Missouri executed a man Tuesday, April 9, for killing his cousin and her husband nearly two decades ago, sparking debate over the state’s anesthetic-free execution method. Brian Dorsey, dubbed a “model inmate” by prison staff, was Missouri’s first execution this year, despite the Supreme Court rejecting his appeals.

Concerns about Dorsey’s health potentially complicating the execution led to a settlement to mitigate severe pain, though specifics weren’t disclosed.

Dorsey’s health conditions, including obesity, diabetes, and past drug use, might have complicated finding a vein for the injection, potentially requiring a more invasive procedure to access a vein, possibly needing a procedure called a cut down.

A cutdown procedure involves making an incision to expose and access a vein using forceps.

Around 85 protesters rallied outside the prison in support of Dorsey. A Missouri Department of Corrections spokesperson confirmed the execution proceeded smoothly without the need for a cutdown procedure.

Brian Dorsey's final words before Missouri execution https://t.co/WuLwXLwb2k pic.twitter.com/ppkQOomeKE

— Newsweek (@Newsweek) April 10, 2024

“To my family, friends, and all of those that tried to prevent this, I love you!” Dorsey said in a handwritten note that he left as his last words. “I am grateful for you. I have peace in my heart in large part because of you and I thank you. To all those on all sides of this sentence, I carry no ill will or anger, only acceptance and understanding.”

Dorsey was convicted of the 2006 murder of his relatives, Sarah and Ben Bonnie, in their home. Prosecutors said he had asked for financial help from Sarah earlier that day to settle a debt with two drug dealers. Later that night, according to prosecutors, Dorsey fatally shot the couple with a shotgun taken from their garage and then sexually assaulted Sarah Bonnie. Police said he then stole various items from their home in an attempt to pay off his drug debt. The couple left behind their 4-year-old daughter.

Dorsey surrendered to police a few days later.