Death row inmate survives two lethal injections in Tennessee

Christa Pike, a woman sentenced to death in the US, survived two injections of pentobarbital administered to her on Thursday at a prison in Nashville, in the American state of Tennessee. The execution was due to take place 30 years after Pike, then 18, murdered her classmate in 1995, but the condemned woman's heart kept beating even after the second injection.

According to journalists present at the execution, the woman briefly lost consciousness, but her heart kept beating and loud gasping sounds came from her chest. Pike complained of pain and thrashed her legs so violently that she pulled off the sheets covering her.

What went wrong

Professor František Duška, head of the anesthesiology and intensive care department at Prague's Královské Vinohrady University Hospital, believes the lethal substance was administered incorrectly. “The drug needs to be given intravenously, straight into the bloodstream. Judging by media reports, what happened to the condemned woman was so-called paravasation — some or all of the substance went not into the vein but under the skin, where it caused pain and tissue death but wasn't absorbed into the blood. That is most likely why the woman survived the execution,” the professor explains.

The condemned woman's lawyers said that even before the execution, Pike had been worried about the whole procedure — in particular because of difficult access to her veins and a lethal drug she believed might be expired.

Duška also sees a possible cause of the failed injection in inadequate training on the part of the person carrying out the execution. “The American Medical Association strictly forbids doctors and medical staff from taking part in executions on ethical grounds, so there is a critical shortage of people willing to perform them. As a result, the execution is often entrusted to someone with no medical training and no skill in placing an IV catheter, which makes the procedure inhumane,” the doctor says.

Prison officials deny any violations

The Tennessee Department of Correction said that every step of the established execution protocol was followed and denied any violations.

A chance of surviving without lasting harm

Details of Pike's state of health have not yet been published. Speculation has emerged that the woman may have suffered irreversible brain damage. Professor Duška, however, allows that the condemned woman could escape the consequences entirely. “If the body was short of oxygen, brain damage is possible. But it's quite possible that the substance was only absorbed gradually while breathing continued throughout the execution — in which case the woman will wake up as normal. There is a real chance that Pike will come through this with no lasting effects at all, but we don't know the details of her condition,” the specialist says.

According to Duška, pentobarbital is also used in medicine — for induction of anesthesia before surgery. “The drug used to be used widely; today it's used rarely, mainly for induction of anesthesia. It's the first medication given to a patient when they are put under before an operation,” the doctor says. In Czech medicine, however, pentobarbital isn't used at all — only in veterinary practice, to euthanize animals.

Why the lethal dose sometimes doesn't work

In high doses, pentobarbital induces deep anesthesia and suppresses breathing — which is why it's used in executions and assisted suicides. In such cases, a dose roughly ten times higher than for ordinary anesthesia is administered. “For euthanasia, hundreds of milligrams are used — that dose alone is enough to seriously suppress breathing. For an execution, 2.5 grams are injected intravenously — about five times more than for induction of anesthesia, and, judging by the available data, that dose is repeated,” the professor explained.

Lethal pentobarbital injections are not a new topic in the US: the administration of former President Joe Biden banned this method of execution at the federal level, citing the risk of unnecessary suffering and pain. Nevertheless, some states later returned to pentobarbital — mainly because of an acute shortage of other drugs.

“When lethal injections first appeared, a so-called euthanasia cocktail of three substances was used — a drug to induce sleep, a muscle relaxant, and an agent to stop the heart. Death was insured three times over. But an execution required three different substances, and pharmaceutical companies often refuse to sell them precisely because of that purpose. If only a sedative is used, the execution can fail,” Duška concludes.

Around Prague, based on reporting by seznamzpravy.cz