Nearly an Hour of Failed Needle Attempts Before Drug Was Given in Pike Case

Christa Pike's lawyer filed a detailed account in legal proceedings on Thursday describing what happened inside the death chamber on 30 September. The filing chronicles an attempt to set an intravenous line that stretched for nearly an hour before any drug was administered. Medical experts who reviewed the account are raising alarms about how the procedure was carried out.

The filing states that four members of the IV team worked on Pike's arms for almost an hour trying to establish a line for the sedative. The account records the use of approximately 10 needles during repeated attempts to access her veins. At several points, the team expressed concern that her veins might have ruptured. Pike, who was 18 when sentenced to death, survived a dose of pentobarbital that is normally fatal.

Jonathan Groner, an emeritus professor of clinical surgery at Ohio State University who studies execution methods, said the timeline indicates no one was in charge and no plan was in place. "I'm shocked and disturbed by what happened inside the death chamber," Groner said. He added, "The level of incompetence is astounding, and difficult to comprehend." Groner, who has an upcoming book titled The Hippocratic Paradox, said the conduct described in the account would constitute malpractice in any other medical setting.

According to the account, at 7.05pm, about half an hour into the procedure, a team member requested a 24-gauge needle and moved it around significantly. Joel Zivot, a professor of anesthesiology and surgery in Atlanta who gave expert testimony before the execution, said that size of catheter is used for infants or small children. Tennessee's protocol called for 50cc of pentobarbital in each arm, for a total of 5g. Zivot said there was "no way" to push a 50cc syringe through such a small catheter without blowing the vein. At 7.07pm, a team member said, "I think it is blown."

The team also attempted to locate a vein using ultrasound. Groner said that technique requires extensive specialist training and up to 20 procedures to perform properly, and that the team did not appear to know how to use it. At 7.23pm, saline was pushed through the line with difficulty, which Groner called a warning sign. A minute later, at 7.24pm, the team concluded the IV was set and proceeded. "No clinician would give a caustic drug through an IV where it didn't flush easily," Groner said.

Pike's lawyers, relying in part on Zivot's opinion, had warned the state multiple times before the attempt that her veins were exceptionally small and compromised. Zivot identified several serious failings in his account: a poorly written protocol, no one in charge, technology the team may not have been authorized to use, and catheters far too small for the task. The label on a pentobarbital vial states that infusion must stop immediately if a patient reports pain. The account records Pike grimacing several times and saying her arm was "really burning."

Pike was sentenced to death for the 1995 murder of a classmate, Colleen Slemmer. After the failed attempt, 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 the hospital and can now talk and walk, though her long-term prospects remain unclear.

Both experts said the case reveals deeper problems with lethal injection, the dominant method of execution in the United States. Groner called it a "medical charade," saying, "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 continued when it should have halted. "Medicine is obsessed with safety, accountability and training," he said. "You didn't see any of those things in Pike's execution chamber." Tennessee has paused all executions pending a review of the incident.

The state has suspended all executions while officials review what happened, a step that places renewed scrutiny on the use of the death penalty across the country.