Rebecca Boone, Associated Press
Long before Christa Pike was brought into Tennessee's execution chamber, prison leaders reviewed and approved a backup plan detailing what to do if the first attempt at lethal injection failed.
However, the backup plan also failed, and on Thursday — 24 hours later — Pike was still alive but in critical condition at a Tennessee hospital, though her prognosis remained uncertain. The specifics of what went wrong are not yet clear.
According to the nonprofit Death Penalty Information Center, 27 states have capital punishment, and they vary widely in how they administer the death penalty and how much of that lethal process is kept hidden from public view.
Tennessee has two redundancies built into its execution process. First, inmates are supposed to have two intravenous lines placed. If the first IV site fails, the execution team can switch to the second one. A physician on the execution team can also insert a central line if needed, which involves making an incision in a major blood vessel to thread a catheter into the body near the heart.
Intravenous lines can fail for several reasons, such as improper placement of the needle and catheter, movement out of place, or a ruptured vein that allows blood and IV fluid to leak into surrounding tissue.
Tennessee allows for a second 100 mg dose of pentobarbital to be administered if the condemned person is still alive five minutes after the first dose. Officials gave Pike a second dose, but it is unclear if they used the primary or backup IV site.
Alabama has a three-drug lethal injection protocol that allows for a backup dose of the first drug, midazolam, if the inmate is not unconscious from the first dose. However, the protocol does not include instructions for what to do if the condemned person is still alive after the first dose of the next two drugs, rocuronium bromide and potassium chloride.
Idaho has contingency plans for nearly every step of the execution process, including backup IV sites and allowances for administering a central IV line, as well as up to three full doses of any of the state's four approved lethal injection drug cocktails. Idaho recently made firing squad its primary execution method, although it has yet to carry out an execution by that method. The firing squad protocol also includes a backup plan, allowing the prison director to order a second volley of shots within a two-minute time span if necessary.
Idaho called off the execution of Thomas Eugene Creech in 2024 after execution team members could not place a viable IV after eight attempts. Tennessee also called off an execution earlier this year after failing to find a suitable vein for a secondary IV line.
In 2014, Arizona executioners injected Joseph Rudolph Wood with a lethal combination of drugs 15 times during the nearly two hours it took him to die, during which he gasped more than 600 times.
Executions are often conducted in secrecy, with the identities of execution team members, details about how lethal drugs are procured, and aspects of the death chamber hidden from public view.
Most death penalty states allow a few members of the media to witness executions on behalf of the public. After the execution, these representatives typically participate in a news conference to share what they observed. Only two states, Indiana and Wyoming, explicitly ban media from witnessing executions. Wyoming has not carried out an execution since 1992, according to the Death Penalty Information Center.
A coalition of news organizations, including The Associated Press, sued Indiana last year for access to the witness room, but in June a federal appellate court upheld the state's law barring media access.
In Idaho, media witnesses can observe the condemned person being placed on a gurney, having IVs inserted, and being put to death. However, AP and other news organizations have sued for increased access to view the drug administration process, which is currently shielded from public view. A federal judge ordered the state to provide that access, but the state has appealed, and the appellate court has not yet ruled.
When Pike's first lethal injection dose failed to end her life, officials closed the curtains and administered a second dose of pentobarbital. When the curtains reopened, Pike was making snoring sounds and was clearly alive, according to AP reporter Kim Chandler, who was one of the witnesses. Eventually, the curtain was closed again, and the microphone in the room was turned off, but Pike could still be heard making gasping or snoring sounds.
Nearly two hours after the execution began, media witnesses were escorted out, and Pike was taken to a hospital for treatment.
Many states, including Tennessee, keep the IV insertion hidden from public view but allow witnesses to observe as the condemned person dies. AP was part of a media coalition that previously sued Tennessee for access to see the IV insertion and to keep the viewing room curtains open until the pronouncement of death. However, in April, the Tennessee Supreme Court blocked a lower court's order that would have allowed for increased access.
One of Pike's attorneys, Steve Ferrell, stated that Pike feared complications due to a lifelong blood disorder that made it difficult to insert needles into her veins. Ferrell suggested that the IV may not have entered Pike's vein properly, potentially causing the drug to fill her arm instead of entering her bloodstream.