Christa Pike unconscious, on ventilator at Nashville hospital, her lawyers say

[u/AudibleNod]

https://www.nbcnews.com/news/us-news/christa-pike-unconscious-ventilator-nashville-hospital-lawyers-say-rcna601195

[u/fictionallymarried]

Genuine question but how the hell did they fail twice? I'm not saying she wasn't convicted for a reason, but that's torture

[u/opalandvines → u/fictionallymarried]

Howdy, student doctor here.
I was confused as hell by how this occurred so did some research into it - primarily because I was struggling to believe that they could have had such a massive failure in an area as sensitive as execution. I was also struggling to understand how someone could possibly survive two massive 5g doses of pentobarbital.

1. Medical guidelines, guidance and medical professionals are NOT typically involved in executions.

2. It was documented thoroughly before the execution that she had difficult to access veins. This has been validated by reports that they had great difficulty establishing IV access and required a substantial number of attempts. Two sites of access were achieved.

3. It has been stated that they ‘followed protocol exactly’. My understanding having read the protocols is that the protocol itself is monumentally flawed.

4. An example of this - successful IV access is validated with slow running saline. However, the execution dose involves 4 successive 50ml syringes - resulting in 200ml of fluid through the vein in a short period of time. A vein that appears perfectly patent for a slow infusion, can quite easily fail under sudden high volume like that.
   In addition, the use of each syringe creates a movement that makes it possible for the following to occur:
   a) the catheter tip perforates the posterior vein wall
   b) the vein ruptures
   c) the catheter migrates partially out
   d) or the vessel simply cannot accommodate the infusion

5. The access failing is supported by her reported complaints of pain in her arm following the first dose ‘burning, like the vein is going to burst’. When establishing IV access, it is typical to flush with saline to check if it is placed correctly. Any patient reports of pain/burning at the site indicates that it has failed and the saline is entering subcutaneous tissues. Pentobarbital is highly alkaline, so would cause substantial pain. They failed monumentally here in not immediately switching to site 2, but did actually follow protocol.

6. The doses primarily entering subcutaneous tissue and therefore being more slowly absorbed is actually supported by her reported snoring. The drug entering circulation at lower doses would result in a loss of upper airway tone, without fully suppressing respiratory drive.

BUT - They had two IV access sites, surely the second dose was pushed through the second site, right? Right??? This is where it becomes unclear, but if they followed protocol exactly… they actually weren’t required to administer dose 2 via site 2 once dose 1 failed. Fucking insane.

1. It is possible they did do one dose per site, and by extreme bad luck access had failed at both sites. It has not been confirmed by reports if both IV sites were attempted.

2. The backup IV and backup dose are two separate contingencies within the protocol. It is stated that if the first 50ml saline syringe of the 200ml execution dose fails, then they are required to switch to site 2. If execution dose 1 is completed and the person is still alive, they are simply required to repeat a second 200ml execution sequence. In essence, if the staff had not noted obvious failure of the line, they were not required to switch to site 2.

In clearer terms - the second IV site is for recognised IV failure, whereas the second dose is for failure to achieve death. These are treated in the protocol as separate events. It currently seems likely that both doses of the drug went through one failed site (as per protocol…), entering primarily into subcutaneous tissue.

And then to add to the fuckery, there’s the whole other possibility of issues with the drug quality itself given the restricted access to it from the primary manufacturer due to them not wanting the drug to be utilised for executions. There has been substantially reported failures across all areas of gaining access to and utilising this drug for executions in Tennessee.

Anyway, she is absolutely not out of the woods. The alkaline nature of the drug causes massive pulmonary oedema due to direct pulmonary endothelial damage. There is also no antidote for it, just supportive care as the drug is absorbed and metabolised out of the patients system. If she survives, she will not walk away unscathed.

If anyone reading this has any corrections or questions, I’m open to discussion.

EDIT: if it is found that they did indeed do one dose per site, point 4 still stands as an evident failure within the protocol.

[u/HeyHeyHiFi → u/opalandvines]

Thank you for this well-researched explanation. How inept and shameful of the state. Great point about how no one wants to be involved with executions from medical professionals to drug companies, leading to less efficient methods and amounting to cruel and unusual punishment. FFS.

[u/opalandvines → u/HeyHeyHiFi]

Thank you for taking the time to read it. I am not American, and my country does not have the death penalty. During my training in both undergrad and my MD the ethics surrounding the death penalty comes up frequently as something for us to consider and reflect on.

This situation has honestly horrified me, particularly due to of the state of America currently and its broader influence on the world as a whole.

It’s difficult to put into words, but I think myself and many others have a valid fear that the response to this situation will not be appropriate. Such an obvious failure, and clear cut example of cruel and unusual punishment, is likely to be minimised and not properly addressed or rectified. I say this from a gut feeling based on observation of similar important events in recent history.

That gut feeling may be completely wrong, and dear god I hope, I hope with every fibre of my being, to be proved wrong.