The state corrections official who stands beside condemned inmates as they take their last breaths in Florida’s death chamber recently pulled back the veil on what has largely been a very secretive execution process.

The testimony was given during a 11 February hearing in a lawsuit involving Paul Howell, a death row inmate scheduled to die by lethal injection 26 February. Howell is appealing his execution; his lawyers say the first of the injected drugs, midazolam, isn’t effective at preventing the pain of the subsequent drugs.

The Florida supreme court specifically asked the circuit court in Leon County to determine the efficacy of the so called “consciousness check” given to inmates by the execution team leader.

The testimony is notable because it shows that the Department of Corrections has changed its procedures since the state started using a new cocktail of lethal injection drugs. A shortage of execution drugs around the country is becoming worse as more pharmacies conclude that supplying the lethal chemicals is not worth the bad publicity or legal and ethical risks.

Timothy Cannon, who is the assistant secretary of the Florida Department of Corrections and the team leader present at every execution, told a Leon County court that an additional inmate “consciousness check” is now given due to news media reports and other testimony stemming from the 15 October execution of William Happ.

Happ was the first inmate to receive the new lethal injection drug trio. An Associated Press reporter who had covered executions using the old drug cocktail wrote that Happ acted differently during the execution than those executed before him. It appeared Happ remained conscious longer and made more body movements after losing consciousness.

Cannon said in his testimony that during Happ’s execution and the ones that came before it, he did two “consciousness checks” based on what he learned at training at the Federal Bureau of Prisons in Indiana – a “shake and shout”, where he vigorously shakes the inmate’s shoulders and calls his name loudly, and also strokes the inmate’s eyelashes and eyelid.

After Happ’s execution, Cannon said the department decided to institute a “trapezoid pinch”, where he squeezes the muscle between an inmate’s neck and shoulder.

It was added “to ensure we were taking every precaution we could possibly do to ensure the person was, in fact, unconscious”, Cannon said. “To make sure that this process was humane and dignified”.

Lawyers for Howell say that they are concerned that the midazolam does not produce a deep enough level of unconsciousness to prevent the inmate from feeling the pain of the second and third injection and causes a death that makes the inmate feel as though he is being buried alive.

“Beyond just the fact that constitution requires a humane death, if we decided that we wanted perpetrators of crime to die in the same way that their victims did then we would rape rapists. And we don’t rape rapists,” said Sonya Rudenstine, a Gainesville attorney who represents Howell.

“We should not be engaging of the behavior that we have said to abhor. If we are going to kill people, we have to do it humanely. It’s often said the inmate doesn’t suffer nearly as much as the victim, and I believe that’s what keeps us civilized and humane.”

Corrections spokeswoman Jessica Cary said on Wednesday that the department “remains committed to doing everything it can to ensure a humane and dignified lethal injection process”.

Cannon explained in his testimony that each execution team member “has to serve in the role of the condemned during training at some point”.

“We’ve changed several aspects of just the comfort level for the inmate while lying on the gurney,” he said. “Maybe we put sponges under the hand or padding under the hands to make it more comfortable, changed the pillow, the angle of things, just to try to make it a little more comfortable, more humane and more dignified as we move along.”

He said an inmate is first injected with two syringes of midazolam and a syringe of “flush”, a saline solution to get the drug into the body. Midazolam is a sedative.

Once the three syringes have been administered from an anonymous team of pharmacists and doctors in a back room, Cannon does the consciousness checks.

Meanwhile, the team in the back room watches the inmate’s face on a screen, which is captured by a video camera in the death chamber. The inmate is also hooked up to a heart monitor, Cannon said.

There are two executioners in the back room – the ones who deploy the drugs – along with an assistant team leader, three medical professionals, an independent monitor from the Florida Department of Law Enforcement and two corrections employees who maintain an open line to the governor’s office.

If the team determines that the inmate is unconscious, the other two lethal drugs are administered.