Tennessee executed a prisoner on Tuesday morning who had a heart implant, in a case that raised concerns about whether a lethal injection without turning the device off could have caused a torturous death.
Lawyers for the prisoner, Byron Black, who was convicted in 1989 of killing his onetime girlfriend and her two young daughters, had already argued unsuccessfully that intellectual disability should have exempted Mr. Black from the death penalty.
The fact that the heart device, which functioned as both a pacemaker and a defibrillator, continued to operate during his execution added another ethical quandary. Mr. Black’s lawyers and some medical experts warned that the device might shock him repeatedly, attempting to keep him alive, during the execution.
The seven reporters who served as witnesses all said that Mr. Black, who was strapped down, did appear to show signs of distress, including heavy breathing, during the execution.
At one point, according to several reporters, Mr. Black said something about it hurting “so bad.” His spiritual adviser, who prayed for him and the three victims, responded, “I am so sorry.”
It was unclear what had directly caused Mr. Black’s pain. His lawyer said his legal team would request an autopsy and documentation from the execution.
Mr. Black, 69, died Tuesday morning by lethal injection at the Riverbend Maximum Security Institution in Nashville. He was pronounced dead at 10:43 a.m. and had no formal last words, according to Commissioner Frank Strada of the Tennessee Department of Correction.
The U.S. Supreme Court refused on Monday to intervene in the case, rejecting four separate petitions. Shortly afterward, Gov. Bill Lee of Tennessee, a Republican, said he would not approve Mr. Black’s request for clemency.
“The courts have universally determined that it is lawful to carry out the jury’s sentence of execution,” Mr. Lee said in a statement.
Mr. Black had been on death row for more than 35 years, after a jury found him guilty of the brutal 1988 murders of his onetime girlfriend, Angela Clay, and her two young daughters, Lakeisha, 6, and Latoya, 9. He was sentenced to death for one daughter’s death.
Mr. Black maintained his innocence, but his appeals were repeatedly denied. In the days leading up to the execution, spiritual leaders and opponents of the death penalty rallied behind Mr. Black and his push for clemency.
“Our office will continue fighting to seek justice for the Clay family and to hold Black accountable for his horrific crimes,” said Jonathan Skrmetti, the Tennessee attorney general, in a statement released after the latest ruling by the Tennessee Supreme Court last month. He cited testimony from an expert witness called by the state that “refutes the suggestion that Black would suffer severe pain if executed.”
In a statement that was read aloud after the execution by a Department of Corrections employee, Linette Bell, Ms. Clay’s sister, wrote that the execution was “a day that was a long time coming.”
“I can’t say I’m sorry, because we never got an apology — he never apologized, and he never admitted it,” Ms. Bell said in the statement. Now, she added, “this is closure for my family.”
A picture of Ms. Clay and her daughters was on display behind the lectern outside the prison where prison officials and witnesses spoke. The reporters who witnessed the execution were from multiple television stations, The Associated Press, the local National Public Radio station, The Tennessean and the Nashville Banner, a local nonprofit.
Polls have shown that a narrow majority of Americans — 53 percent — favor the death penalty generally, but an overwhelming majority opposes it for people who have an intellectual disability or struggle with mental illness. Mr. Black, his lawyers said, is the first intellectually disabled prisoner to be executed in Tennessee since the 1970s, when the death penalty became a legal option again in the state.
Mr. Black was first scheduled for execution in 2022, but it was delayed after an investigation was opened into why the state did not properly test its lethal injection drugs. He was also among the inmates who sued Tennessee over its new injection procedure, which was put in effect this year; the litigation is still pending.
In a letter to Governor Lee asking for a commutation of the sentence to life in prison, Mr. Black’s legal team outlined not only his recent health problems but also the documentation surrounding Mr. Black’s intellectual disability. The letter said that he had never scored higher than 70 on an I.Q. test, that he repeated second grade at a segregated elementary school in Nashville, and that he struggled as a child to learn simple games or to remember to do basic chores.
During an evaluation this year, he was unable to make change for a $5 bill. He used a wheelchair up until his execution.
If convicted today, Mr. Black would not be eligible for the death penalty under the state’s current clinical standards. But because his legal team challenged whether his intellectual disability made him ineligible under the previous standards, the state courts refused to revisit his case and apply the new standards.
“What happened here was the result of pure unbridled blood lust and cowardice,” said Kelley Henry, chief of the capital habeas unit at the federal public defender’s office in Nashville, who repeatedly held back tears as she spoke after the execution. “It was the brutal and unchecked abuse of government power.”
Mr. Black had an implanted cardioverter-defibrillator in place since 2024 because of heart failure and heightened cardiac risk. In the case of lethal drug injection, experts warned that the device could have prevented his heart from slowing down before shocking the heart.
“That’s purposes at odds,” said Arthur Caplan, a top bioethicist at the New York University Grossman School of Medicine. “They’re trying to make this guy die, and you have technology attached that’s trying to keep him alive.”
Ms. Henry, in one legal document, warned that it would be “a grotesque spectacle,” one that would cause Mr. Black “extreme pain and distress” and weigh on the conscience of the witnesses.
Deactivating the device would have required a medical professional. But Nashville General Hospital, which did not respond to a request for comment, told Tennessee officials that its staff members would not willingly assist in the deactivation of the device, according to court documents.
The Tennessee Supreme Court said late last month that the execution could proceed without medical intervention.
Kitty Bennett contributed research.
Emily Cochrane is a national reporter for The Times covering the American South, based in Nashville.
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