Tennessee doctors call for halt to executions, removal of medical staff

Federal appeals court halts Pike execution about an hour before procedure

In May, healthcare workers at Riverbend Maximum Security Institution in Nashville spent about an hour trying to establish IV access on death row inmate Tony Carruthers so they could administer a lethal dose of sedative, according to his attorney, Maria DeLiberato. Workers stuck his arms and feet with needles to no avail. A doctor then attempted to insert a central line through Carruthers’ collarbone and shoulder, which also failed. Carruthers groaned in pain and blood oozed from puncture wounds, DeLiberato said in a news briefing. After more than an hour, Gov. Bill Lee called the warden and ordered the execution attempt halted. He later granted Carruthers a one-year reprieve.

Two months after the halted lethal injection, more than 40 Tennessee doctors and nurses sent a letter to Lee calling on him to pause executions and redesign the protocol to remove health workers from the process. The doctors and nurses have joined defense attorneys and nine Republican state lawmakers in demanding a moratorium on the death penalty and an overhaul of the state’s execution methods. The letter said Tennessee’s rules requiring the participation of pharmacists, physicians, and other healthcare workers in executions are at odds with medical ethics and with guidelines explicitly laid out by the American Medical Association. “This means that the health care professionals who agree to take part in Tennessee’s executions are those willing to set aside their professional ethics,” the letter reads. “The problems that we have seen, such as in Mr. Carruthers’s case, are the predictable result of working with such unscrupulous actors.”

The doctor who attempted to insert the central line in Carruthers, Mark Fowler, is a contractor for the state’s prison system. In an October 2025 deposition, Fowler said he had not performed such a procedure in the 12 years since he had stopped working in an emergency room and did not know that placing a central line could be among his execution duties. Fowler told NPR by phone on Sept. 24 that “the doctor does not participate in the execution. The only thing the doctor does is declare the person dead.” He did not have further comment.

The doctors’ arguments echoed those the AMA has made before the U.S. Supreme Court and in its code of ethics, which says doctors are to preserve life when there is hope of doing so and bars participation in executions. Dr. John Greer, a retired Nashville hematologist, said in a news conference about the letter that he was not surprised the central line placement went awry. “Placing a central line is not just sticking a needle in a person’s arm,” Greer said. He said the doctor has to tap a large vessel above the heart, that the procedure is risky in which an error could cause a collapsed lung or heavy bleeding, and that only those with specific training and routine practice should attempt it. “And I cannot imagine that there would be someone who’s doing these routinely who would be involved in this procedure,” Greer said.

Dr. Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado’s medical school, said there is a broad understanding in the U.S. that the medical establishment does not participate in executions. “We came out of World War II with a whole bioethics and medical ethics enterprise that is really strongly opposed to medicine serving as an arm of the state and using specialized medical skills to hurt people or kill people,” Wynia said. A history of medical abuses by government doctors — forced sterilizations and unethical studies of untreated syphilis in the U.S., and murder and torture in Nazi Germany — forged that consensus, he said. Wynia noted that other nations where medical professionals still participate in executions tend to be authoritarian ones. “But they are, you know, Iran and Saudi Arabia and Russia, sort of authoritarian states, where medicine is an arm of the government,” Wynia said. “Medical involvement in executions ends up happening because medicine is unable to say, ‘No, we don’t do that.’”

Tennessee was scheduled to execute Christa Pike on Sept. 30. She was 18 years old when she and her boyfriend killed Colleen Slemmer. Pike’s attorneys raised concerns this year that the state’s lethal injection protocol would violate her rights, contending that because she suffers from a platelet disorder, she would likely need a central line placed. They also argued that she was at risk of needless suffering, alleging that Carruthers’ execution showed that Fowler — who has confirmed publicly that he will oversee Pike’s execution — is incompetent at placing central lines.

In June, Pike’s attorneys asked the Tennessee Supreme Court to appoint a special investigator to collect evidence and hold hearings to determine whether those concerns warranted an order to delay her execution and design a method for only her. The court appointed senior judge Mark Ward, who held a series of hearings in Knoxville last month. Ward said he did not believe Pike’s rights would be violated by the process and submitted his report to the court. On Sept. 23, the Tennessee Supreme Court denied Pike’s stay, agreeing with Ward, saying none of the concerns amounted to a constitutional violation. On Sept. 28, Lee announced he would not grant her clemency. But on the morning of the scheduled execution on Sept. 30, a federal appeals court halted it about an hour before it was to begin.

Some Republican state senators have also separately called for a hold on executions and an overhaul of the process, saying that “incompetent administration” of capital punishment gives its critics more ammunition. This summer, Lee said he did not want a pause. “The Department of Correction did exactly what they should,” he said. “It should not affect executions in the future.” Lee also said: “It’s one of the most difficult things that we do in this state. But I am committed to making sure that it is done in the way that it should be.”

The state’s lethal injection protocol orders the prison to keep a curtain over the media witnesses’ viewing window until the IVs are established, so none of them could offer a visual account of the failed execution attempt. A lawsuit challenging that policy has been filed by the Reporters Committee for Freedom of the Press and news outlets, including NPR member station WPLN. The lawsuit argues the lack of transparency during the IV placement process obscures problems like the ones that occurred in Carruthers’ case.

Tennessee is among 27 states where the death penalty is legal, according to the Death Penalty Information Center, a nonprofit that compiles data and analysis on capital punishment. Governors in four of those states have halted all executions, citing moral concerns and the refusal of pharmaceutical companies to sell drugs for use in executions. Lethal injection remains the primary execution method nationwide, though some states may use gas, a firing squad, or electrocution. Since the beginning of 2020, 170 people have been executed in 17 states, with most executions occurring in Florida, Texas, and Oklahoma. In that time, six states have had botched lethal injections, which the Death Penalty Information Center defines as executions that include a departure from the protocol because of unanticipated problems and that cause more pain for the prisoner than anticipated, whether they ultimately end with a death or not. Several of the cases resemble Carruthers’ — protracted but ultimately failed attempts to establish IV access.