Tony Carruthers was supposed to die by lethal injection in May, but Tennessee’s execution process turned into an hour-long struggle marked by failed needles, groans of pain, and blood seeping from puncture wounds. By the time Gov. Bill Lee halted the attempt, prison doctors had already tried inserting IVs into Carruthers’ arms, legs, and collarbone—none of which succeeded.
Maria DeLiberato, Carruthers’ attorney, witnessed the ordeal. She later described how his body reacted: needles left his skin marked with blood, and a doctor’s attempt to place a central line—a tube inserted near the heart—failed after the physician admitted in a 2025 deposition that he had not performed the procedure in over a decade. By then, Carruthers had already endured more than an hour of labored breathing, his body showing clear signs of distress.
Doctors demand halt to lethal injections
Lee’s intervention provided relief-not just for Carruthers, but for Tennessee’s reputation as well. The failed execution has sparked a public conflict between the state’s prison system and its medical community. In July, more than 40 doctors and nurses sent Lee a letter demanding a moratorium on executions and a rewrite of the protocol. Their argument centered on Tennessee’s rules requiring the participation of pharmacists, physicians, and other healthcare workers in executions are at odds with medical ethics, as well as guidelines explicitly laid out by groups such as the American Medical Association. The AMA code says doctors are to preserve life when there is hope of doing so and bars participation in executions.
The letter said that the problems that we have seen, such as in Mr. Carruthers’s case, are the predictable result of working with such unscrupulous actors. The authors cited historical abuses-from Nazi-era experiments to U.S. public health atrocities-as evidence that executions should have no place in medicine. John Greer, a retired hematologist, described the central line procedure as more than just inserting a needle. He warned that errors could lead to collapsed lungs or fatal bleeding, risks that increase when the physician lacks routine experience.
Greer’s concerns reflect a broader ethical consensus. Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado, noted that most democracies have long excluded medical professionals from executions. “We came out of World War II with a whole bioethics and medical ethics enterprise that is really strongly opposed to medicine serving as an arm of the state and using specialized medical skills to hurt people or kill people,” Wynia said.
Secrecy shrouds execution failures and public trust
Despite these objections, Tennessee’s execution protocol remains unchanged. The state’s lethal injection protocol orders the prison to keep a curtain over the media witnesses’ viewing window until the IVs are established, so none of them could offer a visual account of the failed execution attempt. A lawsuit filed by the Reporters Committee for Freedom of the Press and NPR argues that this secrecy prevents the public from assessing how often these procedures fail. The state has defended its approach, with Lee saying “The Department of Correction did exactly what they should,” and “It should not affect executions in the future.”
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Yet time is running out. On September 30, Tennessee is scheduled to execute Christa Pike, who was 18 when she killed Colleen Slemmer. Pike’s legal team has raised concerns about her execution, citing her platelet disorder, a condition that could require a central line, the same procedure that failed with Carruthers. They also argue that the state’s reliance on Dr. Mark Fowler, the same physician who struggled with Carruthers, poses unnecessary risks.
In June, Pike’s attorneys petitioned the Tennessee Supreme Court for a special investigator to assess whether her execution would violate constitutional rights. The court appointed Senior Judge Mark Ward, who held hearings in Knoxville last month. On September 23, the court denied Pike’s request for a stay, ruling that her concerns did not meet the threshold for constitutional relief. Five days later, Lee rejected her clemency request.
The following morning, Fowler confirmed he would oversee Pike’s execution. The curtain would remain in place, and if the IVs fail again, no one outside the room will know how long the process takes.
Contract doctors’ lack of expertise risks lives
The reliance on contractors like Fowler, who admitted in a 2025 deposition that he had not placed a central line in over a decade, has raised serious concerns. Tennessee’s Department of Correction contracts with private physicians for executions, and Fowler’s involvement in both Carruthers’ and Pike’s cases has drawn scrutiny. In his deposition, he acknowledged never reviewing Tennessee’s execution protocol before agreeing to participate, despite its requirement that he perform procedures he had not practiced in years. The state has not disclosed how many other contracted physicians share Fowler’s lack of experience with central line placement.
Governors in four states- Colorado, Virginia, Pennsylvania, and New Mexico -have halted executions, citing moral concerns or logistical challenges, such as drug shortages. While lethal injection remains the primary method nationwide, some states have turned to alternatives like nitrogen gas, firing squads, or electrocution when drug shortages or legal challenges arise. Since 2020, six botched executions have been documented across the U.S., with most involving prolonged struggles to establish IV access, similar to Carruthers’ case.
