Medical experts fault Tennessee's IV team after Pike's failed execution

Lawyer’s timeline details prolonged struggle to establish an IV

Medical experts said Tennessee’s execution team appeared incompetent and fell short of medical standards during Christa Pike’s failed lethal injection, based on a chronology her lawyer released in legal proceedings on Thursday. Randy Spivey, who was inside the death chamber for the 30 September attempt, described four unidentified IV team members struggling for almost an hour to establish a line in Pike’s arms.

According to Spivey’s account, the team used about 10 needles as it repeatedly poked Pike’s arms and failed to secure a line. At several points, team members worried that her veins might have “blown.” The timeline reached the team’s decision at 7.24pm to proceed with the execution.

Jonathan Groner, an emeritus professor of clinical surgery at Ohio State University and an expert in execution methods, said: “I’m shocked and disturbed by what happened inside the death chamber.” He added: “The level of incompetence is astounding, and difficult to comprehend.” Groner, who was preparing The Hippocratic Paradox, a book about ethical contradictions involved in lethal injections, said the chronology painted a picture in which nobody was in charge and no plan was in sight.

Groner said the procedure would have been malpractice in a clinical situation because pentobarbital can cause burns and clinicians would not infuse it if they were unsure the IV was in place. The label on the vial instructs that infusion should cease immediately if a patient complains of pain, Groner said. Spivey’s timeline records Pike “grimaced” and said her arm was “really burning” multiple times.

Joel Zivot, a professor of anesthesiology and surgery based in Atlanta, Georgia, gave expert testimony at legal hearings before Pike’s failed execution. He said the new chronology pointed to several areas of serious concern: “Here we have a poorly written protocol, no one in charge, technology that they may not have had permission to use, and catheters that are far too small for the purpose.”

At 7.05pm, about half an hour into the attempt, a member of the IV team asked for a 24-gauge needle “and moved that needle around a lot. Christa continued to grimace,” according to Spivey’s timeline. Zivot said: “That’s the kind of catheter you put in a baby, or a small child.” He added there was “no way that you can push a 50cc syringe into that small little catheter without it blowing up the vein.”

Tennessee’s protocol called for 50cc of pentobarbital to be injected into each of Pike’s arms, a total dose of 5g. At 7.07pm, another member of the IV team said: “I think it is blown.”

At 7.23pm, the IV team pushed saline through the line “with difficulty,” according to Spivey. Groner said the difficulty should have been “a flashing red light.” He said: “No clinician would give a caustic drug through an IV where it didn’t flush easily. That would be malpractice.” Despite that warning sign, the team concluded at 7.24pm that the IV was set and the procedure could commence.

The IV team also attempted to find a vein with ultrasound. Groner said ultrasound-guided IV placement requires many hours of specialist training and up to 20 actual procedures before an individual can perform the technique smoothly. “The Tennessee team clearly didn’t know how to use it,” he said.

Pike’s lawyers, partly on the basis of Zivot’s expert opinion, warned Tennessee on several occasions before the failed attempt that Pike had exceptionally small and compromised veins. Zivot said the team pressed on when it should have stopped. He said: “It was clear this was not doable, and yet they kept on doing it anyway.”

Pike was sentenced to death for the 1995 murder of her classmate Colleen Slemmer. The killing occurred when Pike was 18. After the failed execution, Pike spent several days on a ventilator, and her lawyers assumed she was brain-dead. After 10 days in the hospital, Pike was returned to her prison cell. Pike can now talk and walk, but her long-term prospects are not known.

Tennessee has called off all executions pending a review. Some have likened Pike’s experiences in the death chamber to torture, and the failed procedure prompted a reckoning over the death penalty nationwide. Medical experts said the chronology highlighted fundamental problems with lethal injections, the overwhelmingly dominant form of executions in the US in the modern era. Groner called lethal injection a “medical charade.” He said: “Pike didn’t deserve this. The ultimate penalty in our country, whether one agrees with it or not, is death. It is not torture, then death.” Zivot offered a broader assessment: “Lethal injection is a theft of a medical procedure, and they stole the wrong part. Medicine is obsessed with safety, accountability and training. You didn’t see any of those things in Pike’s execution chamber.”