Christa Pike is conscious and speaking after surviving two doses of the lethal injection, in what her legal team has called a "medically unprecedented" recovery. The 50-year-old was set to be executed on September 30 at Riverbend Maximum Security Institution in Nashville, Tennessee, using pentobarbital, but remained alive and snoring after the procedure.
Legal warnings before the execution
More than a month before the execution, Pike's lawyers spent three days arguing with the Tennessee Supreme Court that the drug would not work and would cause extreme pain and suffering. Pike had been sentenced to death for the 1995 murder of Colleen Slemmer, 19. Her legal team argued that, having suffered numerous sexual attacks as a child, Pike would be retraumatised by being restrained and touched by male officers. She had even begged to be hanged or killed by an all-female firing squad, but the state refused both requests.
Before the execution, lawyers argued that Pike had small, difficult-to-access veins and suffered from thrombocytosis, a blood disorder involving an abnormally high number of platelets which can increase the risk of blood clots. Defence medical expert Dr Joel Zivot told the hearing that Pike could potentially feel as though she was "burning alive" if problems occurred. However, the state disputed the claims. Hematologist Dr Richard Mansour told the court that Pike's recent medical records showed her veins were accessible and that medical staff had successfully completed almost all of her recent blood draws with a single needle stick. The judge rejected most of Pike's claims, concluding that the evidence did not establish a substantial risk of severe pain.
What happened during the execution
On September 30, the execution team reportedly went through at least seven needles in attempts to establish suitable intravenous access. One needle is said to have been bent at a 90-degree angle when it was removed. Randy Spivey, one of Pike's lawyers, said she even tried to help execution staff find a suitable place for the IV lines. "She over and over again said, 'Please, try up on my shoulder higher, please try here, please try here,'" he said. According to Spivey, Pike eventually thanked staff when they believed the two IV lines had been successfully established.
But the lawyers later alleged that the lines were not correctly placed, or that the veins had blown, allowing some or all of the pentobarbital to enter Pike's tissue rather than her bloodstream. Witnesses heard Pike complain about a burning sensation in her arm. At one point, she reportedly said: "My arm feels like it's about to burst open" and asked if what was happening was 'normal'.
Medical explanations and aftermath
The medical term for this is IV infiltration. If an IV catheter is not properly positioned inside a vein, medication can instead enter the surrounding tissue. In Pike's case, experts said that could have meant the pentobarbital failed to reach the concentration in her bloodstream needed to cause death. Dr Mark Heath, an assistant professor of anesthesiology at Columbia University Irving Medical Center, said the pain Pike described during the execution should have been a warning sign that the IV was infiltrating.
Pike's lawyers later said she was left with blistering and burning around the sites where the IV lines were inserted. The Tennessee Department of Correction has maintained that it followed the state's established execution protocol. Dr Zivot said an infiltration could potentially explain what witnesses saw, noting that Pike's small veins may have made her particularly susceptible to the problem. "Her venous system was small, and there could be some fragility there," he told The Telegraph. He explained that pushing a large quantity of a caustic substance into a small or fragile vein could cause the vein to rupture, allowing the drug to enter the surrounding tissue.
Tennessee's execution protocol provides for a secondary set of syringes if an inmate has not died after the first set of drugs. But even after the second dose, Pike survived. By then, the execution had lasted more than two hours. Members of the media reported hearing Pike crying, whimpering and breathing loudly. She was eventually taken to hospital unconscious, with swollen and blistered arms around the IV sites, and was intubated and placed on a ventilator.
Dr Zivot said there could also have been an issue with the pentobarbital itself, including the possibility that the drug had degraded, expired or was improperly constituted. Medical experts have warned that if the drug lowered her oxygen levels or weakened her circulation for a prolonged period, she could have suffered permanent brain damage. Her lawyer Stephen Ferrell has said that Pike may not fully recover and that her long-term prognosis remains unknown.
