Last year, Tennessee’s lethal injection execution protocol underwent a striking transformation.
The manual laying out the procedure was slashed in half, stripped down from 104 pages in a previous version to 44 pages. Details about certain staff and the single drug now at the heart of the protocol were shrouded in secrecy.
And some directions were made vague or vanished altogether, including the requirement that execution teams practice inserting an IV line.
Tennessee has botched two of its three executions this year, mostly recently in the case of Christa Pike last month. Her case in particular has prompted a wave of questions about why the state has struggled to carry out death sentences, while some other states, such as Texas, have not.
The stark differences between the protocol put in place last year and the one before it, which was last updated in 2018, have emerged as a focus of scrutiny in Tennessee.
The granular, grim elements of an execution, especially by lethal injection, have taken on greater interest and importance in the aftermath of Ms. Pike’s botched execution, as more Americans wrestle with the morality and ethics of capital punishment.
Even as polls have shown a decline in support for the death penalty, some leaders continue to champion capital punishment. The Pentagon announced this week that the Army officer convicted in the 2009 Fort Hood shooting would be carried out in public and broadcast via a livestream.
Republicans in Tennessee, where they hold a supermajority, say they remain committed to carrying out death sentences. But they have said they will examine how capital punishment is carried out and will consider changing the lethal injection protocol or switching to a different execution method.
The Tennessee Department of Correction said it had followed every step of the protocol in Ms. Pike’s execution attempt, which has “consistently been effective.”
Gov. Bill Lee, a Republican who is in the final months of his second and last term in office, has paused all executions and ordered an investigation into Ms. Pike’s botched execution. U.S. Senator Marsha Blackburn, also a Republican and the front-runner to replace Mr. Lee, has called for the state to switch to the electric chair.
Cameron Sexton, the speaker of the Tennessee House, said that Ms Pike should still face execution and that the state intends to find a way to carry on with capital punishment. “We’ll look at different methods and alternatives, and then we’ll look at how to speed up the process,” Mr. Sexton said in an interview.
Ms. Pike, 50, was convicted in 1996 of the torture and murder of a classmate.
The Department of Correction declined to answer questions about the current protocol or its changes, citing pending litigation. During earlier lawsuits brought by other death row inmates, the agency cited attorney-client privilege and a protective order in refusing to allow staff members answer a number of questions, including about the development of the protocol, the qualifications of the execution staff and details about the drugs used.
After the botched Pike execution on Sept. 30, the agency’s commissioner, Frank Strada, who had led the development of the new lethal injection protocol, said he would step down later this month.
Ms. Pike’s lawyers had warned about possible issues with the execution protocol, especially given her small veins and underlying medical conditions. She survived two doses of the drug, pentobarbital, and remains hospitalized. Her lawyers on Thursday said she was able to walk with some assistance, but continues to struggle with concentration and memory.
Like in other states, Tennessee law prohibits the public identification of workers who carry out executions or any company that assists in procuring or preparing drugs for lethal injection. There are strict limits on who can witness an execution; cellphones and outside photos are prohibited; and only lawyers for the death row inmate can witness the insertion of IV lines.
“The idea is to keep it from being sensationalized,” said David Raybin, a Nashville lawyer who helped write Tennessee’s death penalty statute. But in switching to lethal injection, he added, “we’ve involved more people. We’ve made it more complex.”
Yet key details of the process appear masked in the current Tennessee protocol, compared with the previous one and with those of some other states that use lethal injection. In Tennessee’s previous protocol, from 2018, only five pages appeared to have been removed, mainly related to security details of the prison where executions are held. But in the current protocol, the state appears to have withheld details of staff roles and duties.
“It’s why we can say that secrecy is a big part of all botched executions,” said Robin Maher, the executive director of the Death Penalty Information Center. “When we don’t understand what’s happening, there’s not the opportunity to ask the hard questions that get good answers.”
In 2022, Mr. Lee instituted a moratorium on executions, and there was an independent review of the Tennessee process. During a deposition last year, Mr. Strada said he estimated he had read the report two or three times.
Some recommendations — including providing a copy of the protocol to the chemical provider — were followed, he said. Some were not. He said he did not enlist an outside consultant with a pharmaceutical background to offer guidance over the lethal injection process, as the report had recommended.
“It was only a recommendation,” Mr. Strada said when asked at the time, according to excerpts from the deposition reviewed by The New York Times. “It wasn’t a requirement.”
Directly asked if there was any unwritten guidance, Mr. Strada said everything was contained within the protocol.
The Texas protocol, which also uses pentobarbital, requires that all members of the drug team have at least one year of professional experience and a new team member must be supervised through two executions.
In Florida, which carried out 40 percent of all executions in the United States in 2025, the protocol specifies the kinds of certification each team member involved with the lethal injection process should have. It also directs the team to prepare for contingencies, including issues finding a vein and what to do if the prisoner is not unconscious after the first drug is administered.
Tennessee’s protocol does not publicly list contingencies. It says execution staff members should be “currently certified, licensed and/or qualified within the United States to place IV lines,” but does not offer specifics.
There is also an absence of public details in Tennessee’s protocol about how to handle complications in the execution chamber. In Idaho, for example, where execution by either lethal injection or a firing squad is allowed, there is a requirement for outside medical services to be on site and provide any necessary aid, “including resuscitation efforts for the condemned person as needed.”
On Sept. 30, the night Ms. Pike was set to be executed, emergency medical services were called to the Nashville prison at 8:50 p.m., according to a Nashville Fire Department report, and the first unit arrived at 9:15 p.m. It was not clear if Ms. Pike, who could be heard breathing, received care before that arrival.
Jesus Jiménez contributed reporting.
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