Tennessee Botched Execution Fuels Medical Ethics Revolt

In May, a team of health care workers at Tennessee’s Riverbend Maximum Security Institution spent roughly an hour trying and failing to establish IV access in death-row inmate Tony Carruthers before a doctor attempted a deeper central line — also unsuccessfully — prompting the governor to halt the lethal injection. Now, as the state moved to execute its first woman in at least two centuries, dozens of the state’s doctors and nurses are demanding that medical professionals be removed from capital punishment altogether, arguing the practice violates medical ethics.

According to NPR, the failed May 21 attempt and the state’s insistence on continuing executions have ignited a widening confrontation between the medical community and Gov. Bill Lee’s administration — one that came into sharp focus again on Sept. 30, when a federal appeals court halted the scheduled execution of Christa Pike about an hour before it was set to begin.

What Went Wrong in May

Maria DeLiberato, Carruthers’ attorney, was in the execution chamber. She said workers stuck his arms and feet with needles to no avail, blood oozed from the puncture wounds, and Carruthers groaned and moaned in pain throughout, according to The Guardian.

After the peripheral IV attempts failed, physician Mark Fowler — a contractor for the state prison system — tried to place a central line, a quasi-surgical procedure in which a plastic tube is threaded into a deep vein in the chest, groin, or neck. Following protocol, he used a series of syringes, attempting to insert the line under Carruthers’ collarbone and then through his shoulder. That failed too.

After more than an hour, Lee called the warden, ordered the attempt halted, and granted Carruthers a one-year reprieve. In an October 2025 deposition, Fowler said he had not performed a central line placement in the 12 years since he stopped working in an emergency room and did not know it could be among his execution duties. Fowler told NPR by phone on Sept. 24 that “the doctor does not participate in the execution. The only thing the doctor does is declare the person dead.”

Carruthers’ family says the botched attempt left him partially paralyzed. They filed a complaint alleging the doctor attempted a central IV line despite being told that “jugular access” was not advisable.

Doctors and Nurses Push Back

Two months later, more than 40 doctors and nurses sent a letter to the governor calling on him to pause executions and redesign the state’s protocol to omit health workers. According to WSMV, the letter states that Tennessee’s rules requiring the participation of pharmacists, physicians, and other health care workers “are at odds with medical ethics, as well as guidelines explicitly laid out by groups such as the American Medical Association.”

“This 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 letter reads. “Although as a group we take no position on capital punishment, each of us was horrified by the torturous treatment of Mr. Carruthers.”

The letter asserts that “the health care professionals who agree to take part in Tennessee’s executions are those willing to set aside their professional ethics,” adding that the problems seen in Carruthers’ case “are the predictable result of working with such unscrupulous actors.” The AMA code holds that doctors should preserve life when there is hope of doing so and bars participation in executions.

Dr. John Greer, a retired Nashville hematologist, said at a news conference that he was not surprised the central line placement went awry. “Placing a central line is not just sticking a needle in a person’s arm,” he said, noting that an error could cause a collapsed lung or heavy bleeding, and that only those with specific training and routine practice should attempt it.

“To do this well, you’d need somebody who’s well-trained and perhaps in the medical profession, but we forbid that from occurring,” Greer said. “So there’s a paradox.”

Dr. Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado’s medical school, told NPR that a broad U.S. consensus holds that the medical establishment does not participate in executions, forged in the aftermath of World War II and the history of medical abuses by government doctors, from forced sterilizations to the Nazi regime’s crimes. He noted that nations where medical professionals still participate in executions are “Iran and Saudi Arabia and Russia, sort of authoritarian states, where medicine is an arm of the government.”

Some Republican state senators also called for a hold on executions and an overhaul of the process, saying that “incompetent administration” of capital punishment gives its critics more ammunition. Still, Lee resisted a pause. “The Department of Correction did exactly what they should,” he said this summer. “It should not affect executions in the future.”

Compounding the dispute, Tennessee’s protocol orders the prison to keep a curtain over the media witnesses’ viewing window until the IVs are established, so none could offer a visual account of the failed attempt. A lawsuit challenging that policy has been filed by the Reporters Committee for Freedom of the Press and news outlets, including NPR member station WPLN.

The Pike Execution, Halted at the Last Minute

As the ethics debate unfolded, Tennessee was preparing to execute Christa Pike, 50, the only woman on the state’s death row. She and her boyfriend were convicted of the 1995 stabbing and beating death of 19-year-old Colleen Slemmer, a fellow Knoxville job-training classmate; Pike was 18 at the time. Her execution would have been the state’s first of a woman in at least 200 years.

Pike’s attorneys argued this year that the lethal injection protocol would violate her rights. They contended that because she suffers from a platelet disorder, she would likely need a central line placed, and that she was at risk of needless suffering because Fowler — who confirmed publicly he would oversee her execution — was incompetent at placing central lines.

The Tennessee Supreme Court appointed senior judge Mark Ward as a special investigator; he held hearings in Knoxville, concluded no rights violation, and submitted a report. On Sept. 23, the state Supreme Court denied Pike’s stay, agreeing with Ward. On Sept. 28, Lee denied clemency. On Sept. 29, the U.S. Supreme Court denied a stay request.

Then, on the morning of Sept. 30, the U.S. Court of Appeals for the Sixth Circuit halted the execution “until further order of this court,” to review whether her childhood sexual abuse and rape allegations were fully considered at sentencing. Witnesses had already gathered at Riverbend. In a 2-1 majority, the court said “the interests of justice and the finality of Pike’s impending execution compel the entry of a short stay.”

Pike’s attorney, Stephen Ferrell, said the court had acted “recognizing the serious concerns about Christa’s scheduled execution.” The state filed an appeal with the U.S. Supreme Court, with Attorney General Jonathan Skrmetti’s office saying it would “continue to advocate for the lawfully imposed sentence.”

Slemmer’s mother, May Martinez, had wanted the execution to proceed. “Every time I think about it, I think about Colleen feeling that pain and trying to get up and run,” Martinez told the Associated Press.

A National Question Resurfaces

Tennessee is among 27 states where the death penalty is legal, according to the Death Penalty Information Center, though governors in four of those states have halted executions. Since the start of 2020, 170 people have been executed in 17 states, and six states have had botched lethal injections in that period by DPIC’s definition.

Tennessee’s recent history is particularly troubled. Executions accelerated in 2025 after a three-year pause triggered by the discovery that the state was not properly testing lethal injection drugs for purity and potency. In 2022, inmate Oscar Smith came within minutes of execution before Lee issued a reprieve over untested drugs; a new protocol arrived in 2024.

With Lee in his final term, ending in January 2027, the question of who — if anyone — should be present at an execution in a medical capacity now rests with a state that has failed to answer it even as courts, doctors, and the governor’s own party press for change. What to watch: whether the Sixth Circuit’s review extends Pike’s reprieve, whether the state replaces Fowler before its next scheduled execution, and whether Lee’s administration makes any protocol changes before he leaves office.