What's missing from the lethal injection conversation

You might have seen the news that Christa Pike, a convicted murderer in Tennessee, did not die from the injections given to her as part of her death penalty sentence last week. After her failed execution, she was hospitalized, where she continues to receive critical medical care, according to her attorneys. Her survival is singular, but her mishandled execution is not. A review of executions carried out between 1890 and 2010 indicated that three out of every hundred executions were botched – and that lethal injection executions, which began in 1982, have a more frequent incidence of complications than any other method. All of this has re-raised the question of how humane lethal injections are as a form of execution. So, today on the show, we speak to anesthesiologist Gail Van Norman https://www.uwmedicine.org/bios/gail-van-norman, a medical expert who testified about Christa’s case and many other lethal injection executions. She told us how she and other experts predicted much of how Christa's execution would unfold. Read a perspective piece https://www.npr.org/2026/10/06/nx-s1-5991669/failed-execution-christa-pike-tennessee-reporter-witness from one of the seven media witnesses to last week's failed execution. Interested in more science and criminal justice stories? Email us your question at [email protected] mailto:[email protected]. Support public media with NPR+ and enjoy perks for over 25 podcasts like this one. This show’s perks include sponsor-free listening. Learn more at plus.npr.org http://plus.npr.org/. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

• 0:00Speaker 00

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• 0:22Speaker 01

  Hey, Short Wavers. Nate here. So you might have seen the news that Krista Pike, a convicted murderer in Tennessee, did not die from injections given to her as part of a death sentence. But what you might not have known is that well before Krista Pike went into the death chamber, multiple medical experts testified before a judge about how poorly it was likely to go.

• 0:45Speaker 02

  So we predicted that she would have a protracted and painful experience just getting IVs placed. And then because of her essential thrombocytosis and the fragility of her veins, plus the large volume of drug that they inject under pressure, I predicted that pentobarbital would likely be injected around the vein and not in the vein, which would cause agonizing pain because pentobarbital is caustic. It's like Drano being injected under the skin. But it would also cause less drug to enter the bloodstream immediately, probably making the execution prolonged and more agonizing.

• 1:27Speaker 01

  This is Gail Van Norman, one of the medical experts who testified. And her testimony is basically exactly what happened.

• 1:34Speaker 02

  The only thing we did not predict is that she would actually survive all of this.

• 1:39Speaker 01

  Gail's a physician and professor emeritus of anesthesiology and pain medicine at the University of Washington. She's been giving expert testimony on lethal injections for years.

• 1:49Speaker 02

  Lethal injection executions have a frequent incidence of complications, most of which are related to IV access and IV injections of the drugs.

• 1:58Speaker 01

  For example, the person administering the lethal injection might have difficulty getting access to their veins, or have trouble injecting the drug. And this is not the first time this has happened. In 2022, 1/3 of the lethal injection executions that took place were mishandled. The Death Penalty Information Center, a nonprofit that does not take a stance on the death penalty, says three out of every 100 executions in the United States between 1890 and 2010 were botched. Of those, lethal injection executions are estimated to go wrong more frequently than any other method. And I got to be honest, as we were reporting

• 2:40Speaker 01

  out this episode, I found myself really surprised by some of this information. Because in my head, death by lethal injection seems way more humane than, say, death by hanging or electrocution or firing squad. That's why it was proposed in the first place.

• 2:56Speaker 02

  There were lots of execution methods that were quite brutal, including hanging in chains and burning alive. And people were becoming disturbed. So in order to calm public sensibilities, it became a quest to find something that would be seen as humane by the public.

• 3:13Speaker 01

  That quest was answered in 1982, when lethal injection was first used to kill Charles Brooks Jr. And now, in some states, it's the only method offered.

• 3:24Speaker 02

  And because it looks medical and it looks like it's not too brutal, it became more popular. But looks are deceiving.

• 3:33Speaker 01

  So today on the show, how humane are lethal injections as a form of execution? Why do they go wrong so often? And what does a medical expert think we should do about Krista Pike? You're listening to Short Wave, the science podcast from NPR.

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• 5:07Speaker 01

  Heads up, Short Wavers. Gail and I are going to discuss what went wrong with Krista's execution, as well as a couple of other previous lethal injection executions. Cool? All right. So, Gail, I think it might be helpful to start with the drug that was used in the Krista Pike case, pentobarbital. What is this drug exactly? And how is it supposed to work?

• 5:29Speaker 02

  It's a funny question. How's it supposed to work? Pentobarbital is a drug that affects a receptor in the brain called the GABA receptor. It's what's called the class barbiturates. And injecting this drug produces decreased responsiveness in the part of the patient. For many, many years, anesthesiologists referred to this as unconsciousness, but it turns out that you're still awake inside and aware of what's going on. Pentobarbital does not have any pain-relieving effects at all. And in fact, we don't use barbiturates much anymore in anesthesia because we simply have better drugs. But in the past, it would have been thiopental or pentathal would be used with a number of other drugs to reduce pain, produce

• 6:14Speaker 02

  amnesia, produce calmness, and to reduce movement during surgical care.

• 6:21Speaker 01

  Okay, so when it's used in a lethal injection setting, given that it's not an anesthetic, and so it doesn't relieve pain, do they give an anesthetic as well?

• 6:32Speaker 02

  No. Nothing that happens in the death chamber is even remotely similar to administering an anesthetic, even though they like to draw parallels between them. We would never use a single drug, particularly one that has no pain-relieving properties, as an anesthetic during, say, a surgical procedure. It just wouldn't be done. And I don't know of an anesthesiologist who would allow anyone to do that to them.

• 6:57Speaker 01

  Okay, but for lethal injections, it is just the one?

• 7:01Speaker 02

  In some cases, they are combined with other drugs. So, for example, it's common to give pentobarbital in combination with a drug to paralyze the prisoner so they can't move, can't show any pain that they're having, can't indicate whatever they're feeling. So prevent the disturbing sight of people gasping for air, or moaning, or crying out. And then potassium chloride to stop the heart more quickly. But in some cases, as it was in Tennessee, it's used as a sole agent, in which case the other drugs to prevent movement are not given. And potassium isn't given to stop the heart, so you simply have to wait for that to happen.

• 7:43Speaker 01

  So when Krista Pike was snoring, that wasn't an indication that she was peacefully asleep?

• 7:49Speaker 02

  No. In fact, what snoring says to me as an anesthesiologist is the person's trying to breathe and their airway is obstructed, and they're making that snoring sound.

• 7:58Speaker 01

  Yeah, I worked on an ambulance for a short while, and if a patient was snoring, it was a sign that I had done a bad job of securing their airway.

• 8:06Speaker 02

  That's right. It's a bad sign. But many, many laypeople don't realize that. They think it's, you know, it's a pleasant sign. And it definitely is not. It's a sign of suffocation, imminent suffocation that's happening.

• 8:18Speaker 01

  Is pentobarbital the only drug that is used for lethal injections in the US now?

• 8:23Speaker 02

  No, there are many drugs that have been used. Probably the most popular alternative is midazolam, which is a benzodiazepine. It's powerful at producing amnesia, which of course doesn't matter in prisoners you're going to execute because they're not going to be alive later to remember. Other kinds of drugs are being experimented with, such as hydrocodone, for example, and ketamine, which have their own set of problems that are pretty awful as well, given in high dose. But they have been given far less frequently.

• 8:57Speaker 01

  Do we know if one of these drugs are? More humane than others?

• 9:04Speaker 02

  Well, I'll answer two ways to you. First of all, I'm not going to compare different execution methods or ingredients for you. And there's a very important reason why I'm not going to do that. As a physician, it's unethical for me to promote executions or to participate in them. And comparing different drugs and saying, oh, this is better or more humane than another is a way of promoting one drug over another. And so it's unethical for me to comment on that.

• 9:32Speaker 01

  Yeah, do no harm.

• 9:33Speaker 02

  Yeah, exactly. But there's another reason, and that is, I can tell you, without the comparison, that individually, looking at these drugs, they all have very similar problems. They all fail to produce the kind of brain unconsciousness that the states want to promote them as having. And they have all, when they've been used in executions, been associated with similar problems.

• 9:57Speaker 01

  Can you kind of provide some context for that? Like, what are the ways that they go wrong?

• 10:03Speaker 02

  Well, I mentioned some of the ways that the IVs go wrong, which is the most common source of complications. And there have been some spectacular instances of it, of which now Krista has become one of them. For example, we can think of Angel Diaz. He was executed in a three-drug protocol in Florida. He was given penobarbital, a paralytic drug, and potassium chloride. And then when they started injecting the drugs, he started yelling that it was hurting, which should have made them stop, but they didn't. Once they gave him the paralytic agent, he stopped making any sounds. And in fact, someone commented later, one of the Department of Corrections officials said, well, if it hurt so much, why didn't he scream? And the answer is, well, you gave him an agent that paralyzed him, so he couldn't scream.

• 10:48Speaker 02

  And at autopsy, he had extensive horrific damage to both arms from the injections of penobarbital. In fact, about a foot in diameter around his elbows, up and down his arms, had completely sloughed away.

• 11:04Speaker 01

  Oh, man.

• 11:05Speaker 02

  Clayton Lockett was executed using midazolam, and they took quite a long time trying to get an IV in him. Finally got what they thought was an IV in his groin. He was awake and crying out the entire time. He finally died about three quarters of an hour later from a heart attack. He didn't die of the drugs. I mentioned a couple of those, but there are actually a litany of similar occurrences. And those are usually the kinds of complications we see. It's a little hard to define, in fact, what would be an execution without complications, since many of those are executions in which the prisoner is paralyzed, and we actually don't know what is happening.

• 11:50Speaker 01

  Physiologically, what's going on, yeah.

• 11:52Speaker 02

  Yeah. And 100% of patients that I've looked at, which I've looked at dozens of these autopsies, have developed something called pulmonary edema or pulmonary congestion, where when the drug is injected into a vein, it travels to the lungs, causes immediate caustic burns in the lungs. And this is before the drug has exited the heart and gone to the brain, so there's no effect on the brain yet. And when that happens, the lung tissue inside falls apart, and fluid from the bloodstream floods into the lungs, and the person starts to drown in their own fluids. So all of those prisoners experienced sensations of drowning and suffocation before they died.

• 12:36Speaker 01

  Wow.

• 12:36Speaker 02

  Which I would consider a complication, but which is not always visible or apparent to the people who are witnessing the execution.

• 12:43Speaker 01

  It seems like a lot of the examples you're giving involve administering the drug. So who are doing these lethal injections? Are these anesthesiologists that are doing this?

• 12:56Speaker 02

  Well, they're specifically not anesthesiologists that we know of. And the reason I can say that is that, early on, Missouri and California and a couple of other states attempted to require anesthesiologists to participate in lethal injection executions. But what happened in 2010 is the American Board of Anesthesiology agreed with all of the other boards of medical subspecialties that participation in executions is anathema to their professional obligations, and they will take away your credentials if they find out that you've done that. That takes somebody reporting you, and most of the states have confidentiality laws, so this information is hard to get at.

• 13:41Speaker 02

  However, having said that, every state protocol that I've looked at requires a physician to be present.

• 13:46Speaker 01

  So a medical professional, somebody who theoretically knows what they're doing.

• 13:50Speaker 02

  Yeah, not just a medical professional, a physician specifically.

• 13:54Speaker 01

  In the case of Krista Pike, what do you think the most humane thing is to do next?

• 13:59Speaker 02

  Oh, God. Well, it depends on if you're the state, or if you're her doctors, or if you're her family members, I suppose. The most humane thing would be to see what her recovery is like, if any, and then to allow the people who know her best, and who care about her and who love her, to help determine what she would most want done next, particularly if she has been profoundly damaged by this execution. If you're asking me as a state official, I think that she's been subjected to the worst that the state can do so far, and that they would be wise to stop.

• 14:42Speaker 01

  So, given everything that's happened, Gail, all of the conversations about lethal injection that this case has caused, is there anything that you hope can come from this?

• 14:53Speaker 02

  At the very least, I hope that an understanding comes out of this, that lethal injection executions are a farce, that they are not a humane way to kill a person, and that we should, at the very least, admit that. We should stop saying that it is. If you want to kill people with lethal injection executions, the state should be honest about it and say that it's going to be brutal, but this is what the law calls for. And then the American public can decide if brutality is what they want to vote for. On a secondary level, I would love to see our medical societies stand up, take notice, and take action. I think it's time that doctors took responsibility for their role in lethal injection executions and quit.

• 15:35Speaker 01

  Well, Gail, thank you very much for talking to us about all of this. I know it's a difficult topic, but I appreciate you bringing your expertise to us.

• 15:42Speaker 02

  Thanks, Nate, I really appreciate it.

• 15:45Speaker 01

  Since speaking with Gail, Krista Pike's attorneys say that Krista has regained consciousness, is speaking, and is still getting critical medical care. This episode was produced and reported by Hannah Chin. It was edited by Rebecca Ramirez. She and Hannah Chin checked the facts. Special thanks to Alana Gordon and Angela Zong. The audio engineer was Jimmy Keeley. I'm Nate Rot. Thanks for listening to Short Wave from NPR.