In the year and a half leading up to Christa Pike’s failed execution, warnings about the state’s lethal injection protocol and its weaknesses piled up.
On Sept. 30, Pike was injected with two lethal doses of pentobarbital, but she survived. Her attorneys said that when she got to the hospital, her arms were covered in burns and blisters. Because the drug is alkaline like drain cleaner, it’s known to cause these kind of burns if it’s administered incorrectly.
Pike’s team spent the summer ringing alarm bells that her execution was likely to be botched. They weren’t the first to raise concerns about Tennessee’s lethal injection program. There have been concerns about competency within the department for years.
But Pike was executed using a method approved in early 2025. That’s when the latest lethal injection protocol was published. Critics immediately said it failed to protect death row inmates from unnecessary suffering.
Warnings got louder after the failed attempt to execute Tony Carruthers in May of this year. Republican lawmakers and medical professionals warned that the protocol couldn’t prevent catastrophe.
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Special master proceedings from June to August
In June, Pike’s legal team filed a request with the Tennessee Supreme Court for a special master. That’s a process where the court appoints an investigator to work on the justice’s behalf to collect information and make a recommendation.
Pike’s team wanted the special master to investigate whether Pike was particularly vulnerable to having her rights violated because of a slate of health problems.
The request by Pike’s team discussed her lifetime of sexual trauma and resulting post traumatic stress disorder. It argued that she’d be re-traumatized by several portions of the process, including when the restraint team comes and straps her to a gurney. It also focused on a blood disorder she has, which can cause her to clot and interfere with IV drug absorption. And it talked about Pike’s veins being small and unstable, and the threat that poses to her body during the lethal injection process.
“It is likely that Pike will require multiple doses, or that the time for death contemplated in the protocol (5 minutes), will be grossly underestimated and result in a lingering death,” the filing reads. “Even if the execution team can achieve peripheral IV access on Pike, her small and compromised veins will make it nearly impossible to maintain IV access for the duration of the execution.”
Each side — Pike’s attorneys and those representing the State of Tennessee — made their arguments in briefs. Then, the special master, Mark Ward, held several days of evidentiary hearings in Knoxville in August.
At the end of that month, Ward wrote in his report that none of the concerns amounted to a violation of Pike’s 8th Amendment protection against cruel and unusual punishment. He recommended against taking action, like delaying the execution or finding an alternative method.
“The evidence Ms. Pike has produced amounts to speculation about potential problems with peripheral IV access,” it reads. “But such speculation is not sufficient as a matter of law to establish an Eighth Amendment violation.”
Ultimately, the state supreme court agreed in an order filed a week before the attempted execution.
“Ms. Pike’s argument that she may survive the execution are too speculative to show a likelihood of success on the merits,” the order reads in part. ‘Pentobarbital . . . [h]as been used to carry out over 100 executions, without incident,’ … and such speculative theories do not warrant Eighth Amendment relief.”
New protocol published in January 2025
There aren’t any regulations on Tennessee’s executions, other than the lethal injection protocol. The Department of Correction writes the rulebook and promises to follow it. There is no independent organization or federal agency that checks.
The governor can exercise oversight, and Gov. Bill Lee has. In 2022, on the day TDOC was scheduled to execute Oscar Franklin Smith, Lee learned the state wasn’t following the protocol’s requirements to test the drugs for contaminants and potency. He called a moratorium on the death penalty and ordered TDOC to re-write the protocol.
He also commissioned an independent investigation. The results were damning. It found the state used bad drugs several times leading up to 2022. Sometimes they weren’t potent enough. Sometimes they were “falling out of solution,” meaning they’d separated like salad dressing. Experts say injecting separated drugs feels like putting rocks in the veins.
TDOC’s lethal injection program was a one-man show. Despite having no health care training, the person was responsible for sourcing the drugs, storing them and preparing them.
The new protocol, published in January 2025, was meant to address some of the systemic problems found in the investigation. But critics, mostly capital defense attorneys, said the new protocol would fail to do so.
Critics raised concerns shortly after the protocol was published
The guidebook is much shorter. The old version, published in 2018, was nearly 100 pages. The new one spans 44. It removed nearly all requirements on drug testing. It says the lethal chemicals are subject to “quality assurance and quality control testing,” but it doesn’t lay out the kinds of testing, like searches for endotoxins or checks on potency.
Kelley Henry, who was a federal public defender in Nashville in April of 2025, held a press conference. She and her team were arguing the new protocol wasn’t offering her death row clients enough protection from a needlessly painful death.
“The testing that was so important that the governor paused all executions in 2022 because they failed to do it, has been eliminated from the new protocol,” she said. “They haven’t put in more safeguards. They’ve made it worse. It’s riskier now.”
She said that risk is not limited to the drug testing. The investigation found rampant management issues, and she said in response, the Department of Correction wrote a shorter, vaguer rulebook.
The investigation chastised the old protocol for failing to define the drug procurer’s role, and for not requiring anyone involved in buying or storing the drugs to have pharmaceutical education. Those recommendations are not reflected in the new protocol.
Henry was among the attorneys who filed a lawsuit now called Burns v. Strada. It asks the Davidson County Chancery Court to do a deep dive and assess whether the protocol is constitutionally sound. It’s been underway since early 2025.
After the Carruthers execution attempt
Kit Thomas is another lawyer on the case. She participated in a press briefing after Carruthers’ failed execution this spring. She said that execution attempt, in which the IV team and contracted doctor failed to establish IV access, illustrated one of the central issues in the Burns lawsuit.
“Difficulty establishing IV lines is not a hypothetical problem in executions,” she said. “It’s a known complication that has caused prolonged and botched executions across this country for years. That is precisely why competence, training, and clear procedures matter so much. The complaint specifically warned that the 2025 protocol failed to ensure the execution participants were sufficiently trained, qualified, and prepared to establish IV access safely and reliably.”
The old protocol required three EMTs, plus three correctional officers with IV training from the Tennessee Correction Academy. Now, it requires “at least” two members who are doctors, physicians assistants, nurses, EMTs, paramedics, or military corpsmen with relevant training. It says they have to be licensed “and/or qualified,” but doesn’t define what counts as qualified. Under the old protocol, the IV team held monthly practices. Under the new one, they don’t.
“Repeatedly, throughout the litigation, TDOC has been dismissive of our concerns as speculative,” she said. “But there’s nothing speculative about what happened to Tony Carruthers.”
Calls for a moratorium before Pike’s execution
After Carruthers’ failed execution, several groups who are not involved in death penalty proceedings called on Lee to suspend executions and investigate TDOC.
Republican lawmakers wrote a letter in June. They said the families of Carruthers’ victims had been waiting decades for his death sentence to be carried out.
“They, and the people of this state, are entitled to a Department of Correction capable of executing a lawful sentence competently and according to its own written protocol. On May 21, the Department was not… Repeated failures of this kind do not advance justice; they obstruct it, prolong the suffering of victims’ families, and hand the opponents of capital punishment their most effective argument against a penalty Tennesseans have chosen to keep.”
They wanted Lee to commission an independent investigation then, and to delay all future executions until problems were identified and addressed.
A group of more than 40 doctors and nurses from across Tennessee also called for an investigation and moratorium. And, they wanted Lee to overhaul the state’s execution methods completely. They want Tennessee to stop using the lethal injection because it emulates medicine. They instead want the state to find a method that involves no one in the health care field. That’s because codes of ethics bar doctors and other practitioners from participating in executions.
“This means that the health care professionals who agree to take part in Tennessee’s executions are those willing to set aside their professional ethics,” the letter to Lee reads. “The problems that we have seen, such as in Mr. Carruthers’s case, are the predictable result of working with such unscrupulous actors.”
They argue that as long as the lethal injection is used, flawed executions are always a risk.
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