A court is deciding whether Tennessee’s execution methods violate Christa Pike’s rights. Hearings are underway.

Days before Tennessee’s next execution, a court is considering whether the state’s execution methods violate another death row inmate’s rights.

Christa Pike is scheduled to undergo lethal injection on September 30. She would be the first woman put to death in Tennessee in two centuries. Her gender, as well as her extensive history of sexual trauma, pose unique logistical challenges. She also has health conditions that could make delivering the lethal drugs difficult.

That’s why the state’s supreme court appointed a special master to investigate whether the process will violate Pike’s Eighth Amendment rights, which protect against cruel and unusual punishment.

The multi-day hearing started on Tuesday morning in Knoxville. That’s where Pike, at 18, killed her Job Corps colleague Colleen Slemmer in 1995. Pike was convicted in 1996.

The state supreme court denied a request to appoint a special master for Anthony “Darrell” Hines, who is scheduled to be executed at 10 a.m. on Thursday. His team has raised several concerns about how his health complications — which resulted from a series of strokes — could make delivering the injection difficult.

Hines has a stay request pending before the U.S. Supreme Court. Gov. Bill Lee announced on Tuesday that he will not grant Hines clemency.

Updates from the first day of hearings

After Pike’s legal team laid out their concerns about the lethal injection process and how it could cause Pike severe pain and suffering, they pitched alternatives. One of them was hanging. They argued that even if it is maladministered, the worst-case scenario would be 20 seconds of pain. They compared it to risks associated with lethal injection, which include a form of lung damage that can cause a drowning sensation until death.

Tennessee’s executions happen at Riverbend Maximum Security Institution, a men’s prison in Nashville. Its warden, Kenneth Nelsen, told the court that hanging is not a possibility in the state.

“We don’t have the equipment to conduct that execution,” he said via video conference. “It’s not approved by Tennessee law. And just the logistics — we wouldn’t be able to support that.”

State law allows only lethal injection and electrocution.

The court also heard from Maria DiLiberato, an attorney for the American Civil Liberties Union who represents another condemned inmate, Tony Carruthers. DiLiberato accompanied Carruthers during his attempted execution in May, which failed after IV difficulties, and she testified about the details of that day.

Filings submitted ahead of time

Each side submitted long legal filings ahead of the hearing, basically making their cases in full ahead of the proceedings.

Pike’s legal team went into heavy detail about how the lead-up to her death would trigger traumatic memories, and how those are experienced less like typical memories and more like flashbacks.

They also spent dozens of pages explaining the physiology of her blood disorder, and the risks it poses to the lethal injection portion of the execution process.

“Depending on her platelet count at the time of execution, Ms. Pike’s thrombocytosis creates a dual, paradoxical risk: an increased risk of clotting at the IV site—which can occlude the catheter and prevent drug delivery—or an increased risk of catastrophic bleeding,” the filing reads. “These mechanisms, operating simultaneously, expose Ms. Pike to uniquely severe complications during lethal injection.”

Since last year, Tennessee has used a single drug in executions: pentobarbital. The filing explains that’s a notoriously corrosive compound, and can cause burns in a way similar to drain cleaner. If Pike’s platelets did clog the catheter, the filing argues drugs would likely seep out into other flesh, causing burning pain. And all lethal injections come with a risk of pulmonary edema, a form of damage that causes the lungs to fill with fluid. It’s believed to cause a drowning sensation. Pike’s team and their medical experts argued that because her circulatory system is damaged, that’s an even more likely outcome for Pike.

State argues Carruthers’ case not relevant

Like Hines, Pike’s team argued that Tennessee is likely using the same doctor involved in Carruthers’ execution. Dr. Mark Fowler tried and failed to place a central line that day. The state’s protocol tasks the on-site doctor with placing a central line if the medical staff fail to place traditional IVs. Pike’s team argues this is a likely need, and that Fowler is likely to fail as he did during Carruthers’ execution.

Attorneys for the state noted that the concerns about Fowler have already been shot down in Hines’ state supreme court case. They quoted the decision:

“Mr. Hines’ guesses that the State might use a physician who might be unqualified to establish a backup central IV line during his execution, if needed. … But mere possibilities or hypotheticals, like Mr. Hines’s allegations about the ‘risks of maladministration,’ are not sufficient to establish a substantial risk of severe pain.”

The state also argued that Fowler’s failure in Carruthers’ attempted execution was irrelevant to Pike’s case — and that there is no concern that the Department of Correction will fail to place IVs in the first place.

“The Protocol also provides for trained medical professionals to ‘determine the IV sites,'” the filing reads in part. “TDOC has trained personnel who are prepared and able to establish peripheral IV access. Pike’s argument that her thrombocytosis places an impossible burden on these trained professionals does not ‘raise … beyond the speculative level’ the possibility that the trained medical professional of the IV Team will be unable to locate peripheral vein access.”

Throughout the filing, the state’s legal team argues that nothing that happened during Tony Carruthers’ failed execution — when the medical staff failed to place an IV — is relevant.

“And even if Pike could make such a showing, she will not be able to show that repeated attempts to find IV access (something that happens in hospitals every day) is sufficient to qualify as ‘serious illness or needless suffering,'” the filing reads.