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Dr. Winawer breaks down botched Tennessee execution
The lethal injection line infiltrated during Christa Pike's execution after seven failed IV attempts, leaving a drug reservoir in surrounding tissue.
ATLANTA - An Atlanta doctor broke down how a botched lethal injection attempt in Nashville left death row inmate Christa Pike hospitalized on a ventilator with severe arm burns.
What we know:
The powerful barbiturate pentobarbital depresses the central nervous system, rendering a person unconscious while drastically depressing respiration and causing cardiovascular collapse, according to Dr. Neil Winawer, a faculty member at the Emory University School of Medicine.
"So, if you're unconscious, you're not breathing, and you don't have blood pressure, you are not typically going to survive for more than a few minutes," Winawer said.
Winawer compared the drug to the chemical agents used in animal euthanasia.
While the exact sequence of events remains unconfirmed, Winawer noted that the IV line infiltrated, meaning the drug leaked out of the vein and formed a reservoir pooling in the surrounding tissue.
Before the two lethal doses were administered, officials performing the execution made seven attempts to establish IV access, according to The Associated Press.
Once the execution was halted, Christa Pike was hospitalized with severe burns and blisters on her arm.
Winawer explained that pentobarbital is highly alkaline, which likely caused the tissue damage.
"Overwhelmingly, based on what they described about the arm and the difficulty getting IV access, you can be certain that a large portion of the drug infiltrated — came out of the blood vessel into the surrounding skin," Winawer said.
Another contributing factor may have been the executioner's lack of medical training.
Although the identity of execution personnel is kept secret by law, Winawer noted it is highly unlikely the procedure was carried out by a critical care intensivist.
"The American Medical Association and other medical societies say it's unethical for physicians to participate in this. Doctors are supposed to preserve the sanctity of life and to relieve suffering, not intentionally try to cause death," Winawer said.
He added that while licensing boards rarely revoke credentials in such cases, few physicians are willing to assume the professional stigma.
Pike's attorneys told the AP that she remains unconscious on a ventilator at a Nashville-area hospital under guard while medical personnel work to flush the massive dose of pentobarbital from her system.
"We don't know, but if she has a brain injury, if she went for minutes without oxygen or blood pressure, and now it gets even more muddy because now you have a person who is not in a vegetative state. They're not brain-dead. So technically, the state now has to provide life-sustaining therapy until next of kin decide what to do," Winawer explained.
Pike's attorneys have not disclosed who holds her medical power of attorney, noting only that the designated individual is protecting her privacy.
Tennessee, like many death penalty states, conceals details surrounding executions, including the identities of executioners, the manufacturing and sourcing of lethal drugs, and quality-testing records.
"And then lastly, no pharmaceutical company wants their drug name associated with this, so you have to go to a compounding pharmacy that's not FDA-approved. So who knows, perhaps maybe also when they compounded the drug, it wasn't a sufficient dose or concentration," Winawer added.
The backstory:
Pike was 18 when she and her boyfriend killed 19-year-old classmate Colleen Slemmer in Knoxville in 1995.
Prosecutors said Pike believed Slemmer was a romantic rival and lured her to a secluded area, where the couple slashed her with a box cutter, beat her with asphalt, and carved a satanic symbol into her body.
The trial drew national attention, making Pike one of the youngest women sent to death row in modern U.S. history.
Execution officials delayed the procedure for more than eight hours while the U.S. Supreme Court reviewed and overturned a lower court order staying the execution.
What's next:
Gov. Bill Lee ordered an independent investigation into capital punishment procedures, appointing former U.S. Attorney Ed Stanton to lead the review.
Stanton previously investigated execution protocols after Lee called off an execution in 2022.
Correction Commissioner Frank Strada announced his resignation Saturday following the incident.
This marks the second time this year Tennessee failed to carry out an execution, following a halted procedure in May for Tony Carruthers due to IV access issues.
RELATED
- Inside the chamber: The agonizing moments of Christa Pike’s stalled execution
- Christa Pike in critical condition after failed execution attempt in Tennessee
The Source: The information in this story was gathered from medical expert Dr. Neil Winawer, as well as official announcements from Tennessee state officials. The Associated Press contributed to this report.