Medical experts shocked by Tennessee team’s ‘malpractice’ in Christa Pike’s failed execution

Medical experts have expressed shock at the apparent incompetence shown by Tennessee’s execution team during the failed lethal injection of Christa Pike, the prisoner who survived a normally fatal dose of pentobarbital, which they say would be considered medical malpractice in any other setting.

New details emerged on Thursday of how Tennessee’s intravenous (IV) team struggled for almost an hour to set up a line into Pike’s arms through which she would be administered the fatal dose of sedative. A blow-by-blow account was released in legal proceedings from Pike’s lawyer, Randy Spivey, who was present inside the death chamber at her 30 September failed execution.

The technical procedures attempted by the four unidentified members of the IV team as they tried to find a vein, as described by Spivey, provoked alarm among medical experts. They said the standards applied appeared to fall glaringly short of anything that would be deemed acceptable in a medical environment.

“I’m shocked and disturbed by what happened inside the death chamber,” said Jonathan Groner, 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 that explores the ethical contradictions involved in lethal injections, said that Spivey’s detailed chronology painted a picture in which nobody was in charge and there was no plan in sight.

“What they did to Christa Pike would have been malpractice in a clinical situation. Nobody would infuse a drug like pentobarbital that’s known to cause burns if they were unsure that the IV was actually in place.”

Groner pointed out that the label on a vial of pentobarbital instructs that infusion should cease immediately if the patient complains of pain. Spivey’s account records multiple times in which Pike “grimaced” and said her arm was “really burning”.

Pike was sentenced to death for the 1995 murder of a classmate, Colleen Slemmer, when she was 18. Following the failed execution, she spent several days on a ventilator and her lawyers assumed she was brain-dead.

After 10 days in hospital she was returned to her prison cell. She can now talk and walk, but her long-term prospects are not known.

The gruesome nature of Pike’s experiences in the death chamber, which some have likened to torture, have prompted a reckoning on the death penalty nationwide. Tennessee has called off all executions, pending a review.

In Spivey’s detailed account, the IV team used about 10 needles as they repeatedly poked Pike’s arms, failing to secure a line. At several points, team members worried that her veins might have “blown”.

Joel Zivot, a professor of anesthesiology and surgery based in Atlanta, Georgia, who gave expert testimony at legal hearings ahead of Pike’s failed execution, said that 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. We could go on and on …”

Pike’s lawyers, partly on the basis of Zivot’s expert opinion, warned the state on several occasions before the failed execution attempt that the prisoner had exceptionally small and compromised veins.

The Spivey timeline records that at 7.05pm on the evening of the failed execution, about half an hour into the procedure, a member of the IV team asked for a 24-gauge needle “and moved that needle around a lot. Christa continued to grimace.”

Zivot said that a 24-gauge catheter was very small. “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”. Under Tennessee’s protocol, 50cc of pentobarbital were to be injected into each of Pike’s arms, giving a massive total dose of 5g of the sedative.

At 7.07pm another member of the IV team said: “I think it is blown.”

The Spivey chronology also reveals that the IV team attempted to find a vein using ultrasound technology. Groner said that from his own personal experience using an ultrasound requires many hours of specialist training and up to 20 actual procedures before an individual can perform the technique smoothly.

“Inserting an IV with ultrasound guidance is a practice-based skill that takes a lot of training. The Tennessee team clearly didn’t know how to use it,” he said.

At 7.23pm in the timeline, the IV team pushed saline through the line they had established “with difficulty”, according to Spivey. That should have been a flashing red light, Groner 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 IV team concluded that the IV was set and that the procedure could commence just a minute later, at 7.24pm.

The medical experts said the timeline underlined fundamental problems with lethal injections, the overwhelmingly dominant form of executions in the US in the modern era. Groner said that it highlighted that lethal injections were a “medical charade. 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 said his takeaway was that the execution team pressed on when they should have stopped. “It was clear this was not doable, and yet they kept on doing it anyway.”

He added: “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.”