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OKLAHOMA CITY – A scathing, 106-page report from a multi-county grand jury calls for sweeping changes to the state’s protocol for executing inmates, but some said the report doesn’t go far enough.

“When we see this kind of drastic, systematic failure, we should really take a hard look at what we’re doing as a state and why this is something we should continue to do,” said defense attorney Jacqui Ford. “The point is whether the government and the state of Oklahoma should be permitted to continue to engage in state-sponsored homicide when they can’t follow their own rules.”

Attorney General Scott Pruitt asked for an investigation after discovering corrections workers used the incorrect, unapproved drugs to execute Charles Warner in January 2015.

Later that year, the governor stayed Richard Glossip‘s execution, after it was discovered the same incorrect drugs were about to be administered.

Corrections officials discovered they had potassium acetate, instead of the approved potassium chloride.

The grand jury did not indict anyone, but its report details a number of shortcomings, citing the following people for failing to perform their duties with precision and attention to detail:

  • DOC Director Robert Patton, who orally modified the execution protocol without authority
  • The Pharmacist ordered the wrong execution drugs
  • The Department’s General Counsel failed to inventory the execution drugs as mandated by state purchasing requirements
  • An agent with the Department’s Office of Inspector General failed to inspect the execution drugs while transporting them into the Oklahoma State Penitentiary
  • Warden Anita Trammel failed to notify anyone in the Department that potassium acetate had been received
  • The H Unit Section Chief failed to observe the Department had received the wrong execution drugs
  • The IV Team failed to observe the Department had received the wrong execution drugs; the Department’s Execution Protocol failed to define important teiins, and lacked controls to ensure the proper execution drugs were obtained and administered
  • Governor Fallin’s General Counsel Steve Mullins advocated the Department proceed with the Glossip execution using potassium acetate

Read: How the DOC got it wrong twice

“I would respect that report and try to learn from it,” said former prosecutor Lou Keel. “These are things the Department of Corrections must get right.”

Keel prosecuted the Charles Warner case and said he still stands by the death penalty, even after Oklahoma’s well-documented problems, which have only added to opposition to capital punishment.

“Some murders are so horrendous, so heinous that the only right and just punishment is the death penalty,” said Keel, who estimates he sent 15 people to death row. “Certainly, this is a process, as a society, that we have to get right. When you impose the ultimate sanction on people, it’s important this be done in the most humane way possible.”

Keel doesn’t dispute the DOC’s shortcomings but wonders about how serious the drug mix-up was.

Warner died in 18 minutes, and the grand jury concluded “There is no evidence the manner of execution caused Warner any needless pain.”

NewsChannel 4’s Abby Broyles witnessed the execution and reported hearing him say his body was on fire.

The grand jury does not appear to be finished with its investigation.

Its report concludes noting its next scheduled meeting is June 13-16, where it will summon additional witnesses and gather physical evidence.