Medical experts condemn Tennessee execution team over Christa Pike's failed lethal injection

Medical experts have voiced alarm at how Tennessee's execution team handled the failed lethal injection of Christa Pike, who survived a dose of pentobarbital that is normally fatal. They say the conduct described would be considered medical malpractice anywhere else.

New details emerged on Thursday in legal proceedings, where Pike's lawyer, Randy Spivey, filed a detailed account of what he witnessed inside the death chamber on 30 September. According to his chronology, four unidentified members of the IV team struggled for almost an hour to set up a line in Pike's arms for the sedative.

"I'm shocked and disturbed by what happened inside the death chamber," said Jonathan Groner, an emeritus professor of clinical surgery at Ohio State University and an expert in execution methods. "The level of incompetence is astounding, and difficult to comprehend." Groner, who has written an upcoming book, The Hippocratic Paradox, said the timeline showed nobody in charge and no plan in sight.

Spivey's account says the team used about 10 needles as they repeatedly poked Pike's arms without securing a line, and at several points worried that her veins might have "blown." Groner noted that the label on a pentobarbital vial says infusion should stop at once if a patient complains of pain. The account records Pike grimacing several times and saying her arm was "really burning."

The timeline says that at 7.05pm, about half an hour into the procedure, a team member asked for a 24-gauge needle and "moved that needle around a lot." Joel Zivot, a professor of anesthesiology and surgery in Atlanta who gave expert testimony before the execution, said such a catheter is the kind used for a baby or small child. Under Tennessee's protocol, 50cc of pentobarbital were to go into each arm, a total of 5g. Zivot said there was "no way" to push a 50cc syringe through so small a catheter without it blowing the vein. At 7.07pm, a team member said: "I think it is blown."

The team also tried to locate a vein with ultrasound. Groner said that, from his own experience, the technique takes many hours of specialist training and up to 20 actual procedures to perform smoothly, and that the team clearly did not know how to use it. At 7.23pm, saline was pushed through the line "with difficulty," which Groner called a flashing red light. A minute later, at 7.24pm, the team concluded the IV was set and the procedure could begin. "No clinician would give a caustic drug through an IV where it didn't flush easily," Groner said.

Pike's lawyers, partly relying on Zivot's expert opinion, had warned the state several times before the attempt that she had exceptionally small and compromised veins. Zivot listed what he saw as serious failings: a poorly written protocol, no one in charge, technology the team may not have had permission to use, and catheters far too small for the purpose.

Pike was sentenced to death for the 1995 murder of a classmate, Colleen Slemmer, when she was 18. After the failed execution she spent several days on a ventilator, and her lawyers assumed she was brain-dead. She returned to her prison cell after 10 days in hospital and can now talk and walk, though her long-term prospects are unknown. Tennessee has called off all executions pending a review, as the case prompts a reckoning over the death penalty nationwide.

Both experts said the case exposes deeper problems with lethal injection, the dominant method of execution in the US in the modern era. Groner called it a "medical charade," adding: "The ultimate penalty in our country, whether one agrees with it or not, is death. It is not torture, then death." Zivot said the team pressed on when it should have stopped. "Medicine is obsessed with safety, accountability and training," he said. "You didn't see any of those things in Pike's execution chamber."