Dr Mark Fowler, a physician with 25 years' experience, was called into the death chamber at Riverbend maximum security prison in Nashville, Tennessee, to help establish an IV line for the lethal injection of Tony Carruthers, a 57-year-old death row prisoner. The team had struggled to find a vein, so Fowler was summoned to set a central line. Before cutting Carruthers with a scalpel, he asked the IV team if "the patient" was allergic—a strange term for a man strapped to a gurney, condemned for a triple murder in 1994, a crime he has always maintained he did not commit, and for which there was no forensic evidence.
Standing nearby was Carruthers' lawyer, Maria DeLiberato, a senior counsel at the ACLU's capital punishment project. She heard Fowler's description and recoiled. "He called Tony 'the patient'," she said. "And he was trying to kill him."
Who is Mark Fowler?
Fowler, 68, is a rare breed: a doctor whose identity in executions has become public, unlike most execution physicians shielded by secrecy laws. He was identified after a warden inadvertently revealed his name during the announcement of another prisoner's execution by lethal injection last August. The disclosure led to Fowler being subpoenaed by lawyers challenging Tennessee's lethal injection protocol. In a deposition, he scolded his inquisitors, saying he hoped his name would not appear in the Nashville Banner or the Guardian.
When contacted by the Guardian, Fowler declined to answer detailed questions, calling it "a private situation" and dismissing the lawyers' claims as "nonsense." However, his situation has become public, sparking debate about the death penalty and Tennessee's record.
The failed execution
The botched procedure made Carruthers one of the few people to survive an execution attempt. Fowler was unable to secure the central line, and after 75 minutes of repeated needle insertions in Carruthers' arms, feet, and shoulder, the execution was called off. Next Thursday, Tennessee is scheduled to execute Darrell Hines, 65, who is partially paralyzed from multiple strokes. Hines's lawyers have argued that if Fowler participates again, the same botched procedure could be repeated, posing "an intolerable risk that [Hines] will experience severe suffering due to the … use of insufficiently qualified medical personnel." The Tennessee supreme court denied a motion to disclose whether Fowler will be on duty.
Ethical conundrum
Fowler's unmasking has laid bare the ethical conundrum at the heart of lethal injections. The protocol, billed as humane, has required doctors to participate, despite the Hippocratic Oath's edict to "do no harm" and its lesser-known line: "To please no one will I prescribe a deadly drug, nor give advice which may cause his death." In 1980, the American Medical Association issued a clear prohibition: "A physician must not participate in a legally authorized execution." This has limited the pool of physicians to a "rump" of "dissenters," as chronicled by Corinna Lain in Secrets of the Killing State.
Fowler's path to the death chamber is unusual. He studied public administration, worked as a public defender for three years, then retrained as a doctor in 1994. He has worked as an ER physician and family doctor, and now holds multiple medical directorships. His employment at Centurion, a prison healthcare provider, ended after he made provocative comments about a transgender prisoner. He writes opinion columns for a local newspaper, reflecting a staunchly rightwing worldview, and has written about his past death penalty cases.
Motives and qualifications
Fowler said he was recruited by a friend, the previous death penalty physician, in 2018. He is paid $3,000 per execution, less than in other states. In an interview, he said, "Every attempt was made to minimize the defendant's discomfort. No one wants Carruthers to suffer." But Carruthers' lawyers witnessed something alarming. DeLiberato described Fowler as assertive, taking charge and jabbing Carruthers in the foot before attempting the central line—a procedure he had not performed in 13 years, as revealed in his deposition. When DeLiberato objected that he was unqualified, Fowler snapped, "Yes, I am qualified," and the warden ordered him to proceed. Carruthers moaned in agony as blood seeped from the puncture, and Fowler remained dispassionate. After 16 minutes, he conceded defeat, and the execution was called off.
DeLiberato later visited Carruthers, who was "sweaty, pale, tearful, and he seemed to be in shock and pain. He could barely stand or walk." He told her Fowler "was hurting me, and knew he was hurting me." The Guardian sent Fowler a message detailing this, but he did not reply.
Aftermath and concerns
Carruthers' sister has filed a complaint against Fowler with state health authorities, alleging medical ethics violations. Kit Thomas, deputy chief of Nashville's capital habeas unit, said the case gives "a peek behind the curtain," showing the department of corrections drawing on "unqualified physicians" willing to kill "for $3,000 a pop." DeLiberato remains disturbed, saying, "They want to make this a medical procedure, but it's not. It's premeditated murder. There's really no way to kill a person humanely, with or without a doctor. What I witnessed was torture."
