The road to Christa Pike’s botched execution was paved with determination.
Dating back more than 20 years, government officials in Tennessee have been dogged in their efforts to carry out lethal injections despite serious concerns about their ability to do so and waning public support
. Those concerns turned into red flags in the months leading up to Pike’s execution date, death penalty observers say.Most notably: The state botched another execution in May, and Pike's attorneys repeatedly warned Tennessee officials that her medical conditions would make lethally injecting her particularly difficult. Nearly 10 months before the Pike's botched execution, they warned that personnel would have a hard time gaining access to her veins and properly
delivering a fatal dose of pentobarbital.
The result, they said in January, was that Pike, 50, would "experience unnecessary and superadded pain and suffering, terror, and disgrace."
That's exactly what her attorneys say happened in the death chamber in Nashville on Sept. 30 after Tennessee repeatedly dismissed concerns from her attorneys, medical professionals and death penalty observers.
"What happened to Christa is exactly what the state was warned would happen, and there are so many questions that need to be answered − not by Christa, but by the state of Tennessee," attorney Randy Spivey told reporters a week after the botch on Oct. 7. "She deserves answers about what was done to her, and the people of Tennessee deserve those answers, too."
Robin Maher, director of the nonprofit Death Penalty Information Center, told USA TODAY that Tennessee officials "were on notice that there was something very wrong."
"When I looked at what the lawyers had warned officials about, they seemed remarkably prescient about what could go wrong," Maher said. "All of the things things they predicted happened. It is bewildering why Tennessee officials continued to ignore the warnings."
Tennessee Gov. Bill Lee has ordered an investigation into what went wrong, called off the state's only remaining execution this year and announced the upcoming resignation of Department of Correction Commissioner Frank Strada. Lee has not responded to calls from attorneys and death penalty observers to commute Pike's sentence to life in prison, leaving the possibility of a second execution attempt on the table.
While speaking with reporters on Oct. 1, Lee called what happened to Pike a deeply disturbing "tragedy" that should never have happened. He also reiterated his commitment to the death penalty.
"My responsibility is to uphold the sentences that Tennessee juries have handed down, even when it's difficult, and that is exactly what we intend to do in the days ahead," Lee said. "The people of Tennessee have determined that the death penalty is the appropriate penalty for the most heinous crimes in the state. The people of Tennessee make that decision, and my job is to make sure then that those sentences are carried out."
As Pike makes a "medically unprecedented" recovery, USA TODAY is looking at how the state dismissed the many concerns leading up to what was supposed to be her execution day.
Christa Pike's attorneys predicted 'suffering, terror, disgrace'
For many months, defense attorneys warned state and federal officials that executioners would have a hard time putting Pike to death using lethal injection because of her unusually small veins and a blood condition known as thrombocytosis.
"Pike has a history of difficulty with blood draws and needle insertion," they wrote a lawsuit filed in Tennessee court in January. "Prison medical staff often use a butterfly needle on her arm to draw blood because her veins are so difficult to access."
As a result, they said it would be "significantly difficult" for them to establish an IV line and therefore deliver pentobarbital to her veins. They also predicted the possibility that the execution would fail altogether and sought to require Tennessee to have medical personnel on hand to treat Pike.
"Attempting to execute Ms. Pike without a procedure or mechanism to provide medical care or resuscitation makes it sure or very likely that her execution will result in unnecessary and superadded pain and suffering, terror, and disgrace or lingering death," they wrote to the Tennessee Supreme Court in early September.
Pike's attorneys also brought the matter up at a three-day hearing in August before Senior Judge Mark Ward, a special master appointed by the Tennessee Supreme Court. The hearing included testimony from anesthesiology expert Dr. Joel Zivot, who said Pike's conditions would make it feel as though she were "burning alive" during the execution.
At every step, state officials and the judiciary dismissed those concerns, arguing in the Tennessee Supreme Court that her "alleged medical conditions do not warrant a stay."
At the hearing before the special master, state's attorney Will Ayers said that the evidence didn't show that Pike's veins or her blood disorder would create a substantial risk of severe pain during the execution.
Besides, he said: "The standard is not a painless execution."
Courts also denied Pike's request that the state execute her using a different method: either a central line in the jugular vein of her neck, rather than her arm, or hanging.
"Hanging is an unpredictable way of causing death," Ayers said. "It's not easy to do right. There is no evidence that Tennessee has the materials or expertise to carry out a hanging."
Ward concluded that the state could proceed with Pike's lethal injection, and the Tennessee Supreme Court agreed.
Tennessee botched execution 4 months before Christa Pike
Four months before Tennessee failed to execute Pike, they botched another lethal injection, that of Tony Carruthers, who was convicted of a 1994 triple murder.
In May, executioners failed to establish a second IV line required under the state's execution protocol. The doctor carrying out the lethal injection unsuccessfully tried to place a central line.
After Carruthers spent more than an hour strapped down waiting to die, the state abandoned the execution and the governor granted him a rare one-year reprieve. In a lawsuit filed in July, his family said that they believe Carruthers suffered a brain stroke and that the entire right side of his body was left paralyzed.
After Carruthers' botched execution, a group of nine Republican lawmakers wrote a letter to Lee calling for an independent review to correct "every deficiency," and dozens of medical professionals urged the governor to halt all executions until the Tennessee Department of Correction could show improved planning and training.
“The horrifyingly botched attempt to execute Tony Carruthers on May 21 confirmed that TDOC is not presently able to conduct an execution that complies with the law, its own protocol, or basic human decency," the doctors wrote in a letter to Lee in July, three months before Pike's scheduled execution.
The doctors and nurses made clear that they didn't take a position on capital punishment but said they were "horrified by the torturous treatment of Mr. Carruthers."
"Reports of the prolonged, bungled attempts to establish venous access by a doctor who lacked the training or skill to perform this task confirmed our fears about Tennessee’s persistently problematic executions," they wrote.
Dr. Mark Fowler, the doctor who failed to carry out Carruthers' execution, is the same doctor who oversaw Pike's execution and carried out a successful execution in Tennessee in August, according to reporting by NBC News and WSMV-TV.
“I am qualified,” Fowler said during a tense exchange with Carruthers' attorney inside the death chamber, according to the Nashville Banner. USA TODAY has been unable to find contact information for Fowler.
Following the botched execution, Lee's office ignored USA TODAY's request for comment about whether the state was doing anything to avoid another failed execution. The Tennessee Department of Corrections also did not respond to USA TODAY's questions about whether it would continue to use Fowler in future executions and if so, why.
Fowler had not placed a central line in at least 13 years, according to his deposition in litigation over Tennessee's execution procedures. Fowler testified that he had placed about a dozen central lines during his career and had no current hospital privileges.
In their letter to Lee, the Republican lawmakers maintained their support of the death penalty but noted that they "cannot accept its incompetent administration."
“Repeated failures of this kind do not advance justice," they wrote. "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.”
This year's botches follow previous difficulties
Tennessee had problems carrying out the death penalty in the two decades leading up to the recent botched executions.
In 2007, then-Democratic Gov. Phil Bredesen ordered a 90-day moratorium on executions just as four inmates' death dates were approaching. The governor cited multiple problems with the state's lethal injection guidelines, according to archived news reports in the Tennessean, part of the USA TODAY Network.
"The serious problems plaguing Tennessee's death penalty system can be addressed only by means of systemic, institutional changes," the American Bar Association wrote in a report at the time.
The moratorium expired on May 2, 2007, and the state carried out a lethal injection five days later. Four months after that, the state used an electric chair for the first time in nearly 50 years to execute an inmate. The inmate, Daryl Keith Holton, chose the chair over lethal injection, saying he believed it would be the quickest death, the Tennessean reported.
The ensuing years saw more challenges to the state's lethal injection protocols, further canceled executions and difficulties obtaining the lethal drugs needed when companies began refusing to provide them. The state didn't carry out any executions between 2010 and 2017.
Between 2018 and 2020, Tennessee executed five inmates by electrocution and two by lethal injection.
Then in 2022 during his third year in office, Gov. Bill Lee abruptly halted the execution of Oscar Smith and ordered a pause to all executions, announcing that the state had for years failed to ensure that its lethal injection drugs were being properly tested. He appointed former U.S. Attorney Ed Stanton to investigate what led to the failure.
The state resumed executions in 2025 after announcing it had come up with a new lethal injection protocol with just one drug: pentobarbital. The new 44-page protocol was less than half as long as the previous 99-page protocol and has just one page outlining details for pentobarbital, the Tennessean reported.
Since then, the state has carried out four successful executions and two botched ones.
Attorneys expressed concerns about new execution protocol
Attorneys expressed concerns about Tennessee's new slimmed-down execution protocol more than a year before both Carruthers' and Pike's botched executions.
“We have genuine and well-founded concerns that the new protocol − which contains even fewer safeguards than the last − will cause our clients to experience the terror, pain, and suffering that comes from the act of poisoning called for in the protocol,” attorney Amy Harwell said in a letter to Lee in April 2025.
Harwell and other attorneys representing nine death row inmates sued the state, challenging the new protocol over what they said was a high risk of torturous death.
In Pike's lawsuit against the state nine months before her execution, her attorneys argued that the new protocol was plagued with "secrecy, intentional omission, inattention to details, and untrained and unlicensed prison personnel attempting to fill a medical role."
State authorities have previously argued that the execution method is constitutional and effective.
Department of Correction Commissioner Frank Strada, who began developing the new protocol after he was appointed in 2023, said in a December 2024 press release that he was "confident the lethal injection process can proceed in compliance with departmental policy and state laws."
Strada is resigning this month in the wake of the botched executions. Lee hired Strada from the Department of Corrections in Arizona, where he faced scrutiny after that state had trouble carrying out the lethal injections of three inmates in 2022.
As the Arizona execution team repeatedly failed to insert IVs into the arms of one of those inmates, Murray Hooper, he turned and told the witnesses to his execution: "Can you believe this?"
Expert on lethal injection landscape: 'A recipe for disaster'
Pike’s case “feels like déjà vu” to Columbia Law School’s Bernard Harcourt, who represented an Alabama inmate who survived a botched execution in 2018. Harcourt said he warned Alabama officials for months that they would likely not be able to establish an IV line for his client, Doyle Lee Hamm.
He said the state dismissed his warnings and that Hamm’s execution turned into an hours-long “horror story.”
“They tried his shins, his ankles, his feet, and then they finally moved to his groin and were poking and prodding him without any kind of anesthetic,” said Harcourt, whose book about the ordeal, "A Time to Live," is coming in February. “They probably hit his bladder and possibly an artery because there was so much blood.”
Harcourt sued on Hamm's behalf, and the state reached a confidential settlement agreement stating that Alabama would not try again to execute Hamm, who died of cancer on death row in 2021, according to the Death Penalty Information Center.
Following a separate court battle in which three news media outlets − including the USA TODAY Network's Montgomery Advertiser − successfully sued Alabama for access to the state's execution protocol, federal Judge Karon Owen Bowdre wrote of the importance of transparency, something Tennessee has been accused of lacking.
“The public,” Bowdre wrote, “needs to know how the State administers its laws; without such knowledge, the public cannot form an educated opinion on this very important topic.”
Harcourt said that a lot of members of the public don’t realize that executing someone by lethal injection isn’t all that simple.
“When you’ve got very qualified doctors or anesthesiologists in a hospital setting under perfect conditions, it’s relatively easy to place a line on somebody,” he said. “The problem is these executions are usually taking place late at night under very stressful and bizarre conditions … and the people who are doing it are just not very qualified.”
In Pike’s case, the state was attempting to carry out the execution almost 10 hours after it was initially scheduled because of a last-minute stay of execution that was later overturned. The state had until midnight to execute Pike or the process to re-schedule her death would have had to start anew. Plus, the doctor carrying it out had already botched another execution four months beforehand.
"It's just a recipe for disaster," Harcourt said. "And this is tragically not unexpected, particularly when you have states who simply disregard the warning signs and believe that everyone is just faking or trying to avoid justice. You just get these travesties of injustice for everyone."
Contributing: Keith Sharon, Evan Mealins, Kelly Puente, Nashville Tennessean
Amanda Lee Myers is a senior crime and courts reporter who covers the death penalty, cold cases and breaking news for USA TODAY. Follow her on X at @amandaleeusat.
This article originally appeared on USA TODAY: Tennessee ignored serious red flags before Christa Pike. What were they?
