Why botched lethal injections are becoming more common
CNN
By Meg Tirrell, CNN
(CNN) — The failed execution of Christa Pike Wednesday night in Tennessee wasn’t the first time a lethal injection didn’t go as planned.
It wasn’t even the first time this year in the state of Tennessee.
“The incidence of people surviving executions has certainly increased as states have encountered more difficulties with lethal injection,” said Austin Sarat, a professor of jurisprudence and political science at Amherst College who’s written several books about capital punishment.
Over the past decade and a half, pharmaceutical companies have restricted their products from being used in executions, and for even longer, major medical groups, including the American Medical Association and American Nurses Association, have opposed or prohibited their members from participating.
The result is a “Frankenstein version of the medical model,” said Corinna Barrett Lain, a professor at the University of Richmond School of Law and author of the 2025 book, “Secrets of the Killing State: the Untold Story of Lethal Injection.”
It’s “a highly delicate, error-prone procedure that is done by people who are not trained,” Lain told CNN, using “drugs that are bought on the black market, under the table. It’s a recipe for disaster from the start.”
Executions using lethal injection were botched about 7% of the time between 1890 and 2010, according to Sarat, whose data was published by the Death Penalty Information Center. A botched execution means it didn’t proceed as designed, resulting in delays, unnecessary pain and sometimes gruesome outcomes. That compares with a rate of 3.2% for all execution methods combined.
Since 2010, the botch rate for lethal injections has been ticking higher, Sarat said, closer to 8%, including “a spate of people who,” like Pike, “survived lethal injections.”
Pharmaceuticals blocked
Sarat attributes that uptick to “difficulties with drug suppliers.”
Lethal injection was developed in 1977 in Oklahoma as officials sought less brutal-seeming alternatives to hanging, firing squads, gas chambers and the electric chair. It was first used five years later in Texas. The protocol involved an administration of an anesthetic, sodium thiopental, followed by pancuronium bromide, a paralytic agent, and finally by potassium chloride to stop the heart, all in much higher doses than they’re typically used.
Pharmaceutical companies, which sell these drugs for medical purposes, came under pressure in 2010 from a human rights group in the UK, called Reprieve, which led a campaign to stop European companies from exporting drugs to the US for use in capital punishment.
Though some initially balked, saying they couldn’t control distribution of their products once sold to US suppliers, and that the drugs had important medical uses, they ultimately put restrictions in place. The UK and Europe also implemented export controls and American drug companies ultimately followed suit.
“Drug companies began to say, ‘We don’t want this negative publicity,’” Sarat said.
That led to shortages of the products used for lethal injection, leading states to seek supply elsewhere, including compounding pharmacies, Lain said. Compounders typically make drugs that need to be customized for patients, such as when they might have an allergy to an ingredient in the version made by the manufacturer. They aren’t regulated by the US Food and Drug Administration in the same way as traditional pharmaceutical companies.
In 2015, as states were increasingly looking to compounding pharmacies, the Alliance for Pharmacy Compounding said it discouraged compounding of lethal injection drugs – though the group said it recognized “an individual practitioner’s right to determine whether to dispense a medication based upon his or her personal, ethical and religious beliefs.”
The group didn’t say it based its position on a moral stance, but instead on the belief that there should be a “national discussion … on whether a pharmaceutical manufacturer can restrict the use of FDA-approved products only to purposes that adhere to their corporate values.”
Lain said some compounding pharmacies that agreed to supply executioners have been found to have “horrible, just horrible histories,” and noted that as a result, drugs supplied for lethal injection may have the wrong potency, or could have been stored improperly, affecting their performance as well.
Medical group opposition
Even before the first lethal injection was carried out, the American Medical Association said physicians shouldn’t participate, and that ban stands in the group’s Code of Medical Ethics.
“An individual’s opinion on capital punishment is the personal moral decision of the individual,” the code reads. “However, as a member of a profession dedicated to preserving life when there is hope of doing so, a physician must not participate in a legally authorized execution.”
The American Nurses Association said it has also held since the early 1980s that “nurses should not assume any role in the capital punishment of an incarcerated individual,” and in 2016 extended its position to oppose capital punishment broadly. The National Association of Emergency Medical Technicians said in 2010 it had “strong opposition to participation by EMTs, paramedics or other emergency medical practitioners.”
Who actually administers lethal injection drugs is often shrouded in secrecy, like many aspects of the process, Lain said. There may be what she called a “quote medical team” tasked with inserting IVs, but “then you have the other team, the team that pushes the syringes.”
In many places, that may be non-medical prison guards, Lain said, who push down syringes to administer the drugs from “an ante chamber through seven feet of tubing.”
Among the most common reasons cited for botched lethal injections, according to data provided by the Death Penalty Information Center, is an inability to insert the IV.
That’s what happened in May in Tennessee’s previous failed execution. Tony Carruthers’ execution was halted after officials struggled for more than an hour to find a vein. The governor granted Carruthers a one-year stay.
A push for alternatives
The original 1977 lethal injection protocol has changed amid issues with drug supply and botched executions. Pike, 50, who was sentenced to death for a 1995 murder, was administered two doses of just one drug, pentobarbital, a sedative. She was in critical condition and receiving life-saving medical care, her legal team said Thursday afternoon.
It’s not yet clear why the execution failed. Lain said it could have been an error administering the drug, so that it went to tissue instead of the vein; lack of potency; or just that “people react to drugs differently,” and this was just one drug rather than three.
Amid issues with lethal injection, states have been turning to alternative methods, and the US Department of Justice in April said it would expand manners of execution to include death by firing squad. Alabama started using nitrogen hypoxia, a method of asphyxiation, in 2024.
“The United States has been on a quest since the end of the nineteenth century to find a method of execution that would be safe, reliable and humane,” said Sarat. “There is no such method.”
“When we say we’re not going to punish people cruelly, that is not just about them and their suffering,” Sarat added; “that’s about us and who we want to be.”
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