Tennessee officials carried out a lethal injection execution on the evening of 30/9 for Christa Pike, 50, the first woman to be executed in the state in over two centuries. However, after about 90 minutes of what was described as "torture" with two lethal doses of pentobarbital, Pike was still breathing and was rushed for emergency medical treatment.

The incident raises questions about how the drug was administered, the ability to detect complications, and the execution team's capacity to respond.

"The problem with lethal injection is that the most qualified people to perform it cannot participate due to ethical rules", Jonathan Groner, an expert on the medical aspects of capital punishment, told Newsweek.

Death row inmate Christa Pike. Photo: Tennessee Department of Correction

One theory Groner proposed is that the drug may not have entered Pike's bloodstream as intended. He suspected an issue with the intravenous line, causing the pentobarbital to leak into surrounding tissues instead of being delivered directly into the circulatory system. This phenomenon is known as extravasation.

"The parties involved seemed to know that finding a vein for drug delivery was difficult, yet they assigned this task to someone not adequately qualified", Groner stated.

If the drug was injected subcutaneously rather than directly into a vein, it would only be absorbed slowly through the tissues, similar to using a sustained-release drug formulation.

"Essentially, she received a slow, continuous infusion of the drug", explained the former trauma physician at Nationwide Children's Hospital in Columbus, Ohio.

Pike's arm injuries lend credence to this theory. Following the botched execution, Pike's lawyers described her two arms as severely burned, blistered, and swollen "like an inflated surgical glove".

Jonathan Groner, professor emeritus of surgery at the College of Medicine, Ohio State University. Photo: Nationwide Children's Hospital

The expert also addressed the ability to detect complications during the procedure. In an operating room, an anesthesiologist is typically close to the patient, able to observe the injection site and feel resistance when pumping drugs through an intravenous line. An experienced person can recognize signs that the drug is not entering the vein.

In an execution protocol, the person administering the drug might be separated from the inmate by a screen or be in a different room, using a system of tubes connected to the injection site. This setup can limit direct observation and the ability to detect unusual signs.

"This is a skill acquired through practice. Those who do it well are those who do it frequently", Groner noted.

This leads to what Groner described as the "Hippocratic paradox", where a procedure requires medical expertise, but those trained to perform it and manage complications are prevented from participating by professional ethics.

The American Medical Association prohibits doctors from participating in executions according to its Code of Medical Ethics. However, this is a professional ethical rule, not a federal legal ban.

Inside the execution chamber at Riverbend Prison in Nashville, Tennessee. Photo: Tennessean

According to the Death Penalty Information Center, an organization that publishes data and analysis on capital punishment in the US, Pike is the first inmate to survive after receiving lethal doses of drugs used in executions. The exact cause of the execution's failure remains inconclusive.

It is currently unclear what will happen to Pike next. Pike was sentenced to death for her involvement in the torture and murder of Colleen Slemmer, 19, a fellow student at a Job Corps program in Knoxville, Tennessee, in 1995.

Pike's lawyers argued on 7/10 that the death row inmate had suffered enough and requested Tennessee Governor Bill Lee to commute her death sentence to life imprisonment without parole. Meanwhile, supporters of capital punishment in Tennessee are advocating for the use of an alternative method for Pike, such as the electric chair.