Tennessee death-row woman survives two lethal injections

In the US state of Tennessee, the execution of 50-year-old Krista Gail Pike could not be carried out on September 30: she was to become the first woman executed in the state in two centuries, but survived two consecutive doses of a lethal injection. Pike was serving a sentence for murdering a fellow student in January 1995, when she was 18.

Robin Maher, executive director of the Death Penalty Information Center (DPIC), called the case unprecedented: “This is the worst case we’ve seen. It doesn’t resemble any other botched execution in the modern era. There’s nothing comparable to it.” According to DPIC, seven people have survived an execution attempt since 1976, but each time because the team failed to get a catheter into a vein and the drug was never administered at all. Pike is the first condemned person to survive after the drug was actually injected.

The standard execution procedure

In terms of method, Pike’s execution was meant to follow an entirely standard protocol: there is no single federal standard for executions in the US — each state legislature decides the method, while prison administrations set the procedural details, often keeping part of the information secret. The death penalty remains on the books in 27 states, as well as at the federal level and in the military; four of those states currently have a governor-imposed moratorium. The Food and Drug Administration (FDA) does not evaluate execution drugs — according to the US Department of Justice, it simply has no authority to do so. The Eighth Amendment to the US Constitution bans “cruel and unusual punishment,” but the Supreme Court has yet to find any method of execution unconstitutional.

Since 1976, one method has clearly dominated in the US: 1,492 people have been executed by lethal injection, 163 by electrocution, 19 by gas (eight of them nitrogen), six by firing squad and three by hanging (DPIC data). Injection accounts for nearly nine executions out of ten, and all 29 executions carried out in the US from the start of this year through the end of September used this method.

The umbrella term “lethal injection” in practice covers three different protocols. Florida (16 executions) uses a three-drug combination, the first of which is the anesthetic etomidate. Oklahoma and Alabama (five executions) combine the sedative midazolam with two other substances. The remaining eight executions, in Texas, Arizona and Tennessee, used a single drug — pentobarbital: Texas has used it since 2012, Tennessee since December 2024.

Botched executions are not rare: Austin Sarat, a professor at Amherst College, studied US executions from 1890 to 2010 and estimated that about seven percent of lethal-injection executions were in some sense “botched” — more than for any other method (some scholars criticize Sarat’s methodology, so the figure should be treated as approximate). In Tennessee, which resumed executions in May 2025, problems were recorded in three of six attempts — even over that short a period.

Why states chose injection

The first “recipe” for lethal injection appeared in Oklahoma in 1977, a year after the US Supreme Court, following a four-year pause, again allowed death sentences to be handed down. State legislator Bill Wiseman was looking for a cheaper and less agonizing alternative to the electric chair: every new method of execution in American history has been presented as more humane than the last — which is why New York replaced the noose with the electric chair in 1890, and Nevada introduced the gas chamber in 1924 “for humane reasons.”

The Oklahoma Medical Association refused to help on ethical grounds, so the recipe for the law was dictated by medical examiner Jay Chapman. The mixture had three components: the barbiturate thiopental, which induces sleep; a muscle relaxant that paralyzes the muscles, including those used for breathing; and potassium chloride, which stops the heart. Chapman himself later admitted to Human Rights Watch: “I didn’t do any research. I just knew from my own experience with anesthesia what was needed.” The method was first used in Texas in 1982, and other states adopted it without any separate medical review.

The injection’s composition has changed over the years. In 2011, thiopental became unavailable after its sole US manufacturer, Hospira, stopped making it. States switched to pentobarbital — a barbiturate barely used in mainstream medicine today, though veterinarians use it to euthanize animals; in high doses it suppresses brain function on its own, up to stopping breathing, so no other drugs are needed.

But pentobarbital ran into supply problems too. The Danish company Lundbeck, which sold it in the US under the name Nembutal, blocked shipments to prisons, and the European Union required exporters of such substances to obtain licenses that bar their use in executions. States now buy pentobarbital from compounding pharmacies or other opaque sources — and keep their suppliers secret. In practice, even the courts often don’t know what drug a condemned person is actually given.

Wherever this can actually be checked, problems turn up: a January 2025 report by the federal Department of Justice counted 88 pharmacies that had compounded injectable pentobarbital. The FDA had never inspected 31 of them, and inspectors found “serious deviations” at 55 of the 57 that were inspected. Details emerged from a lawsuit filed in August of this year by two Texas inmates: according to them, the Texas prison system compounds pentobarbital from active ingredient bought in 2016 that was affected by a 2023 fire at the Huntsville prison, and stores the finished vials at room temperature — even though pharmacopoeia rules give such vials a shelf life of no more than 24 hours under those conditions. The Texas Court of Criminal Appeals refused to halt executions over the lawsuit, and the state executed one of the plaintiffs in September. In Tennessee, this kind of data isn’t published at all: a judge in Knoxville ordered the disclosure of expiration dates and inspection results for the drug’s stockpile last December, but the law still protects suppliers’ identities, and officials refused in May of this year to say whether their pentobarbital had expired.

What may have gone wrong

Whether any of this played a role in Pike’s execution is still unknown — there has been no official explanation. According to witnesses, shortly after the drug was administered, the woman complained of a burning sensation in her arm and asked if that was normal, then became sluggish and breathed loudly and raggedly; the curtain to the execution chamber stayed drawn for most of the time. The prison administration says staff followed “every step” of the protocol and that the drug “has always been effective,” while the defense cites difficulty accessing her veins, vein rupture and “degraded pentobarbital.”

František Duška, head of the anesthesiology and intensive care clinic at Prague’s Vinohrady University Hospital, suggested this could be a case of so-called paravasation: the drug may have entered the surrounding tissue rather than the vein, from where it is absorbed slowly and never reaches a lethal concentration in the blood — which would be consistent with the burning sensation in her arm. A similar mechanism was confirmed by a 2014 investigation in Oklahoma, when the catheter of condemned inmate Clayton Lockett was inserted incorrectly and the drugs entered tissue rather than a vein. In Pike’s case this remains only a hypothesis; the defense’s mention of “two syringes” leaves it unclear whether she received only the prescribed dose or also the backup set the protocol requires to be kept on hand. Little is known about the substance itself: Tennessee law shields everyone involved in obtaining it, and the protocol does not specify whether it is industrially manufactured or compounded pentobarbital.

Alternative methods of execution

Because the drugs are getting harder to obtain, and because courts are still fighting over how humane injections really are, in recent years states have been bringing older methods of execution back into their laws.

As of July 2026, the firing squad has become the primary method in Idaho, and it is also permitted in four other states. In 2025, South Carolina shot three men who had chosen the method themselves: under the state’s protocol, the condemned person sits strapped to a chair while three volunteers from the prison staff fire from about 4.5 meters at a target over the heart. While in some cases a doctor pronounced death roughly a minute after the shots, an autopsy after the execution of Mikal Mahdi found that the shots missed the heart, and a defense expert estimated he remained conscious for 30 to 60 seconds — even though the South Carolina Supreme Court approved the method on the assumption that death occurs within 10 to 15 seconds.

Nitrogen has been used for executions in Alabama since January 2024 and in Louisiana since 2025: a mask is placed over the condemned person’s face, pure nitrogen is pumped through it, and the body is deprived of oxygen. How quickly consciousness is lost under this method is disputed: witnesses to the execution of Kenneth Smith, the first person executed this way, said he shook and struggled for several minutes. Eight executions have now been carried out this way — seven in Alabama and one in Louisiana. In June 2026, federal judge Emily Marks barred Alabama from executing Jeffrey Lee by nitrogen, citing a “substantial risk of serious harm”; the US Supreme Court let the ban stand, and in September Alabama executed Lee by injection instead.

The electric chair is permitted in nine states; Tennessee was the last to use it, in 2020. Anyone whose crime was committed before 1999 can choose it instead of injection. Pike meets that condition, but it isn’t known whether she considered that option.

A new attempt is nearly inevitable

In Pike’s case — barring something unforeseen, such as severe brain damage from the failed attempt — the question of a repeat execution will likely become relevant in the near future: after botched attempts, states typically suspend executions, investigate the incident, and then carry out the sentence again.

In 1946 in Louisiana, 17-year-old Willie Francis survived because the electric chair had been wired incorrectly. A year later, the US Supreme Court ruled 5–4 that a second attempt was not cruel punishment, since the first had failed by accident: Francis was executed in May 1947.

Oklahoma suspended executions after a mix-up involving one of the drugs in 2015 and resumed them in 2021. Alabama, after a series of failures in 2022, conducted an internal review and returned to executions eight months later. Tennessee, after a called-off execution in 2022, commissioned an independent report, rewrote its protocol around pentobarbital and resumed executions in May 2025. The exception is Ohio, which has not carried out an execution since 2018.

Lawmakers typically respond by adding new methods and more secrecy: Idaho made the firing squad its primary method after the botched execution of Thomas Creech in 2024, and South Carolina passed a law in 2023 shielding drug suppliers. Tennessee Governor Lee said after Wednesday’s events that the state’s residents expect a sentence to be carried out “not just lawfully and constitutionally, but effectively,” and that the investigation he has ordered should identify the error in the procedure used; the statement makes no mention of the death penalty itself.

Around Prague, based on reporting by seznamzpravy.cz