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 Supreme Court justices clashed Wednesday over whether a lethal-injection cocktail used by several states is too painful — with one likening it to being burned alive, and another saying "guerrilla war" is being waged against the death penalty. 
 
 The heated arguments over a challenge by several death-row prisoners in Oklahoma came exactly one year after the botched execution of an inmate there reignited debate over capital punishment and triggered a federal review of protocols nationwide. 
 
 The specific issue is the sedative midazolam. The question is whether it puts condemned inmates into a coma-like state before two other drugs are given, protecting them from the kind of pain that would violate the Eighth Amendment restriction on cruel and unusual punishment. 
 
 Justice Samuel Alito noted that Oklahoma has not been able to obtain more reliable drugs because death-penalty opponents have convinced pharmaceutical companies to not supply them. 
 
 "Is it appropriate for the judiciary to countenance what amounts to a guerrilla war against the death penalty?" Alito asked the lawyer for the inmate. 
 
 Justice Elena Kagan, on the other hand, pointed out that the third drug in Oklahoma's protocol — potassium chloride — has been likened to being burned alive. She asked the state whether it would be constitutional to burn someone at the stake after an anesthetic with debatable pain-killing properties. 
 
 "Maybe you won't feel it, maybe you will," she said. "We just can't tell." 
 
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 Justice Sonia Sotomayor slammed Oklahoma's lawyer, Solicitor General Patrick Wyrick, for what she characterized as deceptive misstatements in the state's brief. 
 
 "Nothing you say or read to me am I going to believe unless I see it with my own eyes," she scolded him. 
 
 Justice Antonin Scalia, meanwhile, vented his frustration with the argument that midazolam is not effective at producing a state of pain-free unconsciousness like other drugs that used to be the standard but are now scarce. 
 
 "The abolitionists have rendered it impossible to get the 100 percent," he told the inmates' lawyer, Robin Konrad. 
 
 Robert Dunham of the Death Penalty Information Center, which opposes execution, said there were no big surprises in the questions from the bench. Justice Anthony Kennedy, seen as the swing vote, said little. 
 
 "Several justices on both sides gave clear signals on where they stand," he said. "There is no clear signal on where the majority of the court stands." 
 
 The lead plaintiff in the case is Richard Glossip, 51, who was one day away from getting the needle for the 1997 murder-for-hire of his boss when the high court agreed to hear a challenge to lethal injections — its first in seven years. ||||| The gurney in the execution chamber at the Oklahoma State Penitentiary in McAlester, Okla. (Photo: Sue Ogrocki, AP) 
 
 WASHINGTON -- In a case that could have broad implications for hundreds of death row inmates, the Supreme Court will consider whether a drug protocol used in recent lethal injections violates the Constitution's prohibition on cruel and unusual punishment. 
 
 The justices agreed Friday to consider a case originally brought by four death-row inmates in Oklahoma -- one of whom was put to death last week, after the court refused to block his execution with a combination of three drugs that has caused some prisoners to writhe in pain. 
 
 Because the court's four liberal justices dissented from the decision to let that execution go forward, it presumably was their votes in private conference Friday that will give the issue a full hearing in open court. Only four votes are needed from the nine-member court to accept a case. It will be heard in late April and decided by late June. 
 
 Lawyers for Charles Warner and three other convicts set for execution in Oklahoma over the next six weeks sought the Supreme Court's intervention after two lower federal courts refused their pleas. While the court's conservatives refused to stop Warner's execution, the request for a full court hearing had been held for further consideration. 
 
 The lawyers claim that the sedative midazolam, the first drug used in the three-drug protocol, is not approved by the Food and Drug Administration as a general anesthetic and is being used in state executions virtually on an experimental basis. They say Inmates may not be rendered unconscious and could suffer painfully as the other drugs in the protocol are administered. 
 
 That, they claim, was a factor in Oklahoma's botched execution last April of Clayton Lockett, who struggled, groaned and writhed in pain for 43 minutes before dying. A state investigation later blamed Lockett's ordeal on a failure by prison staff to realize that drugs had not been administered directly into his veins. The state has since changed its procedures and increased the dose of midazolam used. 
 
 "The time is right for the court to take a careful look at this important issue, particularly given the bungled executions that have occurred since states started using these novel and experimental drugs protocols," said Dale Baich, one of the lawyers representing the death-row inmates. 
 
 'MY BODY IS ON FIRE' 
 
 Charles Warner was executed last week using a controversial three-drug protocol. (Photo: AP) 
 
 Warner's execution last Thursday was the first in Oklahoma since Lockett's. The execution lasted 18 minutes, during which Warner, 47, convicted in the murder and rape of an 11-month-old girl in 1997, said the injection "feels like acid" and "my body is on fire." Witnesses said they saw only slight twitching in Warner's neck for about seven minutes before he stopped breathing. 
 
 The prisoners' lawyers also blame the drug protocol for two other gruesome deaths -- the execution a year ago of Ohio's Dennis McGuire, who made snorting noises for 20 minutes before dying, and July's execution of Arizona's Joseph Wood, who appeared to gasp hundreds of times during a death that took nearly two hours. 
 
 However, Florida has had fewer issues with the same drug protocol. On the day Warner was executed, it used the same three-drug combination to execute Johnny Shane Kormondy, 42, who killed a man during a 1993 home invasion. 
 
 Lawyers for Oklahoma responded that there was no real evidence midazolam would not work as a general anesthetic. They noted that it had been used successfully in at least 10 previous executions. 
 
 "It is undisputed that Oklahoma's protocol, which is identical to Florida's protocol, has been used 10 times in executions without serious incident," the state argued in its brief. "Petitioners can only cite to executions that took place using different drug combinations, or the Oklahoma execution of offender Lockett, in which IV access was subsequently found to be insufficient and flawed." 
 
 The court's four liberal justices -- Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan -- voiced deep concern about the three-drug protocol in trying to block Warner's execution last week. They also dissented last September when the court rejected a stay application from a Missouri inmate executed with the same drug. 
 
 Supreme Court Justice Sonia Sotomayor wrote the dissent last week before Oklahoma's latest execution. (Photo: Jeff Chiu, AP) 
 
 "The questions before us are especially important now, given states' increasing reliance on new and scientifically untested methods of execution," Sotomayor wrote. "Petitioners have committed horrific crimes and should be punished. But the Eighth Amendment guarantees that no one should be subjected to an execution that causes searing, unnecessary pain before death." 
 
 Then, tellingly, she added, "I hope that our failure to act today does not portend our unwillingness to consider these questions." 
 
 The number of executions in the USA peaked at 98 in 1999, then dropped to 35 by last year, according to the Death Penalty Information Center. Four prisoners have been executed so far this year. 
 
 Although the death penalty remains on the books in 36 states, a half dozen of them account for nearly all the recent executions in the United States: Texas, Florida, Oklahoma, Missouri, Arizona and Ohio. Texas and Missouri do not use midazolam. 
 
 A FLURRY OF EXECUTIONS? 
 
 The next three prisoners set for execution in Oklahoma are Richard Glossip, John Grant and Benjamin Cole. Now, presumably, their executions -- including one set for next Thursday -- will be blocked while the Supreme Court considers their case. 
 
 In recent years, states that regularly carry out executions have been scrambling to find the drugs needed to carry out the death penalty. The preferred first drug had been sodium thiopental, a fast-action barbiturate no longer in supply as drugmakers and pharmacies -- particularly in Europe, where the death penalty is widely opposed -- have cut off production. Some states, such as Texas and Missouri, use pentobarbital alone or in combination with other drugs. 
 
 The sedative midazolam is at the center of a Supreme Court case concerning lethal injections. (Photo: AP) 
 
 States that substituted midazolam, a psychoactive drug used as an anti-seizure medication and for sedation, have run into the most problems. According to the Death Penalty Information Center, at least seven states rely on midazolam. 
 
 The justices ruled in 2008 that using three drugs in succession to kill an inmate does not violate the Constitution's ban on cruel and unusual punishment. The first drug would render the inmate unconscious, a second would paralyze him and a third would stop the heart. But at the time, the drug supply was more reliable. 
 
 During the past year, the court has appeared increasingly wary of the death penalty, for a variety of reasons: 
 
 • In May, the justices blocked the execution of a Missouri murderer because his specific medical condition made it likely that he would suffer from a controversial lethal injection. 
 
 • Later that month, they ruled 5-4 that Florida must apply a margin of error to IQ tests, making it harder for states to execute those with borderline intellectual disabilities. 
 
 • In October, the court stopped the execution of yet another Missouri man over concerns that his lawyers were ineffective and had missed a deadline for an appeal. Last Monday, the justices sent his case back to Missouri for further consideration. 
 
 Read or Share this story: http://usat.ly/1Jv1Tsk ||||| The Supreme Court’s hearing Wednesday about the constitutionality of a lethal injection procedure turned into a tendentious, almost bitter battle between the court’s conservative and liberal justices. 
 
 Justice Samuel A. Alito Jr. accused those of trying to prevent the use of the drug midazolam as part of a lethal injection procedure in Oklahoma of waging a “guerrilla war against the death penalty.” Repeated challenges of lethal injection procedures, he said, were meant only to delay the implementation of executions. 
 
 Justice Antonin Scalia agreed, saying the “abolitionist movement” had put pressure on drug manufacturers to stop making available to states drugs that would ensure executions were not needlessly painful. 
 
 Justices Sonia Sotomayor and Elena Kagan were just as forceful on the other side. Kagan said that without proper sedation, the drug used to cause death was akin to being burned at the stake, except a person is being “burned alive from the inside.” Sotomayor told the Oklahoma solicitor general she would not believe assertions in his brief unless she verified them herself. 
 
 The Supreme Court heard arguments on the constitutionality of the lethal injection procedure, a case that stemmed from a botched execution in Oklahoma. (Reuters) 
 
 The questioning of Oklahoma’s Patrick R. Wyrick was so intense by the liberals that Chief Justice John G. Roberts Jr. granted him additional time at the podium. “Hopefully we will have a chance to hear what you have to say,” he said. 
 
 [Oklahoma recently made nitrogen gas its backup execution method] 
 
 These arguments came a year to the day after a botched execution in Oklahoma left an inmate writhing and grimacing on a gurney, drawing international attention to issues facing the lethal injection process in the United States. 
 
 The Oklahoma case centers on a particular drug that has been used by that state and others in executions that went awry last year. But it also touches on the reality that the capital punishment landscape in this country has fractured, pushing execution protocols further and further away from a method the court previously upheld. 
 
 The justices were revisiting the issue of lethal injection for the first time since 2008, when they upheld a three-drug combination and said it did not violate the Constitution’s ban on cruel and unusual punishment. At the time, these drugs were used across the country. But an ongoing shortage of lethal injection drugs fueled largely by European objections to capital punishment has caused states to struggle to find new drugs, create different protocols and seek other methods. 
 
 Until 2010, lethal injections in the United States were generally carried out using an anesthetic, a paralytic drug and a drug that stopped the heart, according to the Death Penalty Information Center. But a company that produced sodium thiopental, the anesthetic that was commonly used, stopped making the drug due to capital punishment. States began using another drug, pentobarbital, but the Danish company that supplied it said it would stop shipping it to U.S. prisons that executed inmates. 
 
 So states began adopting new and different drugs. In Oklahoma, when state officials could no longer obtain the drug they used to rely on, they turned to the drug midazolam. This particular drug was used in three problematic executions last year, turning it into a focal point for debates about lethal injections. 
 
 The most high-profile of these was Oklahoma’s bungled attempt to execute convicted murderer Clayton Lockett. The state used midazolam in one of its executions for the first time, and Lockett kicked, grimaced and survived for 43 minutes after the execution began. He eventually died after officials had already halted the process, and a state investigation blamed the bungled procedure on the execution team’s insertion of the needle during the injection. 
 
 Chief Justice John G. Roberts Jr. and Scalia both pointed out that there were issues with the administration of the drugs in Lockett’s execution. “If in fact the execution was not properly conducted, I don’t see how you can blame it on the — on the drug,” Scalia said. 
 
 Midazolam was also used last year in the execution of an Arizona inmate who gasped and snorted and took nearly two hours to die, as well as the lethal injection of an Ohio inmate who gasped and choked before dying after nearly half an hour. 
 
 “We’ve seen that lethal injection is not the swift, painless, effective method of causing death that it was made out to be,” said Robert Dunham, executive director of the Death Penalty Information Center. “The myth that you can swiftly and painlessly execute somebody in a manner that is humane and marginally civilized seems to have evaporated.” 
 
 Florida, the first state to use the drug in an execution, has utilized it numerous times without many witnesses reporting these kinds of issues; a media witness said that when the state first used the drug, the inmate being executed appeared to remain awake and moving for an unusually long period of time. 
 
 Ohio has since dropped midazolam from its protocol, and that state postponed its executions this year to give it time to adopt a new lethal injection practice. After the botched procedure last year, Oklahoma also changed its execution protocols, keeping midazolam but ramping up the dose to match the level used in Florida. 
 
 [What the Supreme Court’s decision here could mean for the death penalty] 
 
 The week before the justices decided to accept the lethal injection case, Oklahoma carried out its first execution since Lockett was put to death. The inmate, Charles Warner, who was convicted of raping and murdering an 11-month-old, had originally been set to die the same night as Lockett, but his execution was postponed. 
 
 The justices declined to stay that execution when the court’s four justices who wanted the execution stayed were overruled. However, it takes five justices to stay an execution, while it takes only four to accept a case. In the months since the Supreme Court said it would hear the challenge, states have carried out multiple executions. 
 
 Justice Sonia Sotomayor wrote in a dissent arguing for a stay that she found the idea that midazolam could “work as intended difficult to accept given recent experience with the use of this drug.” 
 
 Experts have said it is unclear whether midazolam can produce a deep enough level of unconsciousness to prevent an inmate from feeling pain from the injections that follow. In the briefs filed for this case, midazolam’s effectiveness takes center stage again and again. 
 
 The three Oklahoma death-row inmates arguing against the state’s protocol now argue in their filing to the court that using midazolam will cause them “excruciating pain and suffering during their executions.” 
 
 However, Scott Pruitt, the Oklahoma attorney general, and other state officials argue in their brief that this is not the case, instead painting this argument as an attempt to fight the death penalty under the guise of questioning one drug. 
 
 “Oklahoma’s lethal injection protocol does not present a substantial risk of severe pain and cannot be considered cruel,” the state officials wrote. In addition, the state also calls the attacks on midazolam “unwarranted” and says the higher dosage of the drug would cause unconsciousness during executions. 
 
 Pruitt said in a statement Wednesday after the arguments that he was confident the justices would uphold the state’s procedure. 
 
 More than a dozen professors of pharmacology had also submitted a brief to the court, taking no side in the case but writing that midazolam cannot be considered “an appropriate substitute” for the drugs that had been used to induce unconsciousness in executions. 
 
 Meanwhile, authorities in Florida — which has halted its own executions until the judges issue a decision — submitted a brief to the court agreeing with Oklahoma and saying that their state’s experiences show that midazolam can be used in humane executions. 
 
 The justices were facing questions of how to approach executions that involve substantially different protocols than the one they upheld in 2008, as well as whether condemned inmates should have to provide an available alternative if they object to an execution method. 
 
 In 2008, when the justices agreed to uphold the three-drug method, they did not all come to the same conclusions about the case or what could follow. Seven justices ultimately filed opinions in that case. Roberts, writing for the court, noted that there is always some risk inherent in an execution, but that alone does not make it unconstitutional. 
 
 “Simply because an execution method may result in pain, either by accident or as an inescapable consequence of death, does not establish the sort of ‘objectively intolerable risk of harm’ that qualifies as cruel and unusual,” he wrote. 
 
 Justice Clarence Thomas agreed with the outcome but not the reasoning, instead determining that a method of execution is only unconstitutional “if it is deliberately designed to inflict pain.” 
 
 Related: How the death penalty continued its slow, steady decline in 2014 
 
 [This post has been updated. First published: 8 a.m.]
– Things got about as nasty as they get in the Supreme Court chambers as the justices today debated the constitutionality of a lethal-injection drug. Samuel Alito, for example, accused opponents of the death penalty of engaging in a "guerrilla war" to stop it, while Elena Kagan likened the execution protocol to being burned alive, reports the Washington Post. At issue specifically is whether the first drug in a three-drug combination used by Oklahoma works well enough—critics say the sedative, midazolam, fails to make the following two drugs painless. Kagan likened the effects of one of those drugs to being "burned alive from the inside" and wondered whether the state would sanction burning at the stake after administering an iffy anesthetic, reports NBC News. "Maybe you won't feel it, maybe you will," she said. "We just can't tell." Antonin Scalia, meanwhile, declared that states can't get "100 percent" drugs because death-penalty "abolitionists" are making it impossible with their pressure on manufacturers. The big question, as usual, is where probable swing vote Anthony Kennedy stands. "It seemed clear that he, too, was frustrated with the resistance movement and what it required the Justices to do to examine each state’s approach to executions," writes Lyle Denniston at SCOTUSblog. Meaning that when the decision is eventually announced, it will probably be bad news for death-row inmates. (The arguments came exactly one year after the botched execution of Clayton Lockett in Oklahoma.)