Execution HORROR: Christa Pike Survives Two Rounds of Lethal Drugs

The physician connected to Tennessee’s failed attempt to execute Christa Pike was also involved in another troubled lethal injection just months earlier, adding new scrutiny to the state’s execution system after an extraordinary night inside a Nashville prison.

Dr. Mark Fowler had previously said he expected to serve as the overseeing physician for Pike’s September 30 execution at Riverbend Maximum Security Institution.

Local reporting indicated Fowler was involved in Wednesday night’s procedure, although Tennessee officials have not publicly detailed exactly what actions he performed inside the execution chamber.

What is clear is that the execution did not go as planned.

Pike, 50, received two rounds of the lethal injection drug pentobarbital but remained alive. Witnesses said she continued breathing, made unusual snoring sounds and complained of pain during portions of the procedure.

The execution was eventually halted, witnesses were removed from the area and Pike was transported by ambulance to an off-site medical facility.

The Tennessee Department of Correction later said it had followed every step of the state’s established execution protocol.

Gov. Bill Lee has now ordered a comprehensive third-party review of what happened and halted Tennessee’s remaining executions for the rest of 2026.

The stunning development has placed renewed attention on Fowler because it was not his first involvement in an execution that ran into serious problems.

Earlier Execution Was Aborted

Fowler was involved in Tennessee’s May 2026 attempt to execute death row prisoner Tony Von Carruthers.

Carruthers had been condemned for the 1994 kidnappings and murders of Marcellos Anderson, Delois Anderson and Frederick Tucker.

According to Tennessee officials, medical personnel were able to establish the primary intravenous line needed for Carruthers’ execution but could not successfully place a required backup line.

After unsuccessful attempts to locate another usable vein, the team moved to a central line — a catheter inserted into a large vein.

Fowler was called in to perform the procedure.

Carruthers’ attorney, Maria DeLiberato, questioned Fowler’s qualifications while the execution process was underway. Fowler responded that he was qualified and proceeded with the attempt.

Court records and later reporting revealed that Fowler had acknowledged he had not placed a central line since approximately 2013, when he was working in emergency medicine.

The procedure was unsuccessful.

Carruthers’ execution was ultimately abandoned, and Lee granted him a one-year reprieve.

The governor’s office confirmed at the time that the execution team had been unable to establish the backup IV required under Tennessee’s lethal injection protocol and that an attempted central line had also failed.

Carruthers’ attorneys later described the procedure as extremely painful.

His sister subsequently filed a complaint with the Tennessee Department of Health accusing Fowler of malpractice and raising questions about his participation in the attempted execution.

Those allegations remain allegations, and no publicly announced disciplinary action against Fowler has resulted from the complaint.

Fowler has defended Tennessee prison personnel in the past, saying condemned prisoners are treated with courtesy, respect and professionalism.

Who Is Dr. Mark Fowler?

Fowler has one of the more unusual backgrounds of anyone publicly identified as participating in modern American executions.

Before becoming a physician, he worked as a public defender and represented criminal defendants, including people facing capital punishment.

He later changed careers and attended the University of Tennessee College of Medicine.

Fowler subsequently worked in emergency and family medicine and has held positions connected to medical clinics and other health-care facilities.

His role in Tennessee executions became far more public following a series of recent cases.

Execution-team identities are frequently shielded from disclosure because states argue that secrecy is necessary to protect participants and maintain access to medical personnel and execution drugs.

Fowler’s identity, however, became publicly known.

Byron Black Execution Drew Scrutiny

Fowler has also been identified in connection with the August 2025 execution of Byron Black.

Black was sentenced to death for the 1988 murders of his girlfriend, Angela Clay, and her two young daughters.

Unlike Carruthers and Pike, Black was pronounced dead following his lethal injection.

But witnesses reported disturbing scenes during the execution.

Black repeatedly lifted his head, groaned and said he was in severe pain after pentobarbital was administered.

His attorney later characterized the execution as botched.

An autopsy subsequently found pulmonary congestion and pulmonary edema, meaning fluid had accumulated in his lungs. Experts have debated whether pulmonary edema associated with lethal injection can cause sensations resembling suffocation or drowning.

Tennessee officials maintained that Black’s death sentence had been lawfully carried out.

Another Execution Followed in August

Fowler also acknowledged serving as the physician during Tennessee’s August 2026 execution of Anthony Darrell Hines.

Hines had spent approximately four decades on death row for the 1985 killing of Katherine Jenkins.

Witnesses said Hines declined to make a final statement.

Several minutes after the execution began, he reportedly made a loud groaning sound and took several breaths before eventually being pronounced dead.

There was no failure comparable to what later occurred with Pike or Carruthers.

Still, Fowler’s participation in multiple executions has attracted increased attention because doctors generally operate under ethical principles centered on preserving life rather than intentionally ending it.

Medical organizations including the American Medical Association have long opposed physician participation in executions, although those ethical guidelines are separate from state law and do not necessarily carry the force of law.

What Happened During Christa Pike’s Execution?

Pike had spent approximately three decades on Tennessee’s death row for the January 1995 murder of 19-year-old Colleen Slemmer.

Pike was 18 at the time.

Prosecutors said Pike, her then-boyfriend Tadaryl Shipp and another woman lured Slemmer to an isolated area near the Job Corps facility they attended in Knoxville.

Slemmer was beaten, cut and killed during a prolonged attack.

Pike was convicted of murder and sentenced to death in 1996.

Her attorneys mounted numerous appeals over the years, including arguments involving her age at the time of the murder, mental health and allegations that she endured severe abuse during childhood.

Slemmer’s family, meanwhile, spent decades waiting for the sentence to be carried out.

The legal fight continued into the hours immediately before Wednesday’s scheduled execution.

A federal appeals court temporarily blocked the execution, but the U.S. Supreme Court later allowed Tennessee to proceed.

Once the execution began, however, witnesses quickly noticed that something appeared unusual.

Media witnesses said Pike complained of burning and pain during the procedure.

After the first round of pentobarbital failed to result in her death, a second round was administered under Tennessee’s protocol.

Pike continued breathing.

Witnesses described hearing prolonged and sometimes irregular snoring or breathing even after curtains separating them from the execution chamber were closed.

Eventually, the witnesses were told to leave.

Emergency vehicles were later seen at Riverbend, and Pike was transported to a hospital.

As of Thursday morning, state officials had not publicly released detailed information about her medical condition.

Tennessee Says Protocol Was Followed

Despite the extraordinary outcome, the Tennessee Department of Correction said its execution team had followed the state’s established protocol.

“The Tennessee Department of Correction followed every step of the State’s lawful, established execution protocol approved by the Attorney General’s Office,” the department said after the execution attempt.

Officials also said the lethal injection chemical used in the protocol had previously been effective.

But Tennessee’s protocol creates an unusual question following what happened to Pike.

The procedure allows officials to administer a second set of lethal injection drugs if the inmate remains alive following the first.

What happens when the second round also fails to cause death is far less clear.

That scenario is now expected to be one of the central issues examined during the state’s review.

Victim’s Mother Calls Execution ‘A Mess’

The failed execution also prolonged an ordeal for Slemmer’s family.

Her mother, May Martinez, had traveled to witness the execution after waiting more than 30 years for Pike’s sentence to be carried out.

Martinez later described the situation as “a mess” and said the victim’s family initially received little information about why the execution had stopped.

The execution debate surrounding Pike has often focused heavily on Pike’s history and legal appeals, but Slemmer’s relatives have repeatedly argued that attention should not be diverted from the young woman who was murdered.

For them, Wednesday was supposed to mark the conclusion of a case that began in 1995.

Instead, it produced another chapter.

Governor Orders Investigation and Stops Executions

By Thursday, Lee had taken the significant step of ordering an outside review.

The governor said carrying out a legally imposed death sentence is among the state’s most serious responsibilities and that Tennesseans expect the process to be legal, constitutional and effective.

Tennessee’s remaining scheduled execution for 2026 will not go forward while the state investigates.

That means the Pike case is no longer simply about one inmate or one execution.

It has become a broader examination of Tennessee’s death penalty system.

The state adopted a revised execution protocol using a single drug, pentobarbital, in 2024 after earlier problems with its execution procedures.

Since then, the state successfully carried out several executions.

But within a matter of months in 2026, Tennessee was unable to complete Carruthers’ execution because of IV problems and then failed to execute Pike even after the lethal drug was administered twice.

Investigators will now have to determine exactly what happened inside the chamber, whether the drugs or IV system functioned as intended, what role each member of the execution team played and whether Tennessee’s existing protocol needs to be rewritten.

For Fowler, the review could also renew questions about the qualifications, responsibilities and oversight of medical personnel participating in executions.

And for Tennessee, the most pressing question is much larger: how a procedure the state insists was followed correctly ended with the condemned prisoner leaving the execution chamber alive in an ambulance.