua School of Business, Duke University 6/2000-6/2002

Academic training:

Weekend Executive Masters in Business Administration (WEMBA) Program The Fuqua School of Business Duke University January 1998 – August 1999 Honored as Fuqua Scholar (top of class)

Fellowship in Transesophageal Echocardiography Duke University Medical Center Fiona M. Clements, M.D., Chief, Division of Cardiac Anesthesiology Joseph A. Kisslo, M.D., Director, Echocardiography Lab October 1992–December 1992

Fellowship in Cardiac and Vascular Anesthesia and Clinical Research New York University Medical Center Stephen Thomas, M.D., Division Head July 1987–June 1988

Residency Department of Anesthesiology New York University Medical Center Herman Turndorf, M.D., Professor and Chairman July 1985–June 1987

Internship Department of Medicine Westchester County Medical Center Richard Levere, M.D., Chairman July 1984–June 1985

PUBLICATIONS Books published:

1. Robertson KM, Lubarsky DA: Preparing for the Written Boards: Pearls of Wisdom. Boston Medical Publishing, June 2001.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

3

2. Gallagher CJ, Hill SE, Lubarsky DA: Board Stiff Too: Preparing for the Anesthesia Orals. Boston, Butterworth-Heinemann, 2000.

3. Lubarsky DA: The Answer Key to the Written Boards. Durham, NC, A+ Homeprep, 1992, 2nd edition 1993, 3rd edition 1994, 4th edition 1995.

4. Gallagher CJ, Lubarsky DA: Preparing for the Anesthesia Orals: Board Stiff. Boston,

Butterworths, 1990.

Book chapters and monographs published:

1. Ellis J, Roizen M, Mantha S, Schwartze G, McKinsey J, Lubarsky D, Kenaan C: Anesthesia for Vascular Surgery. Clinical Anesthesia 5th Edition, Lippincott Williams & Wilkins Publishing, 2005 (in press)

2. J.G Reves, Peter S.A. Glass, David A. Lubarsky, Matthew D. McEvoy: Intravenous Nonopioid Anesthestics. Miller’s Anesthesia 6th Edition, Elsevier Publishing, 2004 chapter 10.

3. Lubarsky DA and Locke J, Ambulatory Anesthesia Billing, Ambulatory Anesthesia 2005 (in press)

4. Gayer S and Lubarsky DA: Cost-effective Anti-emesis. In International Anesthesiology Clinics: Post-operative nausea and Vomiting 2003 Vol 41(4):145-164.

5. Knudsen NW, Sebastian MW, Lubarsky DA: Cost containment in vascular surgery. Seminars in Cardiothoracic and Vascular Anesthesia 2000 (November) Vol 4(4):256-264.

6. Rock P, Lubarsky DA: The business of perioperative medicine. Anesthesiology Clinics of North America 18(3):677-698, 2000.

7. Reves JG, Glass PSA, Lubarsky DA: Nonbarbiturate intravenous anesthetics, Anesthesia, fifth edition. Edited by Miller RD. New York, Churchill Livingstone, pp 228–272, 2000.

8. Dear GdeL, Panten RR, Lubarsky DA: Operating room information systems, Seminars in Anesthesia, Perioperative Medicine and Pain. Edited by Katz RL and Ward DS. Vol 18, No 4 (December), pp 322-333, 1999.

9. Lubarsky DA: How to write clinical guidelines for value-based anesthesia care, Anesthesia Practice Management: How to Assess and Promote Value. Monograph of the Ad Hoc Committee on Value-Based Anesthesia Care. Copyright American Society of Anesthesiologists, 1999.

10. Tardiff BE, Jollis JG, Lubarsky DA: Use of information systems and large databases in cardiovascular medicine, Outcome Measurements in Cardiovascular Medicine. Edited by Tuman KJ. Lippincott Williams & Wilkins, pp 67–80, 1999.

11. Lineberger CK, Lubarsky DA: Anesthesia for carotid endarterectomy. Curr Opin Anaesthesiol 11:479–484, 1998.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

4

12. Panten RR, Dear GdeL, Lubarsky DA: Pharmacoeconomics and practice guidelines: Moving toward value-based care, Problems in Anesthesia, Vol. 10, No. 3. Edited by Arens JF, Prough DS. Baltimore, Williams & Wilkins, pp 285–291, 1998.

13. Inge WW, Grichnik KP, Lineberger CK, Lubarsky DA: Vascular surgery in the geriatric patient, Geriatric Anesthesiology. Edited by McLeskey CH. Baltimore, Williams & Wilkins, pp 637–644, 1997.

14. Lubarsky DA, Moskop RJ: The “niche” of etomidate in current anesthetic practice, Progress in Anesthesia. Edited by Eisenkraft JB. Philadelphia, WB Saunders, pp 155–168, 1994.

15. Reves JG, Glass PSA, Lubarsky DA: Nonbarbiturate intravenous anesthetics, Anesthesia, Fourth

edition. Edited by Miller RD. New York, Churchill Livingstone, pp 247–289, 1994.

16. Gallagher C, Sladen RN, Lubarsky DA: Thoracotomy: postoperative complications, Problems in Anesthesia: Thoracic Anesthesia, Vol. 4, No. 2, June 1990. Edited by Brodsky JB. Philadelphia, JP Lippincott, pp 393-415, 1990.

17. Lubarsky DA, Rodman R: Carotid endarterectomy: General versus regional anesthesia, Problems in Anesthesia: Cardiovascular Anesthesia, Vol. 1, No. 3, July–September 1987. Edited by Thomas SJ. Philadelphia, JP Lippincott, pp 496-510, 1987.

Journals:

1. Candiotti KA, Birnbach DJ, Lubarsky DA, Nhuch F, Kamat A, Koch WH, Nikoloff M, Wu L, Andrews D; The Impact of Pharmacogenomics on Postoperative Nausea and Vomiting. Anesthesiology 2005 102;543-549.

2. Dexter F, Lubarsky D: Financial Implications of a Hospital’s Specialization in Rare Physiologically Complex Surgical Procedures. Anesthesiology 2005 (in publication)

3. Lubarsky D: Incentivize Everything, Incentivize Nothing. Anesth Analg 2005;100:490-2.

4. Macario A, Dexter F, Lubarsky D: Meta- Analysis of Trials Comparing Postoperative Recovery After Anesthesia with Sevoflurane or Desflurane. Am J Health-Syst Pharm 62:63-68, 2005.

5. Dexter F., Lubarsky, D: Using Length of Stay Data from a Hospital to Evaluate Whether Limiting Elective Surgery at the Hospital is an Inappropriate Decision. J Clin Anesth 2004 16:421-425.

6. Dexter F, Abouleish A, Whitten C, Lubarsky D, Epstein R: Impact of Reducing Turnover times on Staffing Costs. Anesth Analg 2004 98:872.

7. Gan TJ, Lubarsky DA, Flood EM, Thanh T, Masukopf J, Mayne T, Chen C: Patient preferences for acute pain treatment. Br. J. Anaesth 2004 92:681-688.

8. Olson, Ronald P., Schow, Adam J., McCann, Richard, Lubarsky, David A., Gan, Tong J: Absence of adverse outcomes in hyperkalemic patients undergoing vascular access surgery: [Absence de complications chez des patients hyperkaliemiques devant subir une intervention chirurgicale d’acces vasculaire]. Can J Anesth 2003 50:553-557.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

5

9. Abouleish AE, Epstein RH, Lubarsky DA, Dexter F: Use of operating room information system data to predict the impact of reducing turnover times on staffing costs. Anesth Analg 2003 97:1119 – 1126.

10. Gan TJ, Ing RJ, Dear G, Wright D, El-Moalem HE, Lubarsky DA: How much are patients willing to pay to avoid intraoperative awareness? J Clin Anesth 15:108 – 112, 2003

11. Dexter F, Macario A, Traub RD, Lubarsky DA: Operating room utilization alone is not an accurate metric for the allocation of operating room block time to individual surgeons with low caseloads. Anesthesiology, May 2003 98:5.

12. Abouleish AE, Dexter F, Epstein RH, Lubarsky DA, Whitten CW, Prough DS: Labor costs incurred by anesthesiology groups due to operating rooms not being allocated and cases not being scheduled to maximize operating room efficiency. Anesth Analg 2003:96:1109 – 1113.

13. Schow AJ, Lubarsky DA, Gan TJ: Can succinylcholine be safely used in hyperkalemic patients? Anesth Analg 2002 95:119-122.

14. Dexter F, Blake JT, Penning DH, Lubarsky DA: Calculating a potential increase in hospital margin for elective surgery by changing operating room time allocations or increasing nursing staffing to permit completion of more cases. Anesth Analg 2002 94:138-142

15. Dexter F, Lubarsky DA, Blake JT: Sampling error can significantly affect measured hospital financial performance of surgeons and resulting operating room time allocations. Anes Analg 95:184-188, 2002.

16. Dexter F, Blake JT, Penning DH, Sloan B, Chung P, Lubarsky DA: Use of linear programming to estimate impact of changes in a hospital’s operating room time allocation on perioperative variable costs. Anesthesiology 2002; 96:718–724.

17. Dexter F, Gan TJ, Naguib M, Lubarsky DA: Cost identification analysis for succinylcholine. Anesth Analg 92:693-699, 2001.

18. Dexter F, Macario A, Lubarsky DA: The impact on revenue of increasing patient volume at surgical suites with relatively high operating room utilization. Anesth Analg 92:1215-1221, 2001.

19. Gan TJ, Sloan F, Dear G, El-Moalem H, Lubarsky DA: How much are patients willing to pay for avoidance of postoperative nausea and vomiting? Anesth Analg 92:393-400, 2001.

20. Bell ED, Penning DH, Cousineau EF, White WD, Hartle AJ, Gilbert WC, Lubarsky DA: How much labor is in a labor epidural? Manpower cost and reimbursement for an obstetric analgesia service in a teaching institution. Anesthesiology 92:851-8, 2000.

21. Hill RP, Lubarsky DA, Phillips-Bute B, Fortney JT, Creed MR, Glass PSA, Gan TJ: Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo. Anesthesiology 92:958-67, 2000.

22. Lubarsky DA, Fisher SD, Slaughter TF, Green CL, Lineberger CK, Astles JR, Greenberg CS, Inge III WW, Krucoff MW: Myocardial ischemia correlates with reduced fibrinolytic activity following peripheral vascular surgery. J Clin Anesth 12:136-41, 2000.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

6

23. Lubarsky DA, Reves JG: Using Medicare multiples results in disproportionate reimbursement for anesthesiologists compared to other physicians. J Clin Anesth 12:238-241, 2000.

24. Dexter F, Macario A, Manberg PJ, Lubarsky DA: Computer simulation to determine how rapid anesthetic recovery protocols to decrease the time for emergence or increase the phase 1 postanesthesia care unit bypass rate affect staffing of an ambulatory surgery center. Anesth Analg 88:1053–1063, 1999.

25. Dexter F, Macario A, Lubarsky DA, Burns DD: Statistical method to evaluate management strategies to decrease variability in operating room utilization: Application of linear statistical modeling and Monte-Carlo simulation to operating room management. Anesthesiology 91:262–274, 1999.

26. Dexter F, Macario A, Traub RD, Hopwood M, Lubarsky DA: An operating room scheduling strategy to maximize the use of operating room block time: computer simulation of patient scheduling and survey of patients’ preferences for surgical waiting time. Anesth Analg 89:7–20, 1999.

27. Zhou J, Dexter F, Macario A, Lubarsky DA: Relying solely on historical surgical times to estimate accurately future surgical times is unlikely to reduce the average length of time cases finish late. J Clin Anesth 11:601–605, 1999.

28. Dexter F, Lubarsky DA, Gilbert BC, Thompson C: A method to compare costs of drugs and supplies among anesthesia providers: A simple statistical method to reduce variations in cost due to variations in case mix. Anesthesiology 88:1350–1356, 1998.

29. Dexter F, Penning DH, Lubarsky DA, DeLong E, Sanderson I, Gilbert BC, Bell E, Reves JG: Use of an automated anesthesia information system to determine reference limits for vital signs during cesarean section under general or spinal anesthesia: Application to medical malpractice claims. J Clin Monit Comput 14:491–498, 1998.

30. Lineberger CK, Lubarsky DA: Con: General anesthesia and regional anesthesia are equally acceptable choices for carotid endarterectomy. J Cardiothorac Vasc Anesth 12:115–117, 1998.

31. Pisetsky MA, Lubarsky DA, Capehart BP, Lineberger C, Reves JG: Valuing the work performed by anesthesiology residents and the financial impact on teaching hospitals of a reduced anesthesia residency program size. Anesth Analg 87:245–254, 1998 [published erratum appears in Anesth Analg 1998 Nov;87(5):1031].

32. Coleman RL, Sanderson IC, Lubarsky DA: Anesthesia information management systems as a cost containment tool. CRNA 8(2): 77–83, 1997.

33. Lubarsky DA, Glass PSA, Ginsberg B, Dear G de L, Dentz ME, Gan TJ, Sanderson IC, Mythen MG, Dufore S, Pressley CC, Gilbert WC, White WD, Alexander ML, Coleman RL, Rogers MC, Reves JG: The successful implementation of pharmaceutical practice guidelines: Analysis of associated outcomes and cost savings. Anesthesiology 86:1145–1160, 1997.

34. Lubarsky DA, Sanderson IC, Gilbert WC, King KP, Ginsberg B, Dear G de L, Coleman RL, Pafford TD, Reves JG: Using an anesthesia information management system as a cost containment tool: Description and validation. Anesthesiology 86:1161–1169, 1997.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

7

35. Astles JR, Lubarsky DA, Loun B, Sedor FA, Toffaletti JG: Pneumatic transport exacerbates interference of room air contamination in blood gas samples. Arch Path Lab Med 120(7):642–647, 1996.

36. Lubarsky DA: Fast track in the post-anesthesia care unit: Unlimited possibilities? J Clin Anes 8:70S–72S, 1996.

37. Dentz ME, Lubarsky DA, Smith LR, McCann RL, Moskop RJ, Inge W, Grichnik KP: A comparison of amrinone with sodium nitroprusside for control of hemodynamics during infrarenal abdominal aortic surgery. J Cardiothorac Vasc Anesth 9:486–490, 1995.

38. Hadzija BW, Lubarsky DA: Compatibility of etomidate, sodium thiopental and propofol injections with other drugs commonly administered during induction of anesthesia. Am J Health-Syst Pharm 52:997–999, 1995.

39. Lubarsky DA, Smith LR, Sladen RN, Mault JR, Reed RL: Defining the relationship of oxygen delivery and consumption: Use of biologic system models. J Surg Res 58:503–508, 1995.

40. Lubarsky DA: Understanding cost analyses: Part 1, A practitioner’s guide to cost behavior. J Clin Anesth 7:519–521, 1995.

41. Astles R, Lubarsky DA, Loun B, Sedor F, Toffaletti J: Pneumatic tube system exacerbates the effect of room air contamination. Clin Chem 41:155, 1995.

42. Lubarsky DA, Hahn C, Bennett DH, Smith LR, Bredehoeft SJ, Klein HG, Reves JG: The hospital cost (fiscal year 1991/1992) of a simple perioperative allogeneic red blood cell transfusion during elective surgery at Duke University. Anesth Analg 79:629–637, 1994.

43. Moskop RJ, Lubarsky DA: Carbon dioxide embolism during a laparoscopic cholecystectomy. South Med J 87:414–415, 1994.

44. Grichnik KP, Dentz M, Lubarsky DA: Hemodynamic collapse during thoracoscopy. J Cardiothorac Vasc Anesth 7:588–589, 1993.

45. Dentz ME, Lubarsky DA: Leontiasis ossea: an unusual presentation of a difficult airway. Anesth Analg 76:678-679, 1993.

46. Lubarsky DA, Griebel JA, Camporesi EC, Piantadosi CA: Comparison of systemic oxygen delivery and uptake with NIR spectroscopy of brain during normovolemic hemodilution in the rabbit. Resuscitation 23:45-57, 1992.

47. Lubarsky DA, Gallagher C, Berend JL: Secondary polycythemia does not increase the risk of perioperative hemorrhagic or thrombotic complications. J Clin Anes 3:99-103, 1991.

48. Lubarsky DA, Kaufman B, Turndorf H: Anesthesia unmasking benign Wolff-Parkinson-White-Syndrome. Anesth Analg 68:172-4, 1989.

49. Kronenfeld MA, Lubarsky DA, Feiler M, Galloway A, Thomas SJ: The effect of ventilation on aortic blood gases during left ventricular ejection before separation from cardiopulmonary bypass. J Cardiothorac Anes 3:301-304, 1989.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

8

50. Lubarsky DA, Kaufman B, Turndorf H: Anesthetic care of a patient with an intracranial hemorrhage after thrombolytic therapy. J Clin Anes 2:276-279, 1989.

Other works, publications, and abstracts:

1. K. Candiotti, A. Kamat, F. Nhuch, D. Lubarsky, D. Birnbach: Treating PONV Ondansetron Prophylaxis Failures: A Comparison of Redosing with Ondansetron vs. Granisetron. (Abstract presentation at the IARS 79th Clinical and Scientific Congress in Honolulu, Hawaii, March 11 – 15, 2005).

2. Lubarsky D: Financial Implications of a Hospital’s Specialization in Rare Phsysiologically Complex Surgical Procedures. (Poster presentation at the ASA Annual Meeting in Las Vegas, NV, October 2004).

3. Estacio R, Lubarsky D, Barach P: Cardiac Arrest and Death during Anesthesia Secondary to Iatrogenic Hyperkalemia: Case Report and Database Review. (Poster presentation at the ASA Annual Meeting in Las Vegas, NV, October 2004).

4. Vigoda M, Gencorelli F, Lin S, Lubarsky D, Birnbach D: Anesthesia Information System Helps Identify Missed Opportunities for Perioperative Beta Blockade. (Abstract presentation at the ASA Annual Meeting in Las Vegas, NV, October 2004).

5. Vigoda M, Gencorelli F, Lin S, Birnbach D, Lubarsky D: Anesthesia Information System Demonstrates inadequacy of Perioperative Beta Blocker Therapy. (Abstract presentation at the ASA Annual Meeting in Las Vegas, NV, October 2004).

6. Macario A., Lubarsky D: The Impact of Desflurane and Sevoflurane on the Risk of Postoperative nausea and vomiting: a systematic review of the published literature. (Abstract presentation at the IARS 78th Clinical and Scientific Congress, Tampa, Florida, March 2004).

7. Donnelly AJ, Macario A, Lubarsky DA: Pharmacoeconomics of Inhaled Anesthetics. (Special Report Activity, ICPME accredited, McMahon Publishing Group, February 2004.

8. Candiotti KA, Lubarsky DA, Kamat A, Restler C: Implementation of Granisetron 0.1mg for Prophylaxis of P.O.N.V. (Poster Presentation at the American Society of Healthcare Pharmacists meeting in New Orleans, December 8-10, 2003).

9. Breslin D, Lubarsky D, Hopkins M, Gan TJ: Delayed Discharge from the Post Anesthetic Care Unit. An Ongoing Improvement Process. (Abstract presentation at the ASA Annual Meeting, San Francisco, California, October 2003).

10. Epstein RH, Dexter F, Abouleish AE, Whitten CW, Lubarsky DA: Cost Savings from Reducing Turnover Time Result From Reductions in Surgical OR Allocations, Not Less Overtime. (Abstract presentation at the ASA Annual Meeting, San Francisco, California, October 2003).

11. Dexter F, Lubarsky DA, Uncertainty in the Operating Rooms in Which Cases are Performed Has Little Effect on Operating Room Allocations and Efficiency (Award Winning Abstract

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

9

Presentation at the AACD 15th Annual Meeting, Orlando, Florida, October 13, 2002).

12. Dexter F, Lubarsky DA, Anesthesia Groups with Exclusive Contracts can Quantify the Cost of Operating Rooms Not Being Allocated and Cases Not Being Scheduled to Maximize Operating Room Efficiency (Award Winning Abstract Presentation at the AACD 15th Annual Meeting, Orlando, Florida, October 13, 2002).

13. Gan TJ, Lubarsky DA, Main causes of delay in-patient discharge from PACU in a major teaching hospital. (Abstract Presentation at ASA Annual Meeting, Orlando, FL, October 2002).

14. Lubarsky DA, Reves J. Straightening out RVU Formulas (letter). ASA Newsletter. June 2002.

15. Schow AJ, Lubarsky DA, Gan TJ: Can succinylcholine be safely used in hyperkalemic patients? (Abstract Presentation at the 2001 ASA Annual Meeting).

16. Olson RP, Schow AJ, Gan TJ, Lubarsky DA. Vascular Access Surgery in Hyperkalemic Patients. (Abstract Presentation at the 2001 ASA Annual Meeting).

17. Gan T, Dear G, Wright MD, El-Moalem H, Sigl J, Lubarsky DA. Patient Willingness to pay for avoidance of anesthesia related postoperative outcomes. (Poster Presentation at the IARS 75th Clinical and Scientific Congress, March 16-20, 2001).

18. Wright D, Lubarsky DA, Dear G, Sigl J, Reeves J, Gan T. Willingness to pay to avoid intra-operative awareness. (Poster Presentation at the IARS 75th Clinical and Scientific Congress, March 16-20, 2001).

19. Gan TJ, Lubarsky DA: Cost effectiveness ratio: an often misunderstood term (letter). Anesth Analg 88(5):1191–2, 1999

20. Petros KO, Knudsen NK, Sebastian MW, Lubarsky DA. Impact of education and practice guidelines for propofol use in the surgical intensive care unit. (Poster Presentation at ACCP/ESCP 1st International Congress on Clinical Pharmacy, Orlando, FL, April 1999) Pharmacotherapy 19(4):P350, 1999.

21. Lubarsky DA, DeLong ER: The impact of choice of muscle relaxant on postoperative recovery time. Anesth Analg 87:499–500, 1998.

22. Dear G, Lubarsky DA, Gilbert W, J Reves: Compliance with HCFA terminology; an automated

system for audit of anesthesia documentation. Anesth Analg 86:S27, 1998.

23. Dear GdeL, King KP, Gilbert WC, Lubarsky DA: Is it possible to maintain drug cost savings: a two year follow-up report. Anesthesiology 89:A1352, 1998.

24. DeLong ER, Kwatra MM, Gan TJ, Glass PSA, Sanderson IC, Gilbert WC, Coleman RL, Lubarsky DA, Reves JG: A large population study reveals reduced anesthetic requirements in females. Anesthesiology 89:A126, 1998.

25. DeLong ER, Kwatra MM, Gan TJ, Glass PSA, Sanderson IC, Gilbert WC, Coleman RL, Lubarsky DA, Reves JG: Aging profoundly decreases anesthetic requirement. Anesthesiology 89:A825, 1998.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

10

26. Gan TJ, Lubarsky DA, Sloan F, Dear R, Dear G: How much are patients willing to pay for a completely effective antiemetic? Anesthesiology 89:A7, 1998.

27. Sibert K, D’Ercole F, Gilbert W, Smith F, Lubarsky DA: Causes of OR delays: differing perceptions of anesthesiologists and OR nurses. Anesth Analg 84:S54, 1997.

28. Lubarsky DA: Understanding the term “cost-effectiveness.” J Clin Anes 9:603–604, 1997.

29. Lubarsky DA: HMO contracts should cover variable costs too. American Medical News, November 10, Volume 40, Number 42, p. 22, 1997.

30. Lubarsky DA: Response to: Bailey PL, Egan TD: The successful implementation of pharmaceutical practice guidelines? Far from convincing! Anesthesiology 87:1583–1584, 1997.

31. Lubarsky DA: Response to: Riley ET: Economic analysis of anesthetic drug use. Anesthesiology 87:1585–1586, 1997.

32. Lubarsky DA: Response to: Viby-Mogensen J: Implementation of pharmaceutical practice guidelines. Anesthesiology 87:1587, 1997.

33. Lubarsky DA: Sustaining cost savings through distribution control and individualized feedback.

Anesthesiology 85:A969, 1996.

34. Lubarsky DA, Gilbert W, Alexander ML, Sanderson I: Validation of the programming of an anesthesia information management system for cost calculations. Anesthesiology 85:A1046, 1996.

35. Slaughter TF, Gittleson S, Lineberger C, Inge W, Wildermann N, Green C, Greenberg CS, Lubarsky DA, Krucoff MW: Continuous 12-lead ECG in patients undergoing peripheral revascularization: Incidence of ischemia and correlation with fibrinolytic activity. Anesthesiology 85:A72, 1996.

36. Lubarsky DA, Gan TJ, Glass PSA, Dear GD, Mythen M, Dentz M, White WD, Pressley CC,

Dufore SM, Sibert KS, Gilbert WC, Sanderson IC, Coleman R, Ginsberg B, Temo J, Ferrero-Conover D, Alexander ML, Reves JG: PACU clinical outcomes and financial savings following a pharmaceutical cost containment program in anesthesia using practice guidelines. Anesth Analg 82:S285, 1996.

37. King K, Dear G, Ginsberg B, Gilbert W, Lubarsky DA: Cost analyses to develop practice guidelines for muscle relaxants. Anesth Analg 82:S233, 1996.

38. Gan TJ, Lubarsky DA, Robertson K, Bennett D, Parrillo S, Sanderson I, Jhaveri R: The hospital cost of perioperative transfusion of a unit of red blood cells and other blood products. Anesth Analg 82:S123, 1996.

39. Sanderson IC, Gilbert WC, Lubarsky DA: Cost containment using an automated anesthesia record keeper. Anesth Analg 82:S391, 1996.

40. D’Ercole F, Gilbert W, Smith F, Lubarsky DA: Programming an automated anesthesia record keeper to track operating room delays. Anesthesiology 85:A976, 1996.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

11

41. Gan TJ, Ginsberg B, Grichnik K, Sullivan F, Muir M, Lubarsky DA, Glass PSA: The use of patient-controlled analgesia to compare the efficacy of sufentanil for postoperative analgesia and its relative potency to morphine. Anesth Analg 80(supple 2):S142, 1995.

42. Gan TJ, Lubarsky DA, Robertson K, Bennett D, Parrillo S, Sanderson I, Jhaveri R: The hospital cost of perioperative transfusion of a unit of red blood cells and other blood products. Presented at the Joint Congress on Liver Transplantation, London, Sept. 27–30, 1995.

43. Gan TJ, Lubarsky DA, Robertson K, Gilbert WC, Grant AP, Reves JG, Clavien P: Analysis of the variable intra-operative anesthesia costs of a liver transplant procedure. Anesthesiology 83:A1053, 1995.

44. Hertz CM, Pressley CC, Dufore SM, Glass PSA, Gan TJ, Lubarsky DA: Nausea and vomiting—a costly anesthetic complication? Anesthesiology 83:A1036, 1995.

45. Lubarsky DA, Smith LR, Glass PSA: A comparison of maintenance drug costs of isoflurane, desflurane, sevoflurane, and propofol with OR and PACU labor costs during a 60 minute outpatient procedure. Anesthesiology 83:A1035, 1995.

46. Sanderson IC, Gilbert W, Sibert K, Lubarsky DA: Evaluation of a program for calculating and plotting isoflurane utilization. Anesthesiology 83:A388, 1995.

47. Mault J, Cilley R, Lubarsky DA, Bartlett R, Reed L: Physiologic and mathematical modeling of

the oxygen delivery-consumption relationship. Crit Care Med 22:A105, 1994.

48. Lubarsky DA, Hahn C, Bennett DH, Smith LR, Bredehoeft SJ, Klein HG, Reves JG: The hospital cost (1992) of a simple perioperative allogeneic red blood cell transfusion. Anesth Analg 78:S258, 1994.

49. Dentz ME, Lineberger CK, Gilbert W, Ginsberg B, Lubarsky DA: Postoperative complications following the use of etomidate for thoracic and vascular surgery. South Med J 87(suppl 2):S12, 1994.

50. Lubarsky DA, Smith LR, Sladen RN, Mault JR, Reed RL: Defining the relationship of oxygen delivery and consumption: use of biologic system models. Anesthesiology 79:A303, 1993.

51. Lubarsky DA, Kaufman BS: Changes in lactate levels with decreased oxygen delivery and oxygen consumption under anesthesia. Anesth Analg 68:S171, 1989.

52. Lubarsky DA, Kaufman BS, Sharnick S, Turndorf H: The effects of induction of anesthesia on mixed venous and peripheral venous oxygen saturations. Anesth Analg 13:S172, 1989.

53. Lubarsky DA, Kaufman BS: Oxygen delivery under anesthesia: a prospective evaluation of 330 ML/MIN/M2 as a “critical” value. Anesth Analg 68:S173, 1989.

54. Lubarsky DA, Piantadosi C, Camporesi E, Griebel J: Measurement of cytochrome aa3 redox potentials by NIR spectroscopy during normovolemic hemodilution. Anesthesiology 71:A550, 1989.

55. Lubarsky DA, Capan L, Turndorf H: Spinal anesthesia--determination of hemodynamics by bioimpedance technique. Regional Anesthesia 13:S37, 1988.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

12

56. Lubarsky DA, Sharnick S, Feiler M, Kronenfeld M: The effect of ventilation on aortic blood gases during left ventricular ejection prior to separation from cardiopulmonary bypass. Proceedings of the Society of Cardiovascular Anesthesiologists Annual Meeting, 1988.

Video presentations and other private sector publications:

1. Supportive Care for Surgical Patients: Confronting the Risks of PONV CD, PGA Annual meeting December 12 – 16, 2003, produced by Accel Healthcare Communications.

2. “Permission to Be Pain Free™: Understanding Labor Epidurals,” conceived, scripted and presented by David A. Lubarsky, Donald H. Penning, and Janice Henderson; produced as a joint venture between Duke University and The Informed Patient, LLC, © 1999.

3. Sevoflurane, PONV Anzemet & Zofran,” (Product representative training video). Written and presented by David A. Lubarsky, produced by Abbott Video Services, September 4, 1998.

4. “The Niche for Etomidate in Current Anesthetic Practice” (2 part training tape series distributed to hospitals nationwide), produced by Abbott Laboratories, 1992.

5. “Anesthesia Insites: Midazolam,” training video, scripting and appearance by David A. Lubarsky, produced by Roche Laboratories, 1992.

6. “Anesthesia Insites: Romazicon,” training video, scripting and appearance by David A. Lubarsky, produced by Roche Laboratories, 1992.

7. “Clinical Uses of Esmolol: Sub-Section for Uses in Vascular Anesthesia” produced by Anaquest, Inc., 1989.

8. “Anesthesia Demands for Cardiac and Vascular Surgery. Part 1: Cardiac Surgery” by Dr. Lubarsky. BOC Health Care, 1989.

9. “Anesthesia Demands for Cardiac and Vascular Surgery. Part 2: Vascular Surgery” by Dr. Lubarsky. BOC Health Care, 1989.

Conference proceedings and newsletters: 1. Lubarsky, DA: Deriving Value from Informational Systems, New Thoughts on Using

NSAIDS in Perioperative Pain Management and Post-Operative Nausea and Vomiting. 29th Annual Vail Conference in Anesthesiology, February 1-8, 2003

2. Lubarsky, DA: Understanding PONV. Postgraduate Assembly 56th Meeting, December 6 – 10, 2002.

3. Lubarsky, DA: Main Causes of Delay in In-patient Discharge From PACU in a Major Teaching Hospital. American Society of Anesthesiologists Annual Meeting, October 12 – 16, 2002.

4. Lubarsky DA: Are computers useful to reduce costs in outpatient surgery? Society for Ambulatory Anesthesia (SAMBA) 15th Annual Meeting Syllabus, May 5-8, 2000.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

13

5. Lubarsky DA: “Putting a Value on Pain, Suffering and Anxiety: Willingness-to-Pay Analyses” “Pharmaceutical Practice Guidelines”;“Computerization in the OR: Electronic Medical Record” published in the syllabus of the Scott & White Symposium, 6th Annual National Meeting, Santa Fe, NM, June 22-24, 2000 (Scott & White Hospital, Temple, TX).

6. Lubarsky DA, Reves JG: Using Medicare multiples results in disproportionate

reimbursement for anesthesiologists compared to other physicians. Association of Anesthesia Clinical Directors (AACD) 12th Annual Meeting Syllabus, October, 1999.

7. Lubarsky DA: Managing perioperative drug and labor costs. Proceedings of the Society of

Cardiovascular Anesthesiologists 20th annual meeting, April 24–28, 1998.

8. Lubarsky DA: Managing perioperative drug and labor costs. Proceedings of the Association of Anesthesia Clinical Directors Workshop on Operating Room Management, March 21–22, 1998.

9. Dexter F, Lubarsky DA: Managing with information: using surgical services information systems to increase operating room utilization. American Society of Anesthesiologists Newsletter 62(10):6–8, 1998.

10. Macario A, Lubarsky DA: Why are hospitals enamored with clinical pathways? American Society of Anesthesiologists Newsletter 62(10):9–12, 1998.

11. Lubarsky DA: Intravenous anesthesia is too expensive for my practice! Proceedings of the Society for Intravenous Anesthesia annual meeting, October 16, 1998.

12. Lubarsky DA: Cost-effective ambulatory anesthesia: The anesthesiologist’s view. In the Syllabus for the Society for Ambulatory Anesthesia (SAMBA) 12th Annual Meeting, Lake Buena Vista, FL, May 1–4, 1997.

13. Lubarsky DA: ICU care after vascular surgery (con). Proceedings of the Society of Cardiovascular Anesthesiologists 19th Annual Meeting, Baltimore, MD, May 11–14, 1997.

14. Lubarsky DA: Practice guidelines, information management and resource utilization: Buzzwords for the new millennium. Proceedings of the Association of Anesthesia Clinical Directors Annual Meeting, October 19, 1997.

15. D’Ercole F, Lubarsky DA, Reves JG: Duke’s innovative programming of an automated anesthetic record yields information essential for economic management of anesthetic practice. North Carolina Society of Anesthesiologists Newsletter, October, 1996.

16. Becker KE, Johnstone RE, Lubarsky DA: Choice of anesthetic drugs and muscle relaxants. American Society of Anesthesiologists Newsletter 59(5):8–11, 1995.

17. Cohen NH, Lubarsky DA: Cost-effective use of technology in clinical care. American Society of Anesthesiologists Newsletter 59(8):20–22, 1995.

Electronic, world wide web, and/or internet publications:

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

14

1. Lubarsky DA (Chief Editor and Project Manager): Anesthesiology On-Line. (1000 Chapter Textbook in preparation for emedicine.com)

2. Commentary: 1997: The year in review. In AnesthesiaWeb, January, 1998.

3. Commentary: Notes from the SCA (Society of Cardiovascular Anesthesiologists) annual meeting. In AnesthesiaWeb, June, 1998.

4. Commentary: What was new at the ASA in Orlando. In AnesthesiaWeb, November, 1998.

5. Commentary: What I did on my fall vacation in San Diego. In AnesthesiaWeb, November 1997.

PROFESSIONAL

Funded research performed:

1. Co $10,000 University of Miami Office of the Provost – inter school development grant. Co-Principal Investigator with Dr. Michael Vigoda 2004.

2. Organon, Inc., $36,000 clinical study and research agreement with Organon Inc. These funds

will help aid their research project entitled “A Multi-Center Trial to Evaluate the Interaction of Maintenance Doses of Rocuronium with an Intubating Dose of Rapacuronium, Rocuronium, or Succinylcholine.” Co-Principal Investigators: Drs. TJ Gan and David Lubarsky, 2000.

3. Aspect Medical Systems, Inc., $22,590 research agreement to support “Willingness to Pay for

Avoidance of Awareness During General Anesthesia.” Co-Principal Investigators: Drs. David Lubarsky and TJ Gan, 1999.

4. Roche Laboratories, $100,000 grant x 3 years to the Department of Anesthesiology to

administer and direct AnesthesiaWeb.com: An Educational Resource for Anesthesia Providers. Dr. Lubarsky, Founder and Chair, Editorial Board 1996–present.

5. North American Dräger – Co-Principal Investigator – $535,000 to $1.5 million contract to

develop an Anesthesia Information Management System (AIMS) for Duke University Medical Center and Health System, contracted 1998.

6. Roche - $45,000 unrestricted grant in support of Database Use in Outcomes Research 1996

7. Glaxo-Wellcome – Principal Investigator $25,000 project grant, “Development of Methods to

Objectively Value Intangible Elements of Health Care,” 1996–97.

8. Abbott Laboratories - Principal Investigator – $35,000 research grant to determine the Cp50 of etomidate and the relationship of myoclonus to plasma levels closed in 1992-3.

9. Sanofi Winthrop Pharmaceuticals - Principal Investigator – $10,000 research grant for the

study “Comparison of Amrinone versus Nitroprusside for Hemodynamic Control and Support During Infrarenal Aortic Clamping for Abdominal Aortic Aneurysm Repair,” 1993.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

15

10. Abbott Laboratories – $45,000 educational grant for an etomidate study group, 1992.

11. Somatogen – $13,500 educational grant to study the cost of perioperative transfusions, 1992. Professional organizations:

• American Society of Anesthesiologists, 1988 – Present • American Medical Association, 1988 – Present • Association of University Anesthesiologists, 2000 – Present • International Anesthesia Research Society, 1988 – Present • Florida Society of Anesthesiologists, 2002 - Present • North Carolina Society of Anesthesiologists, 1988 – 2002 • Society of Cardiovascular Anesthesia, 1991 – Present

Recent international engagements:

• Featured Speaker - Japanese Society of Anesthesiology May 2004 Nagoya, Japan. • Visiting Professor, Kagoshima Japan. • Commissioned Training in Anaesthesiology 2002/03, Pamela Youde Nethersole Eastern

Hospital, Hong Kong [by Dr. Wallace Chiu (wkychiu@ha.org.hk), Chairman, Training Subcommittee in Anaesthesiology, Hospital Authority, Hong Kong] – January 2003 - Valuing Health Care in 2002 - Using Information Technology in Medicine – Near Future or False hope?

• Valuing Healthcare lecture XXXIIth International Meeting of Anesthesiology and

Critical Care, March 18 & 19, 2000, in Paris, France, Prof. Pierre Coriat, organizer Journees D’Enseignement Post Universitaire (JEPU) (Anesthesiology and Critical Care Conference), Paris, France, March 17-23, 2000. Invited by Dr. Pierre Coriat. Lectures: “Est-on prêt à payer la prise en charge de la douler et de l’anxiété postopératoires?” or “Putting a value on pain, suffering and anxiety: willingness to pay?” and “Gestion informatisée des coûtes des agents d’anesthésie” or “Managing perioperative drug costs using informatics.”

National/state presentations, conferences, speaking and other panel engagements:

American Society of Anesthesiologists, Annual Meeting, panel on Pharmaceuticals, Economics and Anesthesia Practice (The Use of Practice Guidelines to Minimize Drug Costs.) October 26, 2004. American Society of Anesthesiologists, Annual Meeting, panel on Academic Anesthesiology Training Programs – Should you Secede from the Medical School to Better Meet your Academic and Clinical Missions? (Pro: Your Should Secede!) October 26, 2004 American Society of Anesthesiologists, Annual Meeting, panel on Practice Management, Oct 14, 2003. Michigan State Society of Anesthesiologists, April 26, 2003. “Cox-2 Inhibitors: Periprocedural Pain Control and Thoughts on Central Sensitization.”

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

16

New York State Society of Anesthesiologists, Post Graduate Assembly, panel on the Future of Economics and Anesthesia, Dec 2002. Panel Chair, Supporting Surgical Outcomes, dinner meeting at PGA, Dec 2002. Presentation, “The Value of PONV therapy.” Medical University of South Carolina Continuing Education Weekend, Charleston, SC, May 4-6, 2001. Lecture: “Current Concepts in Neuromuscular Blockade.” Kansas University Medical Center 51st Annual Postgraduate Symposium on Anesthesiology, Kansas City, Missouri, April 6-8, 2001. Lectures: “Where is the Value in IT?” and “Valuing Healthcare: New Approaches to Costs and Outcomes.”

Committee Chair, Drug Information Association workshop in collaboration with the Duke Clinical Research Institute, “Internet Health Information Programs: Integrating Vision and Basic Business Principals,” Durham, NC, April 3-4, 2000. Dr. Lubarsky, Program Committee with and Kevin A. Schulman, M.D., M.B.A. (Program Chairperson). Moderator of panel, Specialist content sites. Lecture: “Healthcare Internet Business Models that Work.”

Southern University Department of Anesthesia Chairs (SUDAC), Annual Meeting, Charleston, South Carolina, March 23-25, 2001. Lecture and discussion: “Departmental Practice Plans.” International Anesthesia Research Society 75th Clinical and Scientific Congress, Ft. Lauderdale, Florida, March 16-20, 2001. Lecture: “Valuing Health Care: New Approaches to Costs and Outcomes.” Society for Technology in Anesthesia, “STA 2001: An Information Odyssey,” Scottsdale, Arizona, January 10-13, 2001. Coordinator of Panel: “Who is the Information Consumer? User Perspectives on Anesthesia Information,” and Lecture “Understanding Value Creation from Information Systems Elucidates Consumers of That Information” The University of Chicago Department of Anesthesia & Critical Care 14th Annual Conference, “Challenges for Clinicians in the New Millennium,” Chicago, Illinois, December 1-3, 2000. Presentations: “Willingness to Pay: Valuing Pain, Suffering & Anxiety in Health Care” and “Understanding the Business of E-Health.”

American Society of Anesthesiologists Annual Meeting, San Francisco, CA, October 15-18, 2000. Foundation for Anesthesia Education and Research (FAER) panel on “Information Overload: Data Analysis from Genes to Populations.” Lubarsky’s presentation: “Clinical Data: Outcomes, Cost and Quality” Greater Atlanta Society of Anesthesiologists, New Concepts in Neuromuscular Blockade, September 14, 2000

Scott & White Symposium, 6th Annual National Meeting, Santa Fe, NM, June 22-24, 2000. Presentations: “Putting a Value on Pain, Suffering and Anxiety: Willingness-to-Pay Analyses” “Pharmaceutical Practice Guidelines” “Computerization in the OR: Electronic Medical Record”

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

17

Society for Ambulatory Anesthesia (SAMBA) Annual Meeting, Washington, DC May 5-8, 2000. Participated on the panel “Managing the Costs of Ambulatory Anesthesia” moderated by Alex Macario, M.D., M.B.A. Presentation: “Are Computers Useful to Reduce Costs in Outpatient Surgery?” Participated on the panel “Life After Residency” moderated by Peter S.A. Glass, M.B., Ch.B. Presentation: “Managing Your Money.”

Committee Chair, Drug Information Association workshop in collaboration with the Duke Clinical Research Institute, Durham, NC, April 3-4, 2000: “Internet Health Information Programs: Overview and Market Opportunities.” Dr. Lubarsky, Program Committee with Dr. Robert Califf, Robert Taber, Ph.D., and Kevin A. Schulman, M.D., M.B.A. (Program Chairperson) New York State Society of Anesthesiologists 53rd Annual Post-Graduate Assembly, New York, NY. Participated on the panel: “The Year 2000: How Computers Will Improve Anesthesia,” December 12, 1999. Presentation: “Anesthesia Information Management: Economic Implications.”

American Society of Anesthesiologists Annual Meeting, Dallas, TX, October 12, 1999. Panel: “Practice Management/Compliance Coding—What They Didn’t Teach Us in Medical School,” Peter B. Kane, M.D., Moderator. Presentation: “Income Redistribution: The Politics of Communism in the OR” American Society of Anesthesiologists Annual Meeting, Dallas, TX, October 12, 1999. Panel on Value-Based Anesthesia, Peter Rock, Panel Moderator. Presentation: “Quality Improvement and Identification of Key Indicators: Are Electronic Record Keepers the Answer?” Association of Anesthesia Clinical Directors 12th Annual Meeting, October 10, 1999. Abstract presentation: “Using Medicare multiples results in disproportionate reimbursement for anesthesiologists compared to other physicians.”

New York State Society of Anesthesiologists 52nd Annual Post-Graduate Assembly, New York, NY. Participated on the “Fraud and Abuse” panel (Current Issues Forum) December 13, 1998. Presentation: “Making the Plan Work: How to Get Doctors to Do What They Don’t Want to Do.” Value-Based Anesthesia Care Committee Panel discussion, (a committee of the American Society of Anesthesiologists), Orlando, FL, October 21, 1998. Presentation: “Anesthesia Practice Management: Practice Guideline and Clinical Pathway Development.” Association of Anesthesia Clinical Directors Panel “Practical Approaches to OR Management” at the American Society of Anesthesiologists annual meeting, Orlando, FL, October 19, 1998. Presentation: “Maximizing Use of an Anesthesia Information Management System in 1998—What’s New, What’s Left to Do, and Is It for YOU?” Society for Intravenous Anesthesia (SIVA) Annual Meeting, Orlando, FL, October 16, 1998. Lecture: “Is Intravenous Anesthesia Too Expensive for My Practice?”

Society of Cardiovascular Anesthesiologists (SCA) Workshop on Perioperative Cost Management and Contract Negotiation in Cardiac Surgery, Seattle, WA, April 25, 1998. Lecture: “Managing Drug Costs in the Perioperative Period” and leading a breakout session “Managing

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

18

Labor Costs in the Perioperative Period.” April 27, 1998: Breakfast panel with Dr. Robert Johnstone: “Economics and the Cardiovascular Anesthesiologist.” Association of Anesthesia Clinical Directors workshop on operating room management, Phoenix, AZ, March 20–22, 1998. (Invited by Dr. William Mazzei, University of California-San Diego) Lecture: “Real World Cost Reduction.” Nashville Society of Anesthesiologists, Nashville, TN, September 25, 1997.

Pittsburgh Symposium for Nurse Anesthetists, Pittsburgh, PA, September 27, 1997.

International Anesthesia Research Society annual meeting, San Francisco, CA, March 14–18, 1997. “Anesthesia Information Management: Where Are We?” presented by J.G. Reves, M.D., Thomas E. Stanley, M.D. and the Duke Anesthesia Section on Information Systems (Dr. Lubarsky, member). Society of Cardiovascular Anesthesiologists 19th annual meeting, Baltimore, MD, May 11–14, 1997. (Invited by Steven Frank, M.D. and Jan C. Horrow, M.D., Chair, Scientific Program Committee) Presentation: “ICU Care After Vascular Surgery (Con).”

American Association of Anesthesia Assistants national meeting, Kiawah Island, SC, May 16–18, 1997. Lectures: “The Clinical Use of Sevoflurane” and “The Niche for Etomidate in Current Anesthetic Practice.” American Society of Anesthesiologists Bi-District Meeting, New Orleans, LA, May 23–25, 1997. (Invited by Donald Harmon, M.D. of the Ochsner Hospital) Lecture: “Cost Containment in Anesthesia.” Association of Anesthesia Clinical Directors annual meeting, San Diego, CA, October 19, 1997. (Invited by Barbara DeRiso, M.D., Director of the AACD) Keynote address: “Practice Guidelines, Information Management and Resource Utilization—Buzzwords for the New Millennium.” NC Society of Anesthesiologists 1996 Annual Fall Meeting in Myrtle Beach, SC, September 20–22, 1996. Lecture: “Value Based Anesthesia: The Academic Experience.”

Scott & White Memorial Hospital 5th Annual Anesthesia Update/Resident Research Day, Temple, TX, April 13, 1996. (Invited by Charles McLeskey, M.D.) Lectures: “Pharmaceutical Practice Guidelines” and “Management Controversies for the Patient at Risk for Myocardial Ischemia Undergoing Non-cardiac Surgery.” After dinner keynote address: “Economics vs. Hypocrites.” American Society of Anesthesiologists annual meeting, Washington, DC, March 9–13, 1996. Poster presentation: “PACU Clinical Outcomes and Financial Savings Following a Pharmaceutical Cost Containment Program in Anesthesia Using Practice Guidelines.” Association of University Anesthesiologists Satellite Symposium on Outcomes Research, Chatham, MA, May 19–21, 1996. Poster presentation: “Pharmaceutical Practice Guidelines in Anesthesia: Implementation, Cost Savings and Outcome” American Society of Anesthesiologists annual meeting, Morial Convention Center, New Orleans, LA, October 19–23, 1996. Poster Presentation: “Sustaining Cost Savings Through Distribution

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

19

Control and Individualized Feedback.” Poster-Discussion Presentation: “Validation of the Programming of an Anesthesia Information Management System For Cost Calculations.” Society for Intravenous Anesthesia Fourth Annual Meeting, October 20, 1995. Topic: “Does Fast Track Recovery Have Limitless Possibilities?” Southern University Department of Anesthesia Chairmen (SUDAC) 1995 Annual Meeting, Washington Duke Inn, Durham, NC, April 6–7, 1995. Lecture: “Cost Savings for Hospital and Department—The Duke Plan.”

Dallas County Anesthesia Society, Dallas, TX, September 21, 1995.

Tejas Anesthesia, San Antonio, TX, December 7, 1995.

Greater Atlanta Society of Anesthesiologists, Atlanta, GA, November 17, 1994.

Society of Cardiovascular Anesthesiologists Breakfast Panel at the American Society of Anesthesiologists annual meeting, October 17, 1994. Topic on hemodilution: “Will It Work? How Much Will It Cost?” First National Duke Heart Center Conference—“Shaping the Future: Innovations in Technology, Quality, and Caring” September 22–24, 1994. Presentation: “Patients at Risk for Ischemia Going to the Operating Room for Non-Cardiac Surgery: Management Controversies” American Society of Anesthesiologists Annual Meeting, Washington, DC, October 9-13, 1993. Poster presentation: “Defining the relationship of oxygen delivery and consumption: use of biologic system models.” American Society of Anesthesiologists Annual Meeting, New Orleans, LA, October 14-18, 1989. Poster presentation: “Measurement of cytochrome aa3 redox potentials by NIR spectroscopy during normovolemic hemodilution.”

Visiting professorships, 2004:

Mount Sinai School of Medicine, Department of Anesthesiology, New York, New York, October 5-7

Visiting professorships, 2003:

Medical College of Georgia, Department of Orthopedics, Macon, Georgia, October 7-8 Hong Kong College of Anesthesiology – lectured at all hospitals in Hong Kong. Hosted by Dr. Wallace Chiu, Pamela Youde Nethersole Eastern Hospital, Department of Anesthesiology, Hong Kong, China, January 6-10

Visiting professorships, 2002:

Washington University, Department of Anesthesiology, St. Louis, Missouri, November 5-6 Baylor University Medical Center, Dallas, Texas, May 21-22 (Grand Rounds: “NMB Update-Re-examining Succinylcholine and it’s Alternatives”) University of Wisconsin, Department of Anesthesiology, Madison, Wisconsin, April 2-3

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

20

Visiting professorships, 2001:

State University of New York (SUNY) at Stony Brook, Long Island, NY, June 7-8 (Resident lecture: “Understanding Cost Concepts in the Literature” Grand Rounds: “Valuing Health Care: New Approaches to Costs and Outcomes”)

University of Miami Medical Center, Department of Anesthesiology, Miami, FL, June 7

Christiana Hospital, Newark, DE, May 30

Peninsula Regional Medical Center, Salisbury, MD, May 29

St. Francis Hospital, Greenville, SC, April 30

University of Texas-Southwestern Medical Center Department of Anesthesiology, Dallas, TX, March 15-16 (Faculty lecture: “What Are Patients Willing to Pay?” Resident lecture: “What Are They Willing to Do About Nausea?”)

Atlanta Medical Center Department of Anesthesiology, Atlanta, GA, February 14

Baptist Hospital Anesthesia Group, Pensacola, FL, January 31

Roper and St. Francis Hospitals, Charleston, South Carolina, January 18

Visiting professorships, 2000:

Crawford Long Hospital, Department of Anesthesiology, Atlanta, GA, November 15

St. Luke’s-Roosevelt Hospital, Department of Anesthesiology, New York, NY, November 7.

Christiana Hospital and Health System, Department of Anesthesiology, Newark, DE, May 3.

William Beaumont Hospital, Department of Anesthesiology, Royal Oak, MI, April 12.

Visiting professorships, 1999:

University of Texas-Southwestern Medical Center, Parkland Memorial Hospital, Department of Anesthesiology, April 28, 1999.

University of South Florida, Department of Anesthesiology, Tampa General Hospital, Tampa, FL, April 22, 1999.

Visiting Professor, Department of Anesthesiology, Loma Linda University, Loma Linda, CA, January 27, 1999.

Washington Hospital System, Anesthesiology Department, Washington, DC, January 19, 1999.

Rex Hospital, Department of Anesthesiology, Raleigh, NC, June 3, 1999.

Jackson Memorial Hospital, Department of Oral and Maxillofacial Surgery, Miami, FL, March 11, 1999.

Forsyth Memorial Hospital, Anesthesia Department, Winston-Salem, NC, February 11, 1999.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

21

The Scripps System, Anesthesia Department, San Diego, CA, January 27, 1999

Visiting professorships, 1998

St. Joseph’s Hospital System, Anesthesia Department, Albuquerque, NM, November 11, 1998.

University of Michigan, Department of Anesthesiology, Ann Arbor, MI, February 25–26: “Relational Databases, Benchmarking, Practice Guidelines and Other Buzzwords of the New Millennium” and “Management Controversies for the Cardiac Patient Undergoing Non-Cardiac Surgery”

St. Anthony Hospital, Denver, CO, September 28, 1998.

Olean General Hospital, Jamestown, NY, September 16, 1998.

St. Vincent’s Medical Center in Worcester, MA, May 20, 1998.

Visiting professorships, 1997

Visiting Professor, Stanford University Medical Center, Department of Anesthesia, Stanford, CA, December 3–4, 1997. (Alex Macario, M.D., M.B.A., host) Wednesday Grand Rounds lecture: “Relational Databases, Benchmarking, Practice Guidelines and Other Buzzwords of the New Millennium.” Thursday afternoon case discussion and evening case discussion with Drs. Vitez, Navarro, Scibetta, Diachun of the Stanford faculty Health Policies Fellowship.

Fletcher Allen Health Care, M.C.H.V. Campus, Burlington, VT, November 20, 1997.

Visiting Professor, New York University Medical Center, Department of Anesthesiology, New York, NY, November 18–19, 1997. (Invited by Herman Turndorf, M.D., Chair) Guest Speaker at Morbidity & Mortality Grand Rounds. Lectured on Wednesday morning: “Relational Databases, Benchmarking, Practice Guidelines and Other Buzzwords of the New Millennium.”

Newark Beth Israel Hospital, Newark, NJ, April 7, 1997.

Hackensack University Medical Center, Hackensack, NJ, April 8, 1997.

Hartford Hospital, Hartford, CT, September 4, 1997.

Rhode Island Hospital, Providence, RI, October 8, 1997.

Abbott Northwestern Medical Center, Minneapolis, MN, November 11, 1997.

Visiting Professor, Medical College of Georgia, Department of Anesthesiology, Augusta, GA, November 12, 1997. Conference presentation: “Relational Databases, Benchmarking, Practice Guidelines and Other Buzzwords of the New Millennium.” Case presentation.

Doctors of the Medical Center of Columbus, St. Francis and Doctor’s Hospitals, Columbus, GA, November 13, 1997.

Keynote speaker at the program “New Advances in Anesthesia,” Methodist Hospital, St. Louis Park, MN, November 10, 1997.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

22

Visiting professorships, 1996

Athens Regional and Saint Mary’s Hospitals, joint Grand Rounds, Athens, GA, January 18, 1996.

Visiting Professor, Vanderbilt University Department of Anesthesiology, Nashville, TN, February 22, 1996. (Invited by Charles Beattie, M.D., Ph.D., Chairman) Facilitated a multi-departmental task force meeting. Subject: “Expense Reduction—Anesthesia Drugs.” Lecture: “Pharmacoeconomics in Anesthesia.”

Piedmont Hospital, Atlanta, GA, March 27, 1996.

Tampa General Hospital, Tampa, FL, May 9, 1996.

Richland Memorial Hospital, Columbia, SC, May 16, 1996.

St. Louis University Department of Anesthesiology, St. Louis, MO, August 14, 1996.

The Medical Center of Central Georgia, Macon, GA, August 22, 1996.

Visiting Professor, University of Alabama–Birmingham, Department of Anesthesiology, Birmingham, AL, September 16, 1996. Lectures: “Value Based Anesthesia: The Academic Experience” and “Management Controversies for Cardiac Patients Undergoing Non-cardiac Surgery”

St. John’s Hospital, Queens, NY, September 30, 1996.

Addressed regional gathering of anesthesiologists, Ritz-Carlton Hotel, Boston, MA, May 19, 1996.

Addressed regional gathering of anesthesiologists, The Plaza Hotel, New York, NY, June 9, 1996.

Addressed regional gathering of anesthesiologists, Baltimore, MD, June 30, 1996.

American Association of Nurse Anesthetists national meeting to discuss practice and reimbursement issues when CRNAs and anesthesiologists are working together, Rosemont, IL, September 12, 1996

Visiting professorships, 1995

Baylor University Medical Center, Dallas, TX, September 20, 1995.

Mercy Hospital, Pittsburgh, PA, November 1, 1995.

Visiting Professor, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, November 8, 1995. Lecture: “Management Controversies for the Patient at Risk for Myocardial Ischemia Undergoing Non-cardiac Surgery”

Visiting professorships, 1994

Deaconess Hospital, Boston, MA

Maine Medical Center, Department of Anesthesiology, Portland, ME, August 4, 1994.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

23

Bronx–Lebanon Hospital Center, Department of Anesthesiology, Bronx, NY, November 30, 1994.

Visiting professorships, 1993

New York University Medical Center, New York, NY

Massachusetts General Hospital, Cardiac Division, Boston, MA

University of Medicine and Dentistry of New Jersey, Newark, NJ

Wake Medical Center, Raleigh, NC

Saint Barnabas Hospital, Livingston, NJ

Sutter Hospital, Sacramento, CA

Christiana Hospital, Wilmington, DE

Brandywine Regional Medical Center, Coatesville, PA

Englewood Hospital, Englewood, NJ

Non-physician presentations, 2001

Draeger Global Management Team Meeting, at the R. David Thomas Center of the Fuqua School of Business, Duke University, February 1, 2001. Presentation: “The Value of Information Technology.”

Chair, Roche Pharmaceuticals, Advisory panel on PONV, Miami FL Dec 2001. “Understanding the pharmacoencomics of PONV agents”

Pain Management Advisory Board, Pfizer/Pharmacia

Non-physician presentations, 2000

Chair, Pharmacoeconomic Council on Neuromuscular Blocking Agents Retreat, Organon, Inc., St. Thomas, VI, May 19-21, 2000

Remifentanil Advisory Board, Abbott Laboratories, Chicago, IL, May 12-13

Vertebrae Medical Advisory Board (an Internet company to support web-medicine), Westchester, NY, May 12

Cox-II/Parecoxib – U.S. Health Outcomes Advisory Group Meeting, Searle, Chicago, IL, April 24-25

Dexmedetomidine Advisory Panel, Abbott Laboratories, Aventura, FL, March 3-5

Trainer, Abbott Laboratories Perioperative Services Meeting, Dallas, TX, February 6

AnesthesiaWeb Position Strategy Meeting, New York, NY, January 12.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

24

Other presentations, 1998

“The Impact of Inhalation Agents on Global Cost,” Cog Hill Golf and Country Club, Lemont, IL, September 4, 1998.

Addressed the North American Dräger national sales meeting, Philadelphia, PA, March 29, 1998. Lecture: “Anesthesia Information Systems of the New Millennium.”

Addressed the Abbott Laboratories national sales training meeting, Ft. Lauderdale, FL, February 3, 1998. Lecture: “The Economics of Postoperative Nausea and Vomiting.”

Non-physician presentations, 1997

Addressed Abbott Laboratories national product development group, Chicago, IL, March 24, 1997. Lectures: “Types of Studies to Determine Cost Justification” and “Economic Trends and Issues in Health Care Related to Anesthesia.”

Addressed Abbott Laboratories national sales training meeting, Chicago, IL, July 27–30, 1998. Lectures: “Clinical Implications of Package Insert Changes” and “Cost Perspectives: Low Flow Sevoflurane.”

Non-physician presentations, 1996

Panama City, FL, March 6, 1996.

Addressed the Amidate® (etomidate) Advisory Board of Abbott Laboratories, meeting in Washington, DC, March 8, 1996. Lecture: “General Cost Concepts and Cost Justification for Etomidate”

Addressed the Abbott Laboratories Sevoflurane Speakers Development Meeting, Hotel Sofitel, Rosemont, IL, May 17–18, 1996. Lecture: “The Cost Justification for Sevoflurane.”

Other presentations, 1994

Lectured at the Osler Anesthesiology Review Course, Ft. Lauderdale, FL, February 14–15, 1994. Lectures: “Trauma,” “How to Take the Written Boards,” “How to Take the Oral Boards,” “Anesthesia for Carotid Endarterectomy,” “A Comparison of Induction Agents,” “Management Controversies,” “Answering Strategies for the Oral Boards”.

Other presentations, 1993

Lectured at the Osler Anesthesiology Review Course, Chicago, IL, August 9–14, 1993. Lectures: “Recovery Room,” “Answering Strategies for the Board Exams,” “The Induction Agent for the

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

25

Boards,” “Carotid Endarterectomy,” “Pre-operative Evaluation I,” “How to Take Board Exams,” and “Pre-operative Evaluation II.”

Lectured at the Osler Anesthesiology Review Course, Tampa, FL, January, 1993. Lecture: “How to Take the Oral Board Exam.”

Editorial and review board positions:

1. Co - Editor-in-chief of Anesthesiology , the electronic anesthesia textbook on

emedicine.com. Under construction. 2. AnesthesiaWeb, a World Wide Web site developed for the anesthesia community

(accumulated 16,000 subscribers, the largest anesthesia e-magazine in the world), Chair, Editorial Board, October 1996–2002.

3. Journal of Clinical Anesthesia, Section Editor, Cost Containment and Operations

Improvement, 1995–present.

4. Lubarsky, DA: Abstract Reviewer on Economics, Education and Patient Safety. 77th and 78th Annual IARS Congress, March 27 – 31, 2004

5. Journal of Clinical Monitoring and Computing, Section Editor, Information Systems,

1999-2002

6. Anesthesiology, Guest Reviewer, 1996–present.

7. Anesthesia and Analgesia, Guest Reviewer, 1991–present.

8. Cardiovascular and Thoracic Anesthesia Journal Club Journal – Section Editor, Vascular Anesthesia, 1996–1999.

9. Anesthesia Cost Containment bulletin board on the Internet, Coordinator and Initiator,

1995.

10. TranspO2rt, Contributing Editor, 1993-1994.

11. Butterworths Publishing Company, Boston, Guest Reviewer of anesthesia texts, 1991–93. TEACHING Awards:

• Medical Student “Teacher of the Year” Award, 1990. • Fuqua Scholar Award, 1999.

Teaching specialization:

• Mentor to cost effective care clerkship

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

26

• Annual advisee to multiple residents

Lectures for Fuqua School of Business Course “Informatics, the internet, and healthcare” Fall 2000, Term 1 (Course repeated with update Fall 2001, Term 1)

• “Informatics, The Internet and Healthcare: Introduction and Overview,” August 28 • “IT Development and Value,” “EMR Ideals and Recap,” “Functionality of Other HIS,”

August 31 • “Resource Utilization Control Using Informatics Systems,” September 4 • “The Medicalogic Business Model – ROI for EMR,” Sept. 7 • “Introduction to The Internet,” and B2B business exchanges September 11 • “MD2MD Texts, Journals, CME and Intellectual Property,” September 14 • “The Regulatory Environment,” September 18 • “Content Sites,” Sept 21 • “Medical Care Over the Internet,” Sept 28

Spring 2001, Term 3 • “Operations Management Seminar, Department of Operations: Healthcare and

Management Science,” March 5

University Lectures

University of Miami – School of Medicine Educational Lectures 2002 Duke University Medical Center Educational Lecture, 2001

Resident Lecture: “How to Value Health Care.” Medical Student 2nd year Medical Practice in Health Systems (MPS 206C.82) Lectures,

“Understanding Cost Concepts in the Literature.”

Duke University Medical Center Educational Lectures, 2000

Resident Lecture: “Management Controversies for the Patient At-Risk for Myocardial Ischemia Undergoing Non-Cardiac Surgery.”

Medical Student 2nd year Medical Practice in Health Systems (MPS 206C.82) Lectures, “Understanding Cost Concepts in the Literature.”

Duke University Medical Center Educational Lectures, 1999

Anesthesiology Resident Lecture, “Contracts, Reimbursement, and Compliance Issues” CA-1 Resident Orientation Lecture, “PACU Issues and Transport” Medical Student 2nd year Medical Practice in Health Systems (MPS 206C.82) Lectures,

“Understanding Cost Concepts in the Literature.” Duke University Medical Center Educational Lectures, 1998

Medical Student 2nd year Medical Practice Health Systems Lecture, “Understanding Cost Concepts in the Literature”

CA-1 Resident Orientation Lecture, “PACU Issues and Transport” Resident Lecture, “Preparing for the Oral Boards”

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

27

Medical Student 2nd year Medical Practice Health Systems Lecture, “Understanding Cost Concepts in the Literature”

Resident and Residency Graduate All-day Seminar, “Preparing for the Anesthesia Orals” Duke University Medical Center Educational Lectures, 1997

Grand Rounds, “Relational Databases, Benchmarking, Practice Guidelines and Other Buzzwords of the New Millennium”

Anesthesiology Resident Lecture, “Understanding Cost Concepts in the Literature: Part 2” Medical Student 2nd year Medical Practice Health Systems Lecture, “Understanding Cost

Concepts in the Literature” Anesthesiology Resident Lecture, “Understanding Cost Concepts in the Literature: Part 1” Resident Lecture, “Controversies in Care of the Patient with Coronary Artery Disease for

Non-cardiac Surgery” Resident and Residency Graduate Weekend Seminar, “Preparing for the Anesthesia Orals” Medical Student 2nd year Medical Practice Health Systems Course (previously called the

Cost-Effective Care Clerkship), Lecture, “Understanding Cost Concepts in the Literature” Resident Lecture, ”Common PACU Problems” Medical Student 2nd year Cost Effective Care Clerkship Lecture, “Understanding Cost

Concepts in the Literature” CRNA Staff Meeting Presentation, “New Medicare Teaching Physician Rules: How They

Affect the Anesthesia Care Team” Resident and Residency Graduate Weekend Seminar, “Preparing for the Anesthesia Orals” Medical Student 2nd year Cost Effective Care Clerkship Lecture, “Understanding Cost

Concepts in the Literature” Duke University Medical Center Educational Lectures, 1996

Medical Student 2nd year Cost Effective Care Clerkship Lecture, “Understanding Cost Concepts in the Literature”

Resident and Residency Graduate Weekend Seminar, “Preparing for the Anesthesia Orals” Resident Lecture, “Common Problems and Decision Making” Departmental Grand Rounds, “Morbidity and Mortality”

Medical Student 2nd year Cost Effective Care Clerkship Lecture, “Understanding Cost

Concepts in the Literature” Departmental Grand Rounds, with Dr. JG Reves, Department Chairman, “The New HCFA

(Medicare) Guidelines” Resident lecture, “New Medicare Teaching Rules--How They Affect You, the Resident.”

(Short presentation followed by Question & Answer Session on the Introduction of New Departmental Policies)

Departmental Grand Rounds, “Cost Containment” Resident Lecture, “Preoperative Evaluation of the Cardiac Patient for Non-Cardiac

Surgery” Medical Student 2nd year Cost Effective Care Clerkship Lecture, “Understanding Cost

Concepts in the Literature” Medical Student 2nd year Cost Effective Care Clerkship Lecture, “Understanding Cost

Concepts in the Literature” Critical Care Grand Rounds, “Cost Containment in the ICU”

Duke University Medical Center Educational Lectures, 1995

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

28

Medical Student 2nd year Cost Effective Care Clerkship Tutorial Sessions Anesthesiology Resident Lecture, “Common Problems in Anesthesia” Medical Student 2nd year Cost Effective Care Clerkship Lecture, “Understanding Cost

Concepts in the Literature” Anesthesiology Resident Lecture, “Common Problems in Anesthesia” Grand Rounds in Family Medicine, “Understanding Cost Concepts in the Literature” Anesthesiology Resident Lecture, “Board Review” Medical Student 2nd year Anesthesiology Rotation Lecture, “Hemodynamic Monitoring”

Duke University Medical Center Educational Lectures, 1994

Current Topics in Vascular & Thoracic Anesthesia (CME Category 1 departmental conference), “Prevention of Endotracheal Tube-Induced Coughing During Emergence from General Anesthesia” with Dr. Daryl Malak

CA-1 Resident Orientation Lecture, “Recovery Room Problems (& Transport): Basic Clinical Problem Solving”

Current Topics in Vascular & Thoracic Anesthesia (CME Category 1 departmental conference), “Infection Control in Anesthesia” with Dr. Josef Grabmayer

Anesthesiology Resident Lecture (Vascular & Thoracic Series), “Management Controversies for the Patient at Risk for Myocardial Ischemia Undergoing Non-cardiac Surgery”

Current Topics in Vascular & Thoracic Anesthesia (CME Category 1 departmental conference), “Cell Saver: To Use or Not to Use?” with Dr. Nancy Knudsen

National board review courses (Invited lectures given multiple times 1991–1995): “How to Take the Oral Board Exam” “Carotid Endarterectomy” “Oral Exam Answering Strategies” “Pre-operative Evaluation—History and Physical Exam” “Pre-operative Evaluation—Labs and Tests” “Written Questions and Answers” “Recovery Room—Differential Diagnoses and Therapies for Common Clinical Problems” “Induction Agents for the Boards” “Trauma Anesthesia”

SERVICE

Committees and offices:

Florida Society of Anesthesiologists: FSA Board Member 2003 Ad hoc non-voting Board invitee 2002 – 2003 American Society of Anesthesiologists (ASA) ASA Delegate for FSA, 2003 Committee on Economics 2003- present Committee on Information Management 2002-3 Committee on Electronic Media and Information Technology, 2001-2. Committee on Value Based Anesthesia Care 1995-1999

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

29

Task Force on Value-Based Anesthesia 1994 – 1995 Ad Hoc Committee on Health Outcomes in Anesthesia, chaired by Alex Macario, M.D., M.B.A. (October, 1997 – present) University of Miami-School of Medicine Chair, Department of Anesthesiology overseeing 25MM annual budget, 300 employees including 130 interns, residents and fellows, the largest training program in the world. Medical Center Internet Group Chief Search 2002-2003 Governing Board 2001-present

Duke University Medical Center and Health System Duke University Hospital, Perioperative Executive Committee, 2000 - 2002. Duke University Health System/Duke University Medical Center Internet Advisory Committee, 2000 – 2002. Managed Care Committee (PDC = Private Diagnostic Clinic = 850 MD paratnerhsip) and PDC representative to Managed Care Coordination Group (Duke University Health System and PDC) 2001-2002. Private Diagnostic Clinic Business Strategy Committee, 1999 – 2002. Steering Committee, Duke University Health System Revenue Management Initiative, October, 1999 - 2002. Organizer, Duke University Medical MBA’s (an internal consulting group for the Duke University Health System), 1999. Physician Co-Director, Private Diagnostic Clinic (HCFA/CMS) Compliance Committee, March, 1997 - 2002. Administration and Citizenship Work Group, managed by Provider Transition Strategies, LLC, charged with implementing a physician performance improvement system within the Duke Health System, February, 1998 – February, 1999. Perioperative Services Advisory Committee, 1997 – 2002. Faculty of Medical School cost-effective care course, 1995 – 2002. Private Diagnostic Clinic Retirement Trust Plan Committee, representing the Departments of Anesthesiology, Pathology, Radiation Oncology and Radiology, 1995 – 2002. Product Standardization Committee, Departmental Representative, May, 1995 – 1996. Medical Center Cost Effectiveness Committee, January, 1995 – 2002. Task Force on Teaching Cost Effectiveness, April, 1994 – June, 1995. Duke Hospital Operations Improvement Steering Committee, 1994 – 1996. Operating Room Mission Statement Committee, 1994. Pharmacoeconomics Committee, 1994. Liaison to Operating Room Clinical Laboratories, 1994 – 2002. Task Force to Choose Managed Care Partners, 1994. Duke University Medical Center, Hospital Budget Advisory Committee and Capital Equipment Committee, 1991 – 1994.

Duke Department of Anesthesiology Chairman, Finance Committee, January, 1991–2002. Chairman, Equipment, Supplies, and Product Standardization Committee, 1996–2002. Coordinator, Practice Guidelines Development, 1994–2002. Coordinator, Drug Utilization Review, 1995–2002. Director, Outside Hospital Anesthesia Service Contracts, 1996–2002. Physician Director of Reimbursement Analysts, 1996–2002. Departmental Compliance Officer

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

30

Developer of departmental wide staffing model & incentive plans Direct supervision of business office and business manager Chief, Division of General/Vascular/Transplant Anesthesia and Surgical Critical Care Medicine (12 attendings, 10 CRNAs, 2-4 residents, 2-4 fellows, 8 PA’s in preop screening unit) 1998-2002 Coordinator/creator, Current Topics in Vascular and Thoracic Anesthesia, a weekly CME Category 1 approved conference, July 1991–July 1998. Director, Departmental Retreat, July 1994, “Upping the Pace of ACE (Anesthesia Cost Effectiveness)”. Resident Education Committee, 1991–1994. Director, Mock Oral Board Review Course, 1989–2002.

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

31

APPENDIX A ELECTRONIC, WORLD WIDE WEB AND/OR INTERNET PUBLICATIONS: List of all literature reviews done for AnesthesiaWeb (http://www.anesthesiaweb.com)

1. Literature review: Dexter F et al: Decreases in anesthesia-controlled time cannot permit one additional surgical operation to be reliably scheduled during the workday. Anesth Analg 81:1263–8, 1995 in AnesthesiaWeb, November, 1996

2. Literature review: Dexter F and Tinker J: Analysis of strategies to decrease postanesthesia care unit costs. Anesthesiology 82:94–101, 1995 in AnesthesiaWeb, November, 1996

3. Literature review: Connors AF Jr et al: The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA 276:889–97, 1996 and the accompanying editorial: Should a moratorium be placed on sublingual nifedipine capsules for hypertensive emergencies and pseudoemergencies. JAMA 276:1328 in AnesthesiaWeb, December, 1996

4. Literature review: Mangano et al: Review of effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. N Engl J Med 335:1713, 1996 and accompanying editorial, Eagle and Froelich: Reducing cardiovascular risk in patients undergoing noncardiac surgery. N Engl J Med 335(23):1761, 1996 in AnesthesiaWeb, January 1997

5. Literature review: Katz SG and Kohl RD: Selective use of the intensive care unit after nonaortic arterial surgery. J Vasc Surg 24:235–9, 1996 in AnesthesiaWeb, February, 1997

6. Literature review: Wright I et al: Statistical modeling to predict elective surgery time. Anesthesiology 85:1235–45, 1996 in AnesthesiaWeb, February, 1997

7. Literature review: Twersky R et al: What happens after discharge? Return hospital visits after ambulatory surgery. Anesth Analg 1997;84:319–24 in AnesthesiaWeb, March, 1997

8. Literature review: Blum U et al: Endoluminal stent grafts for infrarenal abdominal aortic aneurysms. N Engl J Med 1997;336:13–20 in AnesthesiaWeb, March, 1997

9. Literature review: Claxton AR, et al: Evaluation of morphine versus fentanyl for postoperative analgesia after ambulatory surgical procedures. Anesth Analg 1997; 84:509–514 in AnesthesiaWeb, April 1997

10. Literature review: Valenzuela RC, Johnstone RE: Cost containment in anesthesiology: a survey of department activities. J Clin Anesth 1997; 9:91–92 in AnesthesiaWeb, April 1997

11. Literature review: Rotondi AJ, et al: Benchmarking the perioperative process. I. Patient routing systems: A method of patient flow and resource utilization. J Clin Anes 1997; 9:159–169 in AnesthesiaWeb, May 1997

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

32

12. Literature review: Woolhandler S, Himmelstein DU: Costs of care and administration at for-profit hospitals and other hospitals in the United States. N Engl J Med 1997;336:769–774 in AnesthesiaWeb, May 1997

13. Literature review: Frank SM, et al: Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: a randomized clinical trial. JAMA 1997;277:1127–1134 in AnesthesiaWeb, June 1997

14. Literature review of a 3-article series: Part 1. Russell LB, et al: The role of cost-effectiveness analysis in health and medicine. JAMA 1996; 276:1172–1177 Part 2. Weinstein MC, et al: Recommendations of the Panel on Cost-Effectiveness in Health and Medicine. JAMA 1996;276:1253–1258 Part 3. Siegel JE, et al: Recommendations for reporting cost-effectiveness analyses. JAMA 1996;276:1339–1341 all reviewed in AnesthesiaWeb, July 1997

15. Literature review: Kharasch ED, et al: Assessment of low-flow sevoflurane and isoflurane effects on renal function using sensitive markers of tubular toxicity. Anesthesiology 1997; 86:1238–1253 and accompanying editorial, Mazze RI, Jamison RL: Low-flow (1 l/min sevoflurane): is it safe? Anesthesiology 1997;86:1225–7 in AnesthesiaWeb, August 1997

16. Literature review: Bito H, et al: Effects of low-flow sevoflurane anesthesia on renal function: comparison with high-flow sevoflurane anesthesia and low-flow isoflurane anesthesia. Anesthesiology 1997; 86:1231–1237 in AnesthesiaWeb, August 1997

17. Literature review: Kearon C, Hirsh J: Management of anticoagulation before and after elective surgery. N Engl J Med 1997; 336:1506–1511 in AnesthesiaWeb, September 1997

18. Literature review: Rooke GA, et al: Hemodynamic response and change in organ blood volume during spinal anesthesia in elderly men with cardiac disease. Anesth Analg 1997;85:99–105 in AnesthesiaWeb, September 1997

19. Literature review: Ballantyne JC, Chang Y: The impact of choice of muscle relaxant on postoperative recovery time: A retrospective study. Anesth Analg 1997;85:476–82 in AnesthesiaWeb, October 1997

20. Literature review: Caldwell JE: The problem with long-acting muscle relaxants? They cost more! Anesth Analg 1997;85:473–475 in AnesthesiaWeb, October 1997

21. Literature review: Snaidach MS, Alberts MS: A comparison of the prophylactic antiemetic effect of ondansetron and droperidol on patients undergoing gynecologic laparoscopy. Anesth Analg 1997; 85:797–800 in AnesthesiaWeb, December, 1997

22. Literature review: Vogt AW, Henson LC: Unindicated preoperative testing: ASA physical status and financial implications. J Clin Anes 1997; 9:437–441 in AnesthesiaWeb, December, 1997

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

33

23. Literature review: Lee TH, Cooper HL: Translating good advice into better practice. (editorial) JAMA 1997;278:2108-2109 and Stiell IG, et al: Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries. JAMA 1997;278:2075-2079 in AnesthesiaWeb, February, 1998

24. Literature review: Pierce ET, et al: Anesthesia type does not influence early graft patency or limb salvage rates of lower extremity arterial bypass. J Vasc Surg 1997;25:226-233 in AnesthesiaWeb, February, 1998

25. Literature review: Olsen MF et al: A randomized controlled trial of prophylactic chest physiotherapy in major abdominal surgery. Br J Surg 1997; 84:1535–1538 in AnesthesiaWeb, April, 1998

26. Literature review: Pollard JB, et al: Use of outpatient preoperative evaluation to decrease length of stay for vascular surgery. Anesth Analg 1997;85:1307–11 in AnesthesiaWeb, April, 1998

27. Literature review: Cher DJ, Lenert LA: Method of Medicare reimbursement and the rate of potentially ineffective care of critically ill patients. JAMA 1997;278:1001–1007 in AnesthesiaWeb, May, 1998

28. Literature review: O’Connor PG, Kosten TR: Rapid and ultrarapid detoxification techniques. JAMA 1998;279:229–234 in AnesthesiaWeb, May, 1998

29. Literature review: Badner NH, et al: Myocardial infarction after noncardiac surgery. Anesthesiology 1998;88:572–578 in AnesthesiaWeb, July, 1998

30. Literature review: Overdyk FJ, et al: Successful strategies for improving operating room efficiency at academic institutions. Anesth Analg 1998;86:896–906 in AnesthesiaWeb, July, 1998

31. Literature review: Leung JM, et al: Automated electrocardiograph ST segment trending monitors: Accuracy in detecting myocardial ischemia. Anesth Analg 1998; 87:4–10 in AnesthesiaWeb, August, 1998

32. Literature review: Swamidoss CP, et al: Health-care report cards and implications for anesthesia. Anesthesiology 1998; 88:809–819 in AnesthesiaWeb, August, 1998

33. Literature review: Fortney JT, et al: A comparison of the efficacy, safety, and patient satisfaction of ondansetron versus droperidol as antiemetics for elective outpatient surgical procedures. Anesth Analg 1998;86:731-8 in AnesthesiaWeb, September, 1998

34. Literature review: Vitez TS and Macario A: Setting performance standards for an anesthesia department. J Clin Anesth 1998;10:166–75 in AnesthesiaWeb, February, 1999

35. Literature review: Fleisher LA and Barash PG: Percutaneous transluminal coronary angioplasty before noncardiac surgery: current state of the debate. (editorial) J Cardiothorac Vasc Anesth 1998;12:499–500 in AnesthesiaWeb, February, 1999

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

34

36. Literature review: Bennett-Guerrero E, et al. The use of postoperative morbidity survey to evaluate patients with prolonged hospitalization after routine, moderate-risk, elective surgery. Anesth Analg 1999;89:514–519 in AnesthesiaWeb, October, 1999

37. Literature review: Posner KL, Freund PR: Trends in quality of anesthesia care associated with changing staffing patterns, productivity, and concurrency of case supervision in a teaching hospital. Anesthesiology 1999; 91:839-47 in AnesthesiaWeb, January, 2000

38. Literature review: Prielipp RC, et al: Ulnar nerve pressure: influence of arm position and relationship to somatosensory evoked potentials. Anesthesiology 1999; 91:345-54 with editorial Caplan RA: Will we ever understand perioperative neuropathy? A fresh approach offers hope and insight. Anesthesiology 1999; 91:335-6 in AnesthesiaWeb, January 2000

39. Literature review: Ramsey SD, Saint S, Sullivan SD et al: Clinical and economic effects of pulmonary artery catheterization in nonemergent coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 14(2) April 2000 113-118, in AnesthesiaWeb, June 2000

40. Literature review: Johnstone RE, Hosaflook C: Financial impact if payers use Medicare rates. Anesthesiology 2000; 93:852-7 in AnesthesiaWeb, October 2000

41. Literature review: Tobias JD: Fenoldopam: Applications in anesthesiology, perioperative medicine, and critical care medicine. Am J Anesthesiology 2000; 27(7):395-401 in AnesthesiaWeb, December 2000

Appendix Page David Alan Lubarsky, M.D. Curriculum Vitae

35

APPENDIX B EDITORIALS ACCOMPANYING ARTICLES: (Numbers refer to the article listed on Lubarsky’s CV)

15 & 16. Shapiro BA: Why must the practice of anesthesiology change? It’s economics, Doctor! Anesthesiology 86:1020-1022, 1997 and Fisher DM, Macario A: Economics of anesthesia care. A call to arms! Anesthesiology 86:1018-1019, 1997

20. Miller RD, Rampil L, Cohen N: Fewer residents: financial, educational, and practical

implications. Anesth Analg 87:242-244, 1998 23. Mazzei WJ: Maximizing operating room utilization: a landmark study. Anesth Analg

89:1-2, 1999 26. Chestnut DH: How do we measure (the cost of) pain relief? Anesthesiology 92:643-645,

2000 27. Watcha MF: The cost-effective management of postoperative nausea and vomiting.

Anesthesiology 92:931-3, 2000