On Wednesday, Tennessee attempted to execute Christa Gail Pike using two doses of pentobarbital, but she did not die as expected. No explanation has been given for the failure, and it remains unclear whether Pike was still alive by Thursday. Republican Gov. Bill Lee called for an outside investigation into the incident and confirmed that no further executions will be carried out in Tennessee this year.
This barbiturate works by slowing down activity in the central nervous system. It has approval for several medical purposes, including making people drowsy, short-term help with insomnia, getting ready for anesthesia, and emergency management of severe seizures. An excessive amount of pentobarbital can put someone into a deep sleep, slow breathing, weaken circulation, and ultimately result in death.
The Failed Execution
Tennessee officials did not say what led to the failure or confirm whether Pike survived after the procedure. During the execution attempt, Pike, 50, received two doses of pentobarbital, yet she remained alive afterward.
Lee’s decision to delay the third execution this year means the state will not carry out that scheduled death sentence. He ordered a third-party review to determine what happened in Pike’s case.
How Lethal Injection Changed
The three-drug method has long been criticized in lethal injection executions. It traditionally included an anesthetic, followed by a paralytic, and then potassium chloride. Critics argued that if the anesthetic did not work, the paralytic would stop a prisoner from showing any signs of distress.
Because drugmakers restricted distribution for executions, keeping the three-drug method going became hard. During Trump’s first term, pentobarbital took over at the federal level as a replacement for the mix used in the 2000s.
This move came amid a wider trend. After past administrations let executions lapse without formally ending them, Trump brought back federal capital punishment. From 2020 to 2021, the federal government put pentobarbital to use in 13 executions, which made Trump the president who carried out the most federal killings in more than 130 years.
The Biden Interlude
During the Biden administration, the Justice Department stopped executions with pentobarbital after a government review raised concerns about “unnecessary pain and suffering.” The review concluded there remained “significant uncertainty” about whether pentobarbital causes unnecessary pain and suffering and advised the government should “err on the side of humane treatment.”
After Trump returned to power, the Justice Department reauthorized the use of lethal injections with pentobarbital in 2026, which reversed the pause on that method put in place during the Biden administration.
State Protocols Differ
Georgia and Texas follow a similar protocol to Tennessee’s, administering a second dose only if the first fails. South Carolina, which turned to pentobarbital in 2024, automatically gives inmates two 5-gram doses spaced about 10 minutes apart.
People on death row’s lawyers argue that administering a massive dose two separate times proves the condemned are enduring a drawn-out death, fully aware and choking as liquid fills their lungs. Their claim is that the repeated doses point to a slow, painful experience instead of a swift one.
The South Carolina Department of Corrections lawyer responded to those claims by saying inmates are rendered unconscious in well under a minute and cannot feel anything, with the heart showing occasional flickers due to stored oxygen and residual electrical impulses.
Past Failures and Expert Review
In the past, lethal injection executions have failed most often due to an improperly inserted IV line, which stops the procedure before any drugs are administered. Other times, a new drug combination has caused violent reactions or a long period before death.
The failed execution using pentobarbital on Wednesday seems to mark the first time issues arose with that drug. Witnesses typically say inmates stop breathing and grow still within seconds of receiving it. According to experts cited in the 2025 federal review, pentobarbital can lead to pulmonary edema, a fluid buildup in the lungs that might produce a feeling of being unable to breathe.
The 2025 review concluded there remains “significant uncertainty” about whether pentobarbital causes unnecessary pain and suffering and advised the government should “err on the side of humane treatment.” Other specialists quoted in a report released by the second Trump administration said a lethal dose causes unconsciousness before that occurs.
What Happens Next
No timetable has been given for the outcome of Lee’s order for a third-party review, which could take months to finish. Tennessee officials have yet to say whether Pike will receive a third dose of pentobarbital.
Where the paper stands
The paper backs the governor’s call for an outside investigation into the failed execution and is against any state office or agency writing its own rules for how executions should be carried out. Lee’s third-party review is the right step — it puts the inquiry outside the hands of the very people running the execution process.
The repeated-dose protocols now in use across multiple states, including Tennessee’s, raise serious questions about whether condemned prisoners are being treated humanely. Those protocols appear to increase the risk of a prolonged, painful death rather than a swift one.
The paper wants officials to stop adding more doses when a single dose fails. It also wants the investigation to consider whether the drug itself is capable of causing unnecessary pain and suffering.
Key Facts Box
- Christa Pike, 50, was still alive after two doses of pentobarbital
- Tennessee officials have not explained what went wrong
- Gov. Bill Lee ordered a third-party review
- Another scheduled execution in Tennessee will not take place this year
- Pentobarbital is a barbiturate that depresses the central nervous system
- Tennessee guidelines call for a 5 gram dose
- Patients typically receive a fraction of a gram in medical settings
- Trump resumed the federal death penalty after an informal moratorium
- Federal executions with pentobarbital: 13 between 2020 and 2021
- Biden-era Justice Department paused executions with pentobarbital
- Reauthorization: 2026, after Trump returned to power
- Georgia and Texas follow a similar protocol, second dose only if first fails
- South Carolina gives two 5-gram doses spaced about 10 minutes apart
Timeline of Executions and Reviews
| Year | Event |
|---|---|
| 2000s | Three-drug mix used in federal executions |
| Early 2020s | Trump resumes federal death penalty after moratorium |
| 2020–2021 | 13 federal executions with pentobarbital |
| Biden era | Justice Department pauses executions with pentobarbital |
| 2025 | Federal review finds “significant uncertainty” |
| 2026 | Justice Department reauthorizes lethal injections with pentobarbital |
| Present | Pike execution fails in Tennessee |
The series of occurrences is laid out in chronological order: Trump restarted executions, pentobarbital was established as the federal standard, the Biden administration put a stop to them once more, and the 2026 reauthorization came next. Pike’s failed execution closes out that chain of events.
The repeated doses suggested in Tennessee’s protocol, and in South Carolina’s automatic two-dose approach, raise serious questions about whether condemned prisoners are being treated humanely. The failure in Tennessee adds urgency to that question.
After two doses of pentobarbital fail to end a life, the danger of a prolonged, painful death increases with every extra dose administered.
Source material: “Pentobarbital, the drug used in Tennessee's failed execution of Christa Gail Pike, has come under past scrutiny,” ABC13 Houston.
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