Tennessee's Death Wish, Botched

The state of Tennessee spent a year planning to kill a woman. It administered the drug, twice, and then discovered the hard way that its protocol contains no instructions for what to do if she lives.

"This is the impersonation of a medical act. It is the theft of a medical act."

— Dr. Joel Zivot, anesthesiology professor who has reviewed hundreds of U.S. execution autopsies

By about 8:25 p.m. Wednesday, the curtains at the execution chamber of the Riverbend maximum-security institution were down, the seven journalist witnesses were being escorted out, and the state of Tennessee had run out of script. Christa Pike, 50, was still alive. Snoring, witnesses said. Still breathing, choking, struggling, with a heartbeat, according to what her lawyer saw and what bystanders overheard. The state had given her two full doses of pentobarbital, roughly five grams of a barbiturate that is supposed to stop a person's breathing in minutes. Pike is the only person in American history to have survived that much of the drug.

She is in critical condition at an off-site medical facility, receiving life-saving care; the extent of any brain damage from oxygen deprivation is not yet known. The state, for its part, has a statement.

Here is what happened, as precisely as a secretive state will let anyone say. Tennessee executes with a single-drug protocol: pentobarbital, one chemical, pushed into a vein. The theory is that it stops the inmate's breathing, the lack of oxygen stops the heart, and it is over within minutes. If the drug never properly reaches the blood, or the dose is wrong, none of that happens.

Pike's execution team needed seven needles just to get into her left arm. One of them, her attorney Randy Spivey said, was bent when it was pulled out. The first dose did nothing. Tennessee's protocol, per the Associated Press, directs a second set of syringes to be administered "if the inmate is not deceased" after the first set. So they did. It did nothing either.

There is no step three. The protocol says what to do if the inmate is not dead after dose one. It does not say what to do if the inmate is still alive after dose two. The Department of Correction told the public it "followed every step of the State's lawful, established execution protocol," that the chemical "has consistently been effective," and that the protocol "does not allow for additional procedures."

Translation: Tennessee had a plan for every possible outcome except the one that happened.

The failure was not a mystery. That is the part that belongs in the front of the record. In August, an anesthesiology professor who reviews execution autopsies for a living warned a court-appointed special master exactly what would be hard. Pike has a blood condition, elevated platelets, that makes her prone to clotting. She is a small woman who has spent nearly 30 years on death row, much of it in solitary, and her veins were almost certainly small and hard to find. The special master rejected almost all of the evidence presented to him.

"I told them. I warned them," Zivot said after Wednesday night.

The warnings continued at the speed of the docket. A federal appeals court stayed the execution on Wednesday itself; the U.S. Supreme Court reversed the stay, having ordered a last-minute delay to consider whether Pike's allegations of childhood sexual abuse were adequately weighed at her 1996 sentencing. Days earlier, Governor Bill Lee had denied her clemency petition, in which she wrote: "I was a mentally ill 18-year-old kid. It took me numerous years to even realize the gravity of what I'd done."

Amnesty International has documented the childhood the state knew about: rape, sexual and physical violence, abuse, neglect. The state that failed to protect her as a child concluded, after fifteen years of litigation, that the appropriate remedy was to kill her. It would have made her the first woman executed in Tennessee in more than 200 years.

Underneath the failed execution is the older scandal: the medical masquerade. Lethal injection was sold to the public as humane, as science, as a kind of mercy. What it actually is, per the anesthesiologists, is an unregulated chemical pushed by corrections staff who are not doctors, using a supply chain nobody can audit, following a script that ends at step two.

Stanford anesthesiologist Richard Levy offered the most charitable mechanical explanation: "The fact that two injections failed indicates that either the doses were too low or they were not injected into her veins." Clive Stafford Smith, the founder of Reprieve, added the question nobody wants to answer out loud: the drug may simply have been out of date, a known risk of states' secret procurement.

Levy's prescription is blunt. "Either eliminate lethal injection entirely or engage medical experts to guarantee the product."

This was not a fluke; it was a pattern that finally became loud. In May, Tennessee failed to execute Tony Carruthers after the team spent more than an hour unable to place an IV line; he gets a new date next May. Alabama's last two lethal-injection attempts collapsed the same way; the state then switched to nitrogen gas, a method veterinarians consider inhumane even for cats, until a federal judge in June ruled it cruel and unusual punishment. Firing squads, the other fallback, have produced recent executions in which the bullets missed the heart, so badly that observers have raised the possibility that some of the misses were deliberate.

The Death Penalty Information Center counts seven other prisoners who survived failed attempts to reach a vein, but until Wednesday nobody had survived the drugs themselves. Robin Maher, the group's executive director, called the Pike case "the worst we've ever seen and unlike any other botched execution in the modern era," and attributed it to "the extreme secrecy" of Tennessee's procedures.

None of this was happening in a vacuum. Trump ordered states to accelerate judicial killings in January 2025, and 2025 delivered 47 executions across 12 states, the most in 16 years. When reporters on Thursday asked the president how an execution could fail like Pike's, he referred them to Tennessee officials, and, when someone on the plane offered that "it should be easy to do," he agreed: "it shouldn't be very difficult."

Every state's method fails differently, but the failures have a single author: a system that industrialized the killing and made the killed into the process.

Now comes the reckoning, such as it is. Lee called the night "a tragedy" and "deeply disturbing," suspended the state's remaining executions through the end of the year, and ordered a "comprehensive, third-party review." He has not yet picked the investigator. His own statement said the people of Tennessee expect a sentence to be carried out "in a manner that is not only legal and constitutional, but is effective," which is the sentence that will be quoted at every future press conference.

The state house speaker, a Republican, announced the legislature would investigate too, and already had a solution: expand the alternatives, and "changing the current medications to include potassium chloride." The first instinct of Tennessee's leadership, after the state failed to kill a woman, is to stockpile the chemical that stops hearts. "Thirty years is too long for justice," he added.

Bryan Stevenson put the real question in one line: "Do our governments which tolerate inequality, unreliability and bias deserve to kill?" His colleague Sandra Babcock was more specific: at minimum, Lee must commute Pike's sentence to life. Helen Prejean offered the only fix that addresses the actual problem, that Americans decide on executions they never see. "We have got to bring this to the people, bring them into the execution chamber, so that they too become a witness." Gallup's numbers suggest she may be right: support for the death penalty has fallen from 80 percent in 1993 to 52 percent now. The last time the country paused its killing, in 1972, the Supreme Court called it arbitrary. Four years later, it was back.

The question was never whether the drug works. The question was whether a government that refuses to let its killings be seen, audited, or explained is fit to perform them at all. Tennessee got its answer Wednesday night, delivered in the only way a state can deliver one: a woman snoring on a gurney while the most powerful machinery in the state stood around, seven bent needles and two empty syringes deep, looking for a step three that does not exist. The state still wants to kill her. It has just learned, at great expense and to its eternal credit, that it is not very good at it.