In a troubling revelation regarding the execution protocols in Tennessee, the American Civil Liberties Union (ACLU) has highlighted failure during the attempted execution of Tony Carruthers earlier this year, leading to further scrutiny surrounding the subsequent planned execution of Christa Pike. Central to this case is Dr. Mark Fowler, the physician assigned to both executions, whose competence and recent experience have come under question.
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On May 21, 2023, the execution of Carruthers was abruptly halted after Dr. Fowler and his team struggled for over an hour to establish the necessary intravenous (IV) lines for the lethal injection. Documents obtained by PEOPLE include a declaration from Carruthers’ attorney, Maria DeLiberto, detailing the distressing scene as Carruthers reportedly experienced significant pain, crying out, “It hurts, it hurts.” Ultimately, officials called off the execution due to the failure to successfully insert two peripheral IV lines.
The Tennessee Department of Corrections (TDOC) had assigned Dr. Fowler to oversee the execution, a role which, according to the state’s Lethal Injection Execution Protocol, includes confirming the inmate’s death and, if needed, establishing a central IV line. However, troubling insights from a deposition in 2025 disclose that Dr. Fowler had not performed such a procedure since 2013, and he did not possess hospital privileges to do so at any medical facility since that time. This raises significant concerns about his capability to fulfil the duties required for executions.
Dr. Fowler’s attempts to insert a central line in two locations during Carruthers’ execution were unsuccessful, leading to increased scrutiny of his qualifications. A declaration by Dr. Gail A. Van Norman, a Professor Emeritus in Anesthesiology and Pain Medicine, indicates that, based on Dr. Fowler’s own admission, he lacked the relevant experience typically required to hold privileges for placing central lines in many leading healthcare institutions today. Dr. Van Norman also stated that the method used by Dr. Fowler was a “violation of the current standard of care.”
Compellingly, just four months following the botched execution of Carruthers, Dr. Fowler was again selected by the TDOC, this time as the lead physician for Christa Pike’s execution. This decision has drawn widespread scrutiny, especially in light of the prior failure. Following the execution of Pike, which also ended unsuccessfully, Dr. Fowler suggested that complications arose due to an improperly placed IV, resulting in the lethal drug, pentobarbital, being delivered to surrounding tissue rather than into the vein.
According to Kit Thomas, Deputy Chief of the Capital Habeas Unit for the Federal Public Defender in Tennessee, the issues surrounding the execution process are indicative of a broader systemic failure. “The investigation into why Tennessee keeps botching executions should have been launched in May,” Thomas commented, alluding to the distress Carruthers endured. “These problems will keep happening until Tennessee takes meaningful steps to increase transparency, oversight, and accountability in the execution process.”
Thomas emphasised that executions should not resume until substantial reforms are instituted, particularly in light of the troubling events surrounding both Carruthers and Pike’s planned executions. The implications of such procedural failures extend beyond the individuals directly involved, calling into question the ethical and humane treatment of inmates facing capital punishment.
As discussions surrounding the death penalty continue to evolve, the struggle to ensure that executions are conducted humanely and effectively remains a critical issue. Stakeholders are urging a reassessment of policies and practices to foster an environment that upholds both justice and compassion, while ensuring robust oversight mechanisms are put in place to avoid the harrowing experiences witnessed in these recent cases.
In the wake of these events, it has become increasingly apparent that the TDOC must address the glaring gaps in procedure and accountability to prevent similar incidents in the future. The call for transparency in the execution process is louder than ever, as the complexities of administering capital punishment come under renewed scrutiny from multiple fronts.
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