Code Blue on Death Row: When Executions Go Wrong

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We're using our medical background to focus on the strange, baffling, and downright unsettling world of medical mysteries.
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We're going to dig into unusual cases, diagnostic puzzles, unexplained symptoms, and medical misadventures.
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Our first three seasons covered a little bit of everything, including crime, conspiracy, mystery, and the occasional rabbit hole we probably shouldn't have gone down.
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Those episodes aren't going anywhere, so the archives remain open for anyone who likes their mysteries, a little more broad spectrum.
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But from season four on, the prescription is different.
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More medicine, more mysteries, more questions.
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So grab a drink, hit the follow, and tune in every Tuesday for a new episode.
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Hey, I welcome back to the three skiing queens.
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I hope you guys are liking our uh dropping two episodes a week.
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That's been fun.
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Yeah, a little bonus bonus episode.
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Like a bonus and if you like to hear us all the time, guess what?
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Now we have a Patreon, right, Megan?
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Yeah, we do have a Patreon, so you should go check it out.
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You know, it has been sort of a hot week.
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I was just about to talk about the weather.
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The weather again, Megan.
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Come on.
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It's not been a hot week, actually.
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I woke up and it was 40 degrees.
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I wasn't gonna talk about the weather.
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What are you talking about?
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I was gonna say it's been a hot week in like medical crime.
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Oh, oh.
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I was like, what are you talking about?
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Is it's been chilly and it's been glorious.
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I don't I don't know if the listeners understand how much I have to.
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I give these girls a look every time they start talking about the weather.
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It's like an iPhone first date every time.
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No, I don't think you understand the weather affects my moods so much.
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And Colleen too, right?
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Colleen.
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Yeah, exactly.
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I feel the opposite.
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I feel like it's already feeling dark all the time.
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No, no, I love it.
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Like I love it.
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So like the feeling of the cold air on my cheek.
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Last few weeks, it has still been dark, but I left for work in the morning.
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Well, daylight savings is coming, and then the sun starts going.
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Is daylight savings actually coming?
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Do we know?
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I can't keep track.
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I thought it was that weekend.
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Yeah, but we were getting rid of it, you know.
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It hasn't passed in the sun yet.
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You guys gotta follow.
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Okay.
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Okay, we'll do.
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Okay.
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She's just trying to watch her friend.
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Although, are the farmers upset?
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Because that's the thing, that's who it affects, right?
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The farmers.
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But does it really affect them?
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It's just I don't think they're still getting the same amount of hours.
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We already have all these states that don't participate, right?
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Uh Arizona.
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It's just like one.
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Yeah.
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And states and countries.
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It's not two.
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I don't think it's the whole state.
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I think it's just a couple cities.
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It's Arizona.
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Well, anyway, what I was trying to say before we went on another weather tangent is that it's been a hot week in medical news, right?
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Yeah.
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Gypsy's husband died.
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Well, mysteriously.
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Gypsy's baby daddy.
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Oh, sorry.
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Died.
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The plague.
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There's a Russian plague.
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There's a Russian plague.
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I swear, if if another is if it's COVID 2.0, I'm leaving care.
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I am getting out.
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I can't do it anymore.
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Uh, and then I think there, you know, we're still kind of getting trickle updates about uh Lindsay Clancy, right?
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And then the hot topic that we're gonna cover today is the death penalty and Krista Pike's failed execution.
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Oh, she's survived.
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I personally have gotten a lot of messages asking us to cover this.
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So I mean I'll tell you what, I got opinions.
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But before we get into it, so is it time for our drink check drink check?
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So for today's drink check, we are drinking apples.
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Yes.
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It's so good made in the instant pot.
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This is I don't even know.
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I hadn't even said it out loud to Megan, but I was like, in my brain, I was like, I'm so craving this.
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And then we then I showed up and Megan had it ready.
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And I was like, How did she know?
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Burn it alive.
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I mean, well, the apples were about to go bad, so I had to do it.
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Although I will say that I mixed it up with a little of Kate's favorite wild turkey 101.
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And Colleen was Colleen was like, didn't you have caramel vodka last year?
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That was I do.
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It's downstairs.
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Caramel vodka.
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This is fantastic what I'm bringing right now.
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But I just remember the caramel vodka.
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That took it to another level.
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Yeah.
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Well, I have some caramel vodka downstairs, and there's probably another batch of hot apple cider.
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So we'll do that.
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Heck yeah.
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We'll do that later this week.
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Cheers! And let's get into it.
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Disclaimer: the views, opinions, and commentary expressed on this podcast are those of the hosts and guests, and do not represent the view or opinions of our employers, organizations, or professional affiliations.
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Colleen.
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Yes.
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Picture this.
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Okay.
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A woman has been sentenced to death.
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She is strapped to the gurney at Riverbend Maximum Security Institution.
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She has already given what she believes are her final words.
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The lethal injection begins.
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And then the first dose doesn't kill her.
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So they administer another.
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And she still doesn't die.
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This is exactly what happened to Krista Pike, who, following two injections of pentobarbital, remained alive and could be heard breathing and snoring.
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She was eventually removed from the prison by ambulance.
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So tonight we're talking about Krista Pike, the convicted murderer who became one of the most infamous women on American Death Row and last week survived her own execution.
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Isn't she the second woman on death row?
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I'm pretty sure she was the first one that was sentenced.
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Aileen was before.
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No, I think the drama is that she was 18 when she committed a crime.
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So she's the youngest put on death.
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Oh, youngest.
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That's what I knew it was.
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There are currently 45 women on death row.
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But how many have been committed in like so I know Krista didn't die, but how many were actually killed?
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Just Aileen, right?
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18 women.
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Oh, never mind then.
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Okay.
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Since 1976.
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But obviously, if we go back to, you know, you're like the witch troms?
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Yeah.
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If we go back to colonial times, uh 576 women have are estimated to have been executed since the first rec recorded instance in 1632.
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So any thoughts before we get into it?
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Well, my immediate thought was they didn't have a good IV.
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Yeah, I feel like I think that's obvious.
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We're gonna talk about it.
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I'm confused.
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Why didn't they just give it IM?
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Why you gotta put an IV?
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Well, here's my question: like, why couldn't we just get a centralized?
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Yo, you're gonna spend all the money on a death row case, you're gonna spend all the money to actually get the paperwork process for death, and you're not gonna get a central line.
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Yeah, or get a pick one or something, but we're gonna be using pentobarbital instead of the old combo.
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These are all such good questions that I have in my notes.
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So immediately your question is well, why don't we just have a central line?
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And then why are we using pentobarb and not the old, the old-fashioned anesthesia, paralytic potassium chloride?
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I want to know who put the IV in.
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Well, I don't have the exact person because it's all actually very concealed to protect them, which is why they have these curtains.
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Like they close the curtains, they do their work, and then when the curtains open, there's no one in there because they don't want anyone they're in another room.
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They don't want anyone to know who put it in.
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But I did look into like what kind of certification and what kind of criteria do they make one comment.
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Uh-huh.
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I don't want to make light of it.
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You may make many, but to be the one to put the IB in it.
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Yeah, that's embarrassing.
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Or maybe not so embarrassing, but like the guilt.
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Okay, hold on.
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Do you know what she did?
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Brutalized a girl.
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She tortured a girl and then killed her.
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It I don't give one shit.
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It's like karma's a bit.
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I'm with you.
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It would, I would be in embarrassed, Colleen.
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If I put in an IV and that was my one job and infiltrated, I'm gonna tell you it was obviously not a Corpsman.
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Okay.
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Yeah.
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If that IV was a good IV, she'd be dead.
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Well, let me tell you about the IV.
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I'm gonna tell you about all of these things.
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But first, let's get into Kate's passionate feelings here.
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Yeah.
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I'm gonna tell you who Krista Pike is.
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And before she had this failed execution attempt, her execution was already very controversial.
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But we're gonna give you all the facts so you can decide for yourself.
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So Krista Pike was born in 1976 in West Virginia, and she did have a rough childhood.
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She was born with fetal alcohol syndrome, and as a toddler, her grandmother's partner sexually abused her like repetitive repeatedly.
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She just knew she was gonna have a bad background.
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When she started school, a teacher asked the class to draw a picture of what she did at home, and she drew a demonic man with large genitalia.
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And despite teachers reporting the incident, she was not removed from the home.
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Then at age eight, she was raped by a neighbor.
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She reported it to her mother, who did not believe her, but she ended up developing an infection at school.
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So her teacher reported it.
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That attacker was prosecuted, but he pled to a uh pled guilty to a reduced charge.
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At home, she allegedly faced physical abuse and neglect, and she has attempted suicide when she was just 12 years old.
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At 15, she was put on probation for breaking into a community center to steal candy, but violated probation and was sent to a juvenile evaluation center, which I had to look, I was like, is this juvenile detention?
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It sounds like it's more short-term than juvenile detention.
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You're not supposed to go for very long.
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And it's you get sort of like a lot of clinical testing and behavioral assessments and interviews to determine why a youth is acting out and develop a plan to keep them out of, you know, oh, the system.
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Again, it's usually a pretty short stay, but and you get released based on a point system.
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So you earn points for good behavior, you lose points for bad behavior.
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She ended up staying for 16 months because she kept losing points for infractions.
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So that was like very uncommon.
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It's a very long stay.
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She was released at the age of 17 in March of 1993.
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And by then she had earned her GED.
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She was like a teacher's assistant in the program, and she entered the Knoxville job corps hoping to become a nurse.
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It was around this time that she was also reportedly raped again by a stranger on the side of the road, and he was never caught.
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While in the job corps, she met boyfriend Tederrill Ship, as well as Colleen Slemmer.
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So Krista Pike believed that 19-year-old Colleen Slemmer was interested in her boyfriend, 17-year-old Tederyl Ship.
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On January 12th, 1985, with the help of friend Shidola Peterson, Krista and Tadaryl lured Colleen to a park near the UT campus and beat and tortured her, with Pike delivering the final fatal blow.
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Slemmer was beaten, cut with a box cutter, and tortured for 30 minutes before being killed.
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Also with the butcher's knife.
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A pentagram was carved into her body, which Ship eventually admitted to being responsible for.
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Pike took a fragment of the victim's skull.
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The next morning, two UT employees found the body and called police.
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In the meantime, Krista was bragging to her job core classmates about what she had done and showing off the piece of skull.
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Showed it off like a trophy.
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Yes, her life is up until the point before she decided to take someone's life.
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That is very sad and very unfortunate.
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But you can choose to make better decisions.
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The reason why she killed someone is because she thought that girl liked her boyfriend.
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That's a good reason to kill somebody.
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She's clearly not competent.
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Well, so I'm in the middle, I'm kind of in the middle of you two here.
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I think she had a terrible upbringing.
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And this is kind of what starts making her lawyers are arguing all these facts is like what makes her eventual her eventual sentencing controversial.
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Uh and she was a juvenile, but I also am and I'm like, but she seems to lack any way she's competent.
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But the problem is that she doesn't like suddenly turn it around as as she hits 26 in that frontal lobe development.
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Okay.
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So because Chris is out there bragging and showing off this piece of skull, she gets arrested within 36 hours.
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So Pike, Ship, and Peterson all arrested.
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Peterson received six years probation in exchange for testimony.
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So they charged her with accessory after the fact, and she testified against both Pike and Ship.
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When searching Ship's dorm, they located satanic paraphernalia, including a satanic Bible, an altar, and a hexagram earring and a hat pin.
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Ship claimed to investigators that he had not planned to kill as a satanic offering, but only considered Slemmer a sacrifice after.
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Pike also confessed to the murder, but claimed that she did not lure her with the attempt to kill her just to fight her to get her to stay away from her boyfriend.
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It should be noted, not that it matters, because even if Colleen was into Ship, like that's not an excuse to kill her, but everyone's like, there was zero evidence.
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None of the classmates believe that Colleen liked this guy.
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So it was like really for nothing.
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This was this whole thing was stupid.
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Adding more than that.
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Yeah.
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So Peterson pleads guilty to accessory after the fact, as I said, gets six years probation.
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Despite confessing, you know, to the police, Pike and Ship both plead not guilty, but were found guilty of first-degree murder and conspiracy to commit first-degree murder in separate trials.
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And this is where things get controversial because she was 18 at the time of the crime and her boyfriend was 17.
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So he was charged as an adolescent and sentenced to life with the possibility of parole.
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He's already eligible for parole.
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He came up before the board and was not approved because of the severity of this crime.
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So he remains in jail.
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But the question is like, we're talking a matter of months.
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Was a matter of months supposed to make her more kind of culpable in this crime?
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So she gets sentenced to death row.
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She's the youngest woman sentenced to death row in modern history.
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At the time of this execution, she was the only woman on Tennessee death row.
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Okay, but 18-year-old men can be charged with statutory rape for a 17-year-old female.
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So how does that change anything?
00:14:18.320 --> 00:14:20.720
I'm not discrediting that she committed a crime.
00:14:21.360 --> 00:14:23.440
It's a crime, a heinous crime.
00:14:24.080 --> 00:14:29.200
She's also clearly not a well person.
00:14:29.440 --> 00:14:32.799
To be committed to death, you have to be able to comprehend that.
00:14:33.039 --> 00:14:37.759
I don't believe that this person is healthy enough to actually comprehend anything.
00:14:38.000 --> 00:14:41.200
I think she needs to be committed to a psych ward for life.
00:14:41.360 --> 00:14:50.240
You don't just take a piece of a patient's or a person's skull and like brag about that without knowing, like, without comprehending the repercussions.
00:14:50.320 --> 00:14:51.360
She's unwell.
00:14:51.600 --> 00:14:56.240
While in prison, she was diagnosed with PTSD and bipolar disorder.
00:14:56.320 --> 00:15:00.320
And her lawyers argue that the system had failed her as a child, which it did.
00:15:00.559 --> 00:15:08.399
We can all agree that I think if she's really being assaulted and she's getting report, it's getting reported by teachers and nothing and they're keeping her in the same location.
00:15:08.559 --> 00:15:09.759
That is a failure by the system.
00:15:11.440 --> 00:15:21.440
Her later appeals argue that her trial lawyers inadequately presented mitigating evidence concerning severe childhood sexual abuse, and that became part of decades of litigation over whether the death sentence should stand.
00:15:21.600 --> 00:15:33.200
So for her part, Krista Pike claimed that she was mentally ill, and it wasn't until she was diagnosed and treated for PTSD and bipolar in prison that she was really able to comprehend what she did.
00:15:33.440 --> 00:15:33.759
Okay.
00:15:34.000 --> 00:15:36.559
That's off fine and well, and maybe I would give that to her.
00:15:36.720 --> 00:15:40.720
Except that in prison she was not a model citizen.
00:15:40.960 --> 00:15:50.799
In 2001, she and another inmate attacked Patricia Jones, who was incarcerated for her own murder conviction and attempted to strangle her with a shoelace.
00:15:51.120 --> 00:15:57.919
In recorded prison phone calls, Pike bragged that it was premeditated and that she would have finished the job if she had 30 more seconds.
00:15:58.159 --> 00:16:02.879
She claims that Jones had been taunting her for years about the electric chair and called her degrading name.
00:16:03.039 --> 00:16:10.399
So I think it's safe to say if she's like, listen, I got mental health treatment, I've worked through my issues, I now know what I did is wrong.
00:16:10.639 --> 00:16:14.639
I would maybe buy into that, except at the same time you're trying to kill another person.
00:16:15.039 --> 00:16:16.159
She needs to be in a sideboard.
00:16:16.320 --> 00:16:18.879
That's what I don't understand why she didn't have a psych workout.
00:16:19.120 --> 00:16:27.120
Okay, so like every serial killer in the world goes to a psych instead of prison because they're all mentally ill.
00:16:27.440 --> 00:16:35.679
I think people don't do these crimes without some form of trauma and illness like impacting their brain as a child.
00:16:35.919 --> 00:16:37.279
Well, she's a direct example.
00:16:37.679 --> 00:16:44.080
This goes back though to the debate that everyone was having during Lindsay Clancy, also, like devil's advocate here, right?
00:16:44.159 --> 00:16:53.039
If you're to argue that way, then we should say that that Ted Jeffrey Dahmer Jeffrey Dahmer should have just been put in a psych ward.
00:16:53.200 --> 00:16:54.879
I don't believe in the death row.
00:16:54.960 --> 00:16:58.159
Like in death, you don't think you don't think they should be in prison?
00:16:58.399 --> 00:17:03.120
I think they should be in prison or in some form of controlled environment.
00:17:03.360 --> 00:17:05.839
But like, I don't believe they need to be killed.
00:17:06.079 --> 00:17:08.400
But did she have a full-sight workup?
00:17:08.559 --> 00:17:09.039
She did.
00:17:09.680 --> 00:17:10.400
That's what she's saying.
00:17:10.559 --> 00:17:15.279
So when she was failed as a child, she goes to jail, she was in psychiatric care in the jail.
00:17:15.359 --> 00:17:16.880
She's diagnosed with P T S D.
00:17:16.960 --> 00:17:19.599
She's PTSD, she's diagnosed bipolar, she's medicine.
00:17:19.759 --> 00:17:21.200
And she tries to kill another person.
00:17:21.440 --> 00:17:22.480
She's therapized.
00:17:22.559 --> 00:17:29.279
She tells everyone that she now is a rational human being and she recognizes she has insight now into what she did.
00:17:29.519 --> 00:17:34.720
And this is all part of her, like, you know, plea with her lawyers to get off death row.
00:17:34.880 --> 00:17:39.039
And then she turns around and tries to kill someone else, and she nearly succeeds.
00:17:39.279 --> 00:17:41.839
And then brags about it again.
00:17:42.240 --> 00:17:42.880
Yeah.
00:17:43.279 --> 00:17:46.480
So I think it's safe to say she wasn't all that reformed.
00:17:46.640 --> 00:17:51.680
She was found guilty of attempted murder, and she had 25 years added to her sentence.
00:17:52.640 --> 00:18:08.559
Then in 2012, the Tennessee Bureau of Investigations and the Department of Corrections foiled an escape plot in which a 23-year-old correctional office at the women's prison and the 34-year-old boyfriend of then 36-year-old Krista Pike were conspiring to break her out.
00:18:08.799 --> 00:18:16.319
So, as I mentioned, Krista Pike's lawyers were attempting to get her death sentence commuted to life without parole, arguing all the reasons we've kind of just discussed.
00:18:16.480 --> 00:18:22.880
And then other issues they raised included Tennessee's lethal injection protocol and Krista Pike's individual medical conditions.
00:18:23.039 --> 00:18:25.039
That's sort of the background on Krista Pike.
00:18:25.359 --> 00:18:32.079
And now I'm gonna shift gears here and talk about the actual lethal injection process.
00:18:32.240 --> 00:18:32.559
Okay.
00:18:32.880 --> 00:18:34.559
How it is supposed to work.
00:18:34.799 --> 00:18:38.240
There are currently 27 states that allow capital punishment.
00:18:38.400 --> 00:18:42.640
And all of those allow lethal injection as a method of execution.
00:18:42.880 --> 00:18:46.160
You guys touched on earlier the three drug cocktail, right?
00:18:46.319 --> 00:18:46.720
Mm-hmm.
00:18:47.119 --> 00:18:54.400
When they would use an anesthetic or sedative to induce unconsciousness, then a paralytic to paralyze the skeletal muscle.
00:18:54.480 --> 00:18:56.799
So this is pretty much what we do when we intubate a patient, right?
00:18:57.119 --> 00:19:05.440
You give them anesthesia first, they don't feel anything, and then you paralyze them so they can't fight you when you're trying to help them, or in this case, you know, they can't breathe.
00:19:05.599 --> 00:19:14.480
And then you give them, inject them with uh a drug, which is usually potassium chloride, to disrupt electrical activity within the heart, leading to cardiac arrest.
00:19:14.559 --> 00:19:21.680
So in theory, this should really be a painless and not traumatic for the people watching, and like just goes to sleep, and that's the end of it.
00:19:21.920 --> 00:19:35.359
I will say though, that if we were still doing this, my biggest fear, I've never even had surgery, but this is what I fear of getting waking up, of being paralyzed, but not sedated because paralysis does not equal sedation.
00:19:35.440 --> 00:19:36.880
You can feel everything.
00:19:37.119 --> 00:19:39.279
You're gonna say and you can't do anything about it.
00:19:39.440 --> 00:19:40.960
Yeah, can't communicate.
00:19:41.119 --> 00:19:43.039
I mean, why do they need a paralytic?
00:19:43.200 --> 00:19:47.759
Like, why can't they just heavily sedate someone and then just just inject potassium chloride?
00:19:48.799 --> 00:19:53.119
I think it's also all the people who are watching this in the audience.
00:19:53.279 --> 00:19:56.720
Yeah, because when people go into cardiac arrest, it's not comfortable to watch.
00:19:56.960 --> 00:20:01.920
So, anyway, the three drug cocktail was already criticized to begin with before we even went away with it, right?
00:20:02.480 --> 00:20:07.519
And then we have like the issue of drug makers, they don't want their meds to be associated with execution.
00:20:07.599 --> 00:20:15.119
So it became very hard for like the DOC to obtain the medications necessary for these executions.
00:20:15.359 --> 00:20:24.720
So now we have drug shortages, and uh as a result, these some states, including Tennessee, transitioned to a single drug protocol.
00:20:24.880 --> 00:20:31.599
And the most commonly used drug in the single drug protocol is an overdose of the sedative pentobarbital.
00:20:31.839 --> 00:20:33.920
Isn't pentobarbidol an old drug?
00:20:34.079 --> 00:20:35.279
It's been around for a while, though.
00:20:35.359 --> 00:20:36.000
We still use it.
00:20:36.240 --> 00:20:39.359
What's older phenobarbidol or pentobarbidol?
00:20:39.519 --> 00:20:40.960
One of them is like a second generation.
00:20:41.359 --> 00:20:46.480
I think phenobarbital is older than pentobarb, but isn't phenobarb like more recommended?
00:20:46.960 --> 00:20:50.720
Well, phenobarb, you can give as like a low-dose pill because it lasts a long time.
00:20:50.960 --> 00:20:52.480
That's what we use for alcohol withdrawal.
00:20:52.640 --> 00:20:52.960
You're right.
00:20:53.119 --> 00:20:59.279
Phenobarbadol was 1904, and then pentobarbadol was 1930.
00:20:59.440 --> 00:21:00.240
So they're both old.
00:21:00.720 --> 00:21:02.079
But pheno is older.
00:21:02.319 --> 00:21:06.079
Well, I kind of feel like after all of this now, pentobarbital is gonna be like propofol after Michael Jackson.
00:21:06.160 --> 00:21:09.519
Like Pentobarbital does have indications.
00:21:09.759 --> 00:21:09.920
Yeah.
00:21:10.000 --> 00:21:10.160
Yeah.
00:21:10.240 --> 00:21:11.440
What do they use it for, Kate?
00:21:11.680 --> 00:21:13.599
Status epilepticus.
00:21:13.759 --> 00:21:14.480
Yes, we use it.
00:21:14.559 --> 00:21:17.839
Uh it's a big drug in the neuroICU, uh neurocritical care.
00:21:17.920 --> 00:21:21.759
And now it is used, it can, you know, be used as like an anesthetic in low doses.
00:21:21.920 --> 00:21:26.079
The big uses I see for it, Stanis epilepticus, that has already failed treatment.
00:21:26.160 --> 00:21:30.559
So it's like oh, this is like the patient is yes, the patient has already been having seizures.
00:21:30.640 --> 00:21:31.599
They've not stopped seizing.
00:21:31.680 --> 00:21:40.960
You have already intubated them and put them down for dick for days with propofol and ketamine and versed and nothing is stopping their seizures.
00:21:41.200 --> 00:21:42.960
Then we try pentobarbital.
00:21:43.119 --> 00:21:51.279
And so pentobarbital acts on the GABA receptors, which is the same thing that the way propofol and versed and alcohol work, right?
00:21:51.519 --> 00:21:53.359
And inhibit nerve transmission.
00:21:53.519 --> 00:21:59.839
So we will use pentobarbital to pretty much, in like layman's terms, practically like cease brain activity.
00:22:00.799 --> 00:22:10.160
Like they're on an EG, titrated up, and you are just kind of limiting the brain activity to let everything cool down and to stop the seizures.
00:22:10.319 --> 00:22:19.039
And so when you do that, the dose, you load them with 15 megs per kig, and then you start a drip of about one megs per kig per hour, which is important when we compare doses.
00:22:19.119 --> 00:22:19.359
Okay.
00:22:19.440 --> 00:22:28.000
So we would say that for a 100-kilogram person, a 220 pound, 220-pound person, they're going to get a gram dose of pentobarbital.
00:22:28.240 --> 00:22:31.200
It's also used for sedation, 100 milligrams of IV for sedation.
00:22:31.279 --> 00:22:34.319
But again, if you're going to use this, the patient has a breathing tube in.
00:22:34.480 --> 00:22:39.839
Again, whenever we use pentobarbital in the hospital setting, there's a breathing tube in doing all of the work of the breathing.
00:22:40.000 --> 00:22:45.279
And there is cardiovascular monitoring because they are on medications to keep their blood pressure up and all of that.
00:22:45.440 --> 00:22:49.920
We also use it for ICP management when a patient has has, again, failed all other treatment.
00:22:50.000 --> 00:22:59.599
These are patients we have standing up in the bed and we've done all the therapies to minimize the pressure in the brain in order to prevent them from progressing to brain death.
00:22:59.839 --> 00:23:01.920
And so then we do petrobatol.
00:23:02.079 --> 00:23:04.319
This is how it is used clinically.
00:23:04.559 --> 00:23:04.880
Okay.
00:23:05.440 --> 00:23:11.680
For lethal injection, they use a five gram dose.
00:23:13.519 --> 00:23:15.279
It's given over about 15 minutes.
00:23:15.599 --> 00:23:17.119
5,000 milligrams.
00:23:17.359 --> 00:23:19.920
So a much, much higher dose.
00:23:20.160 --> 00:23:21.759
Is it just thought to kill them faster?
00:23:21.920 --> 00:23:24.559
Well, I think you want to be make sure that you're sure.
00:23:24.799 --> 00:23:25.119
Yeah.
00:23:25.279 --> 00:23:25.599
Yeah.
00:23:25.839 --> 00:23:26.640
And then here's why.
00:23:26.720 --> 00:23:37.599
So the pentobarbital before her as an execution drug was already controversial because a known side effect of pentobarbital, we see this even when we use it therapeutically at lower doses, is pulmonary edema.
00:23:37.680 --> 00:23:43.279
And they've done autopsies on patients who have had pentobarbital and they have pulmonary edema.
00:23:43.519 --> 00:23:47.359
Pulmonary edema is when is what we call water on the lungs.
00:23:48.079 --> 00:23:48.559
Yes.
00:23:48.720 --> 00:23:51.039
That's when the lungs fill up with blood.
00:23:52.000 --> 00:24:00.640
This happens because the capillary endothelial cells and the alveolar membranes, so the everything, the vessels just kind of leak in the lungs, right?
00:24:00.960 --> 00:24:02.000
It's like you're drowning.
00:24:02.160 --> 00:24:02.319
Yeah.
00:24:02.400 --> 00:24:09.119
So that's the concern is if they give punch barbital to patients and they're not fully unconscious, their tongue falls back, obstructs their airway.
00:24:09.200 --> 00:24:18.319
That the negative pressure of trying to overcome the tongue obstruction is going to exacerbate that that pulmonary edema.
00:24:18.400 --> 00:24:20.480
And so the lungs are going to fill with fluid.
00:24:20.640 --> 00:24:24.799
And are these people being executed having a sensation of drowning?
00:24:25.359 --> 00:24:28.640
Because they're kind of promised a painless death.
00:24:28.720 --> 00:24:30.160
And that's that's traumatic, right?
00:24:30.319 --> 00:24:32.240
I guess we should just bring back the guillotine.
00:24:32.319 --> 00:24:33.839
Well, what's a painless death?
00:24:34.079 --> 00:24:36.160
The other update was the Fort Hood shooter.
00:24:36.240 --> 00:24:39.039
He's gonna be executed by firing squad.
00:24:39.119 --> 00:24:39.279
Yeah.
00:24:39.359 --> 00:24:39.440
Yeah.
00:24:39.759 --> 00:24:40.240
Fire ring.
00:24:40.480 --> 00:24:46.720
The whole point of multi-the three drug usage of using the paralytic was for the audience to not have to watch anything.
00:24:47.200 --> 00:24:49.599
Yeah, I mean, I think it also does chop people's sense.
00:24:49.759 --> 00:24:54.400
It does get a component also of like, I mean, it's stop, it halts your the paralytic is gonna halt your breathing.
00:24:54.480 --> 00:24:54.640
Yeah.
00:24:54.799 --> 00:24:56.400
So I think it is gonna contribute to your death.
00:24:56.480 --> 00:25:01.200
It like halts your breathing and the potassium stops your heart, so it happens much quicker.
00:25:01.359 --> 00:25:05.920
I do, I'm sure that there's an element of let's make this prettier for the people who are watching, also.
00:25:06.480 --> 00:25:06.640
Yeah.
00:25:06.799 --> 00:25:12.720
As the different administrations have changed, there have been a lot of back and forth about the death penalty and and how we should use it.
00:25:12.799 --> 00:25:18.799
So prior to Trump's first term, there had sort of been like a halt on executions.
00:25:18.880 --> 00:25:21.039
It wasn't, they weren't banned, it wasn't a law.
00:25:21.119 --> 00:25:23.200
It was just sort of this like, we're gonna take a pause.
00:25:23.279 --> 00:25:23.599
Okay.
00:25:23.759 --> 00:25:25.279
No one was really getting executed.
00:25:25.519 --> 00:25:32.160
Trump came back, he resumed death penalty, and during his first term, the federal government used pentobarbital for 13 executions.
00:25:32.319 --> 00:25:33.759
The Biden administration took over.
00:25:33.920 --> 00:25:43.680
They continued executions, but they stopped the use of pentobarbital because there was, again, very mixed recommendations about whether pentobarbital was causing pain and suffering.
00:25:43.839 --> 00:25:46.880
And then when Trump came back, they reauthorized pentobarbital.
00:25:47.039 --> 00:25:54.000
So so the reason that Trump brought it back is because lawyers for the DOC were arguing that inmates are unconscious in under a minute after administration.
00:25:54.559 --> 00:26:00.960
And their concern is like if we stop doing this and we go find a new cocktail, like the last cocktail you guys had concerns about, right?
00:26:01.200 --> 00:26:03.119
Red off the Penta Barbara to do something else.
00:26:03.200 --> 00:26:04.799
You guys are gonna have concerns about that.
00:26:04.880 --> 00:26:10.559
And there's a higher risk of having like violent reactions and delayed death as we're getting more comfortable with the new cocktail.
00:26:10.799 --> 00:26:12.079
So that was the argument.
00:26:12.240 --> 00:26:13.200
That's why I came back.
00:26:13.359 --> 00:26:16.480
That's all the background that leads us to this specific event.
00:26:16.720 --> 00:26:21.039
Do you guys have anything to add before we jump into what happened on September 30th?
00:26:21.279 --> 00:26:33.519
My questions going into it are what the protocol is for ensuring a good Ivy line, what the protocol is in prepping the patient, how many people are part of that process, and what are the double checks.
00:26:33.920 --> 00:26:37.119
And my question is why is she a full code?
00:26:37.359 --> 00:26:41.759
My assumption is because she has to be killed with the protocol.
00:26:42.000 --> 00:26:44.640
I have a lot of answers for your questions, Colleen, that I'm gonna get into.
00:26:44.720 --> 00:26:50.319
I don't really have a great answer for you, Kate, because the problem is that the policy ends.
00:26:50.559 --> 00:26:50.960
Ends.
00:26:51.119 --> 00:26:51.440
Yeah.
00:26:51.599 --> 00:26:56.799
It's like it's like they don't they don't die with the first injection, do the second injection, and then it that's just the end of it.
00:26:56.960 --> 00:26:59.680
And so I think there was a lot of standing around for an hour here.
00:26:59.920 --> 00:27:02.240
I'm absolutely shocked they took it in closing.
00:27:02.480 --> 00:27:03.200
That's crazy.
00:27:03.440 --> 00:27:05.680
Pike's execution was scheduled for 10 a.m.
00:27:05.759 --> 00:27:11.519
on September 30th, but there was some frantic last-minute litigation, and the Federal Appeals Court temporarily stayed the execution.
00:27:11.680 --> 00:27:17.680
Krista Pike's lawyers were arguing that her medical conditions, specifically, she had essential thrombocytosis.
00:27:17.839 --> 00:27:18.400
What's that?
00:27:18.559 --> 00:27:19.200
For the listeners?
00:27:19.519 --> 00:27:19.920
Clotting.
00:27:20.160 --> 00:27:20.880
High platelets.
00:27:21.119 --> 00:27:24.319
Kind of like microclot, very high platelet count microclots.
00:27:24.640 --> 00:27:32.400
And that she had very small, hard-to-find veins, which, in their argument, would make the state's lethal injection protocol tortuous and unsafe.
00:27:32.559 --> 00:27:33.039
I'm sorry.
00:27:33.200 --> 00:27:35.119
She had this before they trained her.
00:27:35.359 --> 00:27:38.640
The lawyer is arguing this before the day of the execution.
00:27:38.960 --> 00:27:41.759
They are a diagnosis known beforehand.
00:27:41.839 --> 00:27:42.079
Yes.
00:27:42.319 --> 00:27:43.440
Not discovered afterhand.
00:27:43.680 --> 00:27:43.920
Yes.
00:27:44.079 --> 00:27:46.400
So she is supposed to be executed at 10 a.m.
00:27:46.640 --> 00:27:50.079
Her lawyers are appealing to the federal appeals court.
00:27:50.240 --> 00:27:51.599
They stay the execution.
00:27:51.680 --> 00:27:54.000
They say, You're not being executed at 10 a.m.
00:27:54.319 --> 00:27:56.160
Pause while we consider this.
00:27:56.480 --> 00:27:57.440
Okay, good question.
00:27:57.759 --> 00:28:04.160
What would thrombocytosis have to do with damage to the endothelium of the vessels?
00:28:04.400 --> 00:28:06.880
It can cause rapid needle clotting.
00:28:07.359 --> 00:28:07.680
Yeah.
00:28:08.240 --> 00:28:18.720
And then you can have vessel inflammation and quote blown veins, which they actually asked, you know, at first they'd been like, we don't think she should be executed, we think she'd be executed.
00:28:18.799 --> 00:28:26.799
On the day of the execution, they're like, okay, we agree with execution, but we don't want her executed by lethal injection because she has small, hard-to-find veins.
00:28:26.880 --> 00:28:30.559
She has a history of being a difficult IB stick, and calling it for you.
00:28:30.799 --> 00:28:32.559
They wanted a different execution method.
00:28:32.799 --> 00:28:37.119
That evening, the Supreme Court ruled six to three that the execution would proceed.
00:28:37.599 --> 00:28:39.039
Who gets the pick the method?
00:28:39.279 --> 00:28:39.680
I don't know.
00:28:39.759 --> 00:28:43.039
I don't know if it's like each state, I don't know if there was an alternate alternative method.
00:28:43.599 --> 00:28:47.599
Sometimes when I read about it, it makes it seem like the prisoner gets the pickup, they get killed.
00:28:48.000 --> 00:28:57.759
The patients that we hate putting IVs in in the hospital are like patients who have who've had a lot of sticks.
00:28:57.920 --> 00:29:00.400
So medical conditions that require them to have frequent sticks.
00:29:00.640 --> 00:29:03.920
So cancer patients, dialysis patients, they have damaged vessels.
00:29:04.000 --> 00:29:08.880
And then when we deal with like IV drug users and that kind of thing, they usually don't have any good veins left.
00:29:08.960 --> 00:29:11.039
And I was thinking about the patients who get executed.
00:29:11.200 --> 00:29:14.559
A lot of them probably do have some substance abuse history.
00:29:14.960 --> 00:29:18.240
And these are the people that are dying by lethal injection, you know?
00:29:18.319 --> 00:29:20.240
That's that is that is a challenge.
00:29:20.480 --> 00:29:21.039
Yes.
00:29:21.359 --> 00:29:24.720
Okay, so the how the method is decided.
00:29:24.960 --> 00:29:27.359
They have one, a default state law.
00:29:27.519 --> 00:29:35.839
So each state with the death penalty specifies a primary method, and which is most commonly lethal injection.
00:29:36.079 --> 00:29:38.880
Then Colleen's right, the inmate has a choice.
00:29:39.039 --> 00:29:51.119
So in few states, death row prisoners are given a lethal right, a legal right to pick their execution method, and they would be choosing between lethal injection, electrocution, and a firing squad.
00:29:51.279 --> 00:29:58.319
And then the fallback options, the state's primary method is like not available due to drug shortages, like the lethal injection.
00:29:58.640 --> 00:30:06.319
The state can dictate a backup method, like an electrical chair, nitrogen hypoxics, or a firing squad.
00:30:06.559 --> 00:30:09.440
At the very end, I have a couple quick other failed attempts.
00:30:09.599 --> 00:30:10.000
Oh wow.
00:30:10.079 --> 00:30:10.720
Hanging.
00:30:10.960 --> 00:30:19.440
Hanging is still on there, kept on the books in very rare historical statutes as an extreme backup, though virtually unused in modern practice.
00:30:19.759 --> 00:30:23.680
So the Supreme Court says proceed by lethal injection.
00:30:23.839 --> 00:30:29.839
The team, okay, the team spent nearly an hour attempting to establish a peripheral IV.
00:30:30.000 --> 00:30:31.519
That's what I've been calling it right then.
00:30:31.680 --> 00:30:32.799
With at least seven needles.
00:30:32.960 --> 00:30:33.759
That's ridiculous.
00:30:33.920 --> 00:30:38.000
At one point, Krista Pike herself offered guidance of where they could try.
00:30:38.240 --> 00:30:39.039
That is ridiculous.
00:30:39.279 --> 00:30:42.400
One needle was bent in a 90-degree angle when it was removed.
00:30:42.880 --> 00:30:43.920
Oh, a hip bone.
00:30:44.160 --> 00:30:45.440
Quick timeline here, okay?
00:30:45.680 --> 00:30:47.599
Because again, they get witnesses.
00:30:47.759 --> 00:30:54.079
There's a viewing room of like loved ones, you know, the mother of Colleen of viewing this.
00:30:54.160 --> 00:30:56.640
In another room, there's like reporters.
00:30:56.720 --> 00:30:56.960
Okay.
00:30:57.039 --> 00:30:59.279
So we have seven reporters who are observing this.
00:30:59.359 --> 00:31:01.839
And then in the middle, there's this room and there's curtains.
00:31:01.920 --> 00:31:05.359
So again, the goal is to not see any of the people who were kind of part of this.
00:31:05.440 --> 00:31:10.480
So they'll close the curtains, open them, and there's speakers so they can hear what's happening in the room.
00:31:11.119 --> 00:31:16.319
Then there's a separate room that's concealed where the medical providers are waiting.
00:31:16.480 --> 00:31:22.079
So at 7:27 p.m., the curtains open to the viewing room and Pike was seen strapped to the gurney with an IV.
00:31:22.160 --> 00:31:23.680
The warden asked if she had last words.
00:31:23.839 --> 00:31:25.440
Someone asked what her last words were, right?
00:31:25.599 --> 00:31:32.400
According to one of the reporters in the viewing room, she said, I'm going to leave this world the way I spent most of my life, and that is with love.
00:31:32.559 --> 00:31:36.799
She said she loves the people who were angry with her as much as she loves people who are on her side.
00:31:36.880 --> 00:31:39.599
And she said, quote, I'm at peace and I'm ready to go.
00:31:39.759 --> 00:31:43.440
Another reporter claimed that she said she was ready to be free and that this was a happy day.
00:31:43.599 --> 00:31:46.960
And then at 727, the pentobarbital started flowing.
00:31:47.039 --> 00:31:50.319
So again, they're going to get five grams over 15 minutes.
00:31:50.400 --> 00:32:00.400
And it sort of sounds like it's sort of like when you take a patient to MRI and you have like the pump in in a different room with the providers because everyone's hiding from the magnet.
00:32:00.480 --> 00:32:00.640
Yeah.
00:32:01.039 --> 00:32:03.920
And then the tubing goes into the room to the patient.
00:32:04.240 --> 00:32:07.200
At 7:34 p.m., she started reporting discomfort.
00:32:07.359 --> 00:32:10.480
So again, according to the reporters who were present, they described this.
00:32:10.640 --> 00:32:13.359
So she said, My arm feels like it's about to burst open.
00:32:13.519 --> 00:32:14.160
She was crying.
00:32:14.319 --> 00:32:16.400
She said, one spot is really throbbing.
00:32:16.640 --> 00:32:23.440
Three minutes later, she took four separate significant breaths, large enough to where you could see her body rising at points, sort of on and off the gurney.
00:32:23.599 --> 00:32:26.880
At 7:39, she lifted her head and looked at the IV in her arm.
00:32:27.119 --> 00:32:30.240
And the reporter said that she was kicking her feet this whole time.
00:32:30.319 --> 00:32:32.720
They had to keep like covering her back up with a blanket.
00:32:32.799 --> 00:32:40.960
Now, again, it's a 50-minute infusion, but the DOJ lawyers were arguing to the administration, you know, when they brought this back that within a minute they're unconscious, right?
00:32:41.119 --> 00:32:41.359
Right.
00:32:41.519 --> 00:32:42.559
Obviously, not in this case.
00:32:42.799 --> 00:32:48.160
741, we know that the first infusion completed because they have this like secret code.
00:32:48.319 --> 00:32:50.880
A staff member puts a rock on the windowsill.
00:32:50.960 --> 00:32:52.960
It's like a golf ball-sized rock.
00:32:53.119 --> 00:32:56.640
And that marks the completion of the drug injection.
00:32:56.720 --> 00:33:04.559
And traditionally, that starts a five-minute mandatory countdown or waiting period before medical personnel enter the room and check the vitals and confirm the death.
00:33:04.720 --> 00:33:10.319
So they get their 15-minute infusion, a rock gets placed so that everyone knows that the infusion is complete.
00:33:10.400 --> 00:33:14.720
And then five minutes later, they close the blinds and they confirm death.
00:33:14.960 --> 00:33:17.279
They're not like on a heart monitor and you don't see the core.
00:33:17.440 --> 00:33:21.759
I know I'm like, a rock, a rock is the is the sounds like a freaking Broadway show.
00:33:21.920 --> 00:33:27.039
And the theaters open and the theaters close, and the audience is on one side.
00:33:27.359 --> 00:33:30.240
Witnesses reported that her jaws were moving at 7.43.
00:33:30.400 --> 00:33:34.720
At 7.44, she took a deep breath and was kind of incomprehensibly speaking.
00:33:34.880 --> 00:33:35.920
She was yawning.
00:33:36.960 --> 00:33:40.160
And apparently reporters are like, oh, they're looking at each other like uncomfortable.
00:33:40.240 --> 00:33:41.359
Like, what is happening right now?
00:33:41.440 --> 00:33:41.680
Right.
00:33:42.319 --> 00:33:45.119
At 7.46, she's still alive and she's snoring.
00:33:45.279 --> 00:33:49.119
They close the curtains and at 7:49, they reopen.
00:33:49.200 --> 00:33:53.279
And so we assume at this point a second dose of pentabarbital has started.
00:33:53.359 --> 00:33:57.279
Because in the protocol, if the first one fails, you repeat with the second dose.
00:33:57.599 --> 00:33:58.720
They use the same item.
00:33:58.960 --> 00:34:00.240
Um, I tried to look into that.
00:34:00.319 --> 00:34:04.720
It sounds like she had damage to both arms, so I have to assume that they one IV.
00:34:04.799 --> 00:34:04.880
Yeah.
00:34:05.039 --> 00:34:07.119
That they have two IVs.
00:34:07.279 --> 00:34:07.680
Yeah.
00:34:07.920 --> 00:34:13.599
At 754, she let out a loud grunt, lifted her head up, her mouth opened, and snoring began again.
00:34:13.760 --> 00:34:17.519
And this is when her right arm apparently started to look purple and began to blister.
00:34:17.599 --> 00:34:23.519
Just before 756, her body lifted off the gurney again, both her head and her legs sort of like in a V shape almost.
00:34:23.679 --> 00:34:26.079
At 801, Pike let out a heavy sigh.
00:34:26.239 --> 00:34:27.679
The rock is placed back on the window.
00:34:27.760 --> 00:34:30.159
So now we've had the second dose completely infused.
00:34:30.239 --> 00:34:32.079
We've had 10 grams infused.
00:34:32.559 --> 00:34:40.400
And four minutes later at 8.05 p.m., her body flexed as she gasped for air, and the curtain was abruptly drawn for a second time.
00:34:40.559 --> 00:34:44.719
The witnesses and everyone are hanging out in this room with curtains, just look at each other.
00:34:44.800 --> 00:34:46.559
They said they had no clock, only one of them had a watch.
00:34:46.719 --> 00:34:48.719
They kept being like, hey, dude, how long has it been?
00:34:48.800 --> 00:34:49.360
How long has it been?
00:34:49.440 --> 00:34:50.719
They're trying to track what's going on.
00:34:50.880 --> 00:34:52.159
It was 50 minutes.
00:34:52.320 --> 00:35:00.400
They said they could hear on the microphone her snoring and her breathing until 8.53 when the microphone cut off.
00:35:00.480 --> 00:35:03.119
And then the warden asked all the witnesses to leave.
00:35:03.360 --> 00:35:10.880
As they were leaving and they were talking to the press, EMS arrived at 9.15, and at 9.28, the ambulances with police escorts left the prison.
00:35:11.039 --> 00:35:12.480
So that is how it went down.
00:35:12.559 --> 00:35:14.159
So I think, yeah, it sounds pretty clear.
00:35:14.320 --> 00:35:20.159
I don't know anyone who could survive 10 grams of pentobarbital if it was actually infusing.
00:35:20.320 --> 00:35:21.599
This sounds very clearly, right?
00:35:21.679 --> 00:35:23.119
Like infiltrated IVs.
00:35:23.280 --> 00:35:24.480
She did get all the medication.
00:35:24.639 --> 00:35:26.880
Her arms are burning, she's blistering.
00:35:27.440 --> 00:35:31.039
So that sounds like an infiltrated IV.
00:35:31.760 --> 00:35:31.920
Correct?
00:35:32.079 --> 00:35:32.559
You guys agree?
00:35:32.719 --> 00:35:34.880
Without like reports are coming out now that are kind of confirming that.
00:35:34.960 --> 00:35:40.639
But I think any healthcare professional who heard the story immediately was like, Yeah, we know what happened, right?
00:35:40.800 --> 00:35:41.119
Right.
00:35:41.360 --> 00:35:42.320
And everyone knows too.
00:35:42.400 --> 00:35:49.679
It's like when you treat a patient in the hospital and you give a med and it doesn't work, the first thing you do is like check your IV AIV and switch ID.
00:35:49.920 --> 00:35:53.840
Check your check your connections, make sure everything's connected.
00:35:53.920 --> 00:35:54.079
Yeah.
00:35:54.400 --> 00:35:56.480
Start at the patient, look at the IV in her arm.
00:35:56.639 --> 00:35:56.800
Yeah.
00:35:56.960 --> 00:35:58.079
Is it dangling out?
00:35:58.239 --> 00:36:06.400
Well, sometimes you have IV lines, like IV pumps that will be like beeping because it's hard to, you know, infuse.
00:36:06.960 --> 00:36:07.440
Infuse.
00:36:07.519 --> 00:36:07.679
Yeah.
00:36:07.840 --> 00:36:08.000
Yeah.
00:36:08.239 --> 00:36:15.119
But I guess then there's then, well, yeah, then there's sometimes that your IV infiltrates and then their whole arm is just feeling fluid.
00:36:15.280 --> 00:36:17.119
And this, you know, you just don't know.
00:36:17.199 --> 00:36:17.840
Yeah.
00:36:18.159 --> 00:36:21.440
Which if she blistered that fast, that's kind of what I assume happened.
00:36:21.679 --> 00:36:26.880
And I think one of the big side effects of pentobarbadol is like necrosis.
00:36:28.079 --> 00:36:30.320
Like it can cause necrosis.
00:36:30.559 --> 00:36:34.159
If I'm getting put to death, I'm asking them to just put a central line in me.
00:36:34.239 --> 00:36:34.559
Okay.
00:36:34.800 --> 00:36:37.280
Numb me up and put a central line in and make sure the med goes in.
00:36:37.360 --> 00:36:38.480
So I'm like, why are they not doing that?
00:36:38.559 --> 00:36:38.719
Yeah.
00:36:39.360 --> 00:36:45.199
If you are going to purposefully kill somebody, do it efficiently.
00:36:45.360 --> 00:36:46.079
Uh I looked into this.
00:36:46.159 --> 00:36:48.000
I was like, why did this patient not get a central line?
00:36:48.079 --> 00:36:49.519
Why do they not put central lines in?
00:36:49.679 --> 00:36:52.079
Maybe that's what the Supreme Court could have said.
00:36:52.159 --> 00:36:54.079
Like, hey, we hear you that you're a tough stick.
00:36:54.239 --> 00:36:55.760
So central line.
00:36:56.079 --> 00:37:00.719
There are states that allow for central line placement if a good peripheral cannot be obtained.
00:37:00.880 --> 00:37:02.639
And Tennessee is one of those states.
00:37:02.880 --> 00:37:07.679
Centraline, again, guys, is a is an IB that goes into a much bigger, it's placed by a provider.
00:37:07.920 --> 00:37:10.960
It's a it's a much larger IB that goes into a much larger vessel.
00:37:11.039 --> 00:37:17.039
So we usually put them in in the neck or uh under the clavicle or rarely in the groin.
00:37:17.199 --> 00:37:22.960
And it goes in in the and it's got a much longer catheter, so it kind of trickles down into the heart.
00:37:23.119 --> 00:37:28.880
So we use that in the hospital to give a lot of medications that are too caustic to give peripherally, like a regular IB.
00:37:29.039 --> 00:37:33.360
Again, it's more invasive, and there are risks of like infection, which in this case, who cares, right?
00:37:33.519 --> 00:37:41.840
Pneumothorax, I guess, would be the big risk of dropping a lung, but I feel like that's a very low risk if you have someone who's doing it appropriately, like who is experienced.
00:37:42.480 --> 00:37:46.960
What does it mean to have a cycle line versus just a regular peripheral IV?
00:37:47.039 --> 00:37:48.719
Is that they're going to get the medicine?
00:37:48.880 --> 00:37:49.039
Yes.
00:37:49.119 --> 00:37:51.599
There's no responsible doubt it's getting into their system.
00:37:51.840 --> 00:37:57.679
I wonder, is it you would need like an X-ray machine to confer replacement?
00:37:58.559 --> 00:38:00.719
Is that like an extra cost that they would don't do?
00:38:01.360 --> 00:38:03.840
Or you could do with use it with old, you could do with ultrasound mics.
00:38:03.920 --> 00:38:13.840
Well, if they're willing to spend all the money on the appeal process on just funding for death row in general, why can't they fund or why can't they pay for an ultrasound?
00:38:14.000 --> 00:38:14.239
Yeah.
00:38:14.400 --> 00:38:20.639
So anyway, Tennessee is a state that allows central line placement if the peripheral access cannot be obtained.
00:38:20.800 --> 00:38:23.440
And again, we already know she met criteria.
00:38:23.519 --> 00:38:25.360
They tried seven times and they couldn't get an ID.
00:38:25.599 --> 00:38:26.639
You know what probably happened?
00:38:26.800 --> 00:38:28.719
They've probably said she needs to die today.
00:38:29.119 --> 00:38:32.480
Now I know why, but I think I might have buried that lead for the end.
00:38:32.719 --> 00:38:36.639
The peripheral IVs, again, we don't know who places these because it's all very hush-hush.
00:38:36.719 --> 00:38:40.880
But there is a Tennessee Department of Correction IV team that is authorized to place these.
00:38:41.039 --> 00:38:48.880
Under standard state execution protocols, the team consists of trained prison staff and contracted individuals whose specific medical credentials are kept anonymous by law.
00:38:49.119 --> 00:38:52.639
So we don't know if they're RNs, well, medical assistants.
00:38:52.960 --> 00:38:57.599
Typically, it's a physician, a physician's assistant, a registered nurse, a paramedic, or an EMT.
00:38:57.840 --> 00:39:05.599
So anyone who is currently licensed, certified, and qualified within the United States insert IVs, which I'm gonna be honest though, like if I'm on death row and I'm getting a central one, give me a doctor.
00:39:05.679 --> 00:39:05.920
Okay.
00:39:06.079 --> 00:39:12.559
But I'm getting peripheral IV, I think I want the EMT, maybe, you know, the nurse, the again, I want the EMT.
00:39:12.719 --> 00:39:15.039
Yeah, an EMT or like an ER nurse.
00:39:15.199 --> 00:39:15.599
Yeah.
00:39:15.840 --> 00:39:18.880
Someone who, some a labor and delivery nurse.
00:39:19.039 --> 00:39:20.719
Those girls can get some IVs.
00:39:21.039 --> 00:39:23.039
They did not attempt to place a central line in her case.
00:39:23.119 --> 00:39:24.719
And what I try, I'm trying to figure out why that is.
00:39:24.800 --> 00:39:32.239
And all I can think is because there was a subcentraline drama previously this year in Tennessee with a different execution, which I'll get to later.
00:39:32.400 --> 00:39:35.599
So I'm not sure if they just like didn't want to deal with that drama or what happened.
00:39:35.920 --> 00:39:40.159
Her lawyers had asked for a central one to prevent vein rupture, and the judge had ruled it was unnecessary.
00:39:40.320 --> 00:39:46.639
So again, what we know is that her arms have reportedly become markedly swollen, burned, and blistered.
00:39:46.800 --> 00:39:59.360
An anesthesiologist retained by her defense believes the findings are consistent with pentobarbital leaking from improperly positioned IVs into surrounding tissue rather than reaching the circulation in the intended concentration, which again, we all didn't even get to review the charts.
00:39:59.440 --> 00:40:01.039
And that's what we believe, right?
00:40:01.280 --> 00:40:04.079
You gotta be able to like do a practice run.
00:40:04.159 --> 00:40:08.559
Like, let's practice putting an IV in you before your actual execution.
00:40:08.719 --> 00:40:11.760
Let's practice and prove we can get an IV in you.
00:40:12.079 --> 00:40:15.599
So then if they know they need a central line, they can actually be prepared.
00:40:15.760 --> 00:40:18.639
Because how did that judge determine it wasn't necessary?
00:40:18.880 --> 00:40:28.639
And so again, I would think this pentobarbital was probably mostly delivered to the soft tissue, which would explain delayed absorption, inadequate circulation concentration, tissue injury, and swelling and blistering.
00:40:28.800 --> 00:40:30.079
So Kate kind of talked on this.
00:40:30.159 --> 00:40:34.639
This the pentobarbital is a highly alkalotic lipophilic barbituate.
00:40:35.039 --> 00:40:35.920
Dumb that down.
00:40:36.159 --> 00:40:38.800
Well, it like Kate said, it's gonna make it really caustic, right?
00:40:39.039 --> 00:40:44.559
And the infiltrating into the soft tissue alters its pharmacokinetics completely.
00:40:44.719 --> 00:40:48.559
So when it's given intravenously, it's immediate acting, it's lethal.
00:40:48.719 --> 00:40:56.559
Uh, when it's given kind of subcutaneously through this infrared IV, it's going to be a much slower release sedative.
00:40:56.639 --> 00:40:59.760
So you're going to have much more erratic and delayed circulation.
00:41:01.039 --> 00:41:08.800
It's going to rely on kind of the passive capillary diffusion, all those little kind of, you know, blood vessels into the bloodstream instead of getting through like a big vein.
00:41:08.960 --> 00:41:14.639
Oh, it has a pH of 9.5, and in case anyone cares, uh, because of how caustic it is.
00:41:14.719 --> 00:41:18.239
And it has irritating vehicles like propylene, glycol, and alcohol.
00:41:18.400 --> 00:41:20.960
So this is what causes a local chemical irritation.
00:41:21.039 --> 00:41:22.960
You get burning, you get tissue inflammation.
00:41:23.440 --> 00:41:33.440
And uh again, having like this localized tissue injury is just going to further compromise the blood flow and like further delay your systemic absorption.
00:41:33.679 --> 00:41:39.119
Now you have sort of this um, again, this much slower peak level.
00:41:39.280 --> 00:41:49.679
So I think when we talk about later where she's at now, it's harder to kind of assess her long-term recovery because pentobarbital, when given intravenously, hangs around for a very long time.
00:41:49.760 --> 00:42:03.280
When we use it for ICP issues or seizures, we know, like if something happens, we can't do brain death testing on this patient because we can't believe that their exam is not being masked by the pentobarbital effects, right?
00:42:03.519 --> 00:42:05.840
It hangs around for many, many days.
00:42:06.079 --> 00:42:09.519
And now we've given this subcutaneously, so it's gonna hang around for even longer.
00:42:09.599 --> 00:42:16.880
So I think it's still gonna be a while before we really know, you know, how she although she was talking today.
00:42:17.119 --> 00:42:23.679
What's frustrating to me is that like it's all about them not having the contingency plan of it not working.
00:42:24.159 --> 00:42:31.360
So it's like us in my mind, a central line is mandated for every lethal injection.
00:42:31.599 --> 00:42:32.239
Should be mandated.
00:42:32.639 --> 00:42:43.760
Tennessee has had some problems in the past, and they were was a recommendation made that they get like a farm, like right now, the only person they have to consult on this is the the rep, the drug rep.
00:42:44.159 --> 00:42:44.400
Okay.
00:42:44.639 --> 00:42:52.320
And they're like, you should get like a pharmacist or someone to kind of oversee who could like maybe say these things, like, hey, God, but they didn't do it.
00:42:52.400 --> 00:42:53.440
And after this, they're like, Why'd you do that?
00:42:53.519 --> 00:42:56.000
And they're like, Well, it was just a recommendation, it wasn't a requirement.
00:42:56.159 --> 00:42:57.679
No, so that'd be pretty annoying.
00:42:57.840 --> 00:43:01.599
That is she has to be have like a hypoxic brain injury.
00:43:01.760 --> 00:43:02.719
She's not gonna be normal.
00:43:02.880 --> 00:43:05.440
There's no way that's what I keep thinking.
00:43:05.599 --> 00:43:14.000
So um, before I get into the updates about her, I really quickly had just a handful of cases, like one-liners here, of other two survived their executions.
00:43:14.079 --> 00:43:14.400
Okay.
00:43:14.719 --> 00:43:20.880
Willie Francis in 1946 in Louisiana, he was 16 and he was sentenced to death by the electric chair.
00:43:21.280 --> 00:43:21.920
16?
00:43:22.400 --> 00:43:23.360
This is the 40s.
00:43:23.519 --> 00:43:26.719
Executioners had been out boozing the night before and showed up intoxicated.
00:43:26.800 --> 00:43:31.519
So they improperly set up the portable electrical chair and failed to ground the generator correctly.
00:43:31.679 --> 00:43:34.960
He convulsed and screamed, Take it off, I can't breathe, but he didn't die.
00:43:35.199 --> 00:43:36.559
He was taken back to his cell.
00:43:36.639 --> 00:43:45.199
His lawyers fought a second execution attempt, citing cruel and unusual punishment and saying that executing him again would violate constitutional protection.
00:43:45.440 --> 00:43:49.920
Supreme Court disagreed, and he was successfully executed the following year.
00:43:50.239 --> 00:43:56.320
Rommel Broom in Chasine, Ohio, the execution team couldn't establish adequate IV access.
00:43:56.480 --> 00:43:59.760
They spent two hours and attempted 18 times before a vote.
00:44:00.079 --> 00:44:00.559
My execution.
00:44:00.800 --> 00:44:01.199
Gosh.
00:44:01.519 --> 00:44:05.599
But he never the like they couldn't get an IV and then they were like, go back to your cell.
00:44:06.079 --> 00:44:06.960
Actually, yeah.
00:44:07.280 --> 00:44:12.400
So Ohio planned another execution, but then he died of COVID before that happened.
00:44:12.480 --> 00:44:14.400
So that was that.
00:44:14.639 --> 00:44:17.119
Doyle Ham in 2018, Alabama.
00:44:17.360 --> 00:44:19.599
He had terminal cancer, hep C.
00:44:19.840 --> 00:44:23.760
And as I mentioned, these are patients who have a really hard time getting IBs in, right?
00:44:23.920 --> 00:44:26.079
Like chronically ill people cancer patients.
00:44:26.159 --> 00:44:29.760
So his attorneys warned beforehand that IV access will be extremely difficult.
00:44:30.000 --> 00:44:33.280
Execution personnel attempted for roughly two and a half hours.
00:44:33.519 --> 00:44:38.000
A subsequent medical evaluation suggested his bladder and artery may have been punctured.
00:44:38.159 --> 00:44:40.480
I wondered if they tried to do like ephemeral line or something.
00:44:40.719 --> 00:44:47.440
I don't know how else they were, you know, doing a peripheral near his bladder, which still, I mean, that's still like real bad.
00:44:47.599 --> 00:44:50.000
I'm sure in your bladder is still hard to do, I think.
00:44:50.159 --> 00:44:50.400
Yeah.
00:44:50.559 --> 00:44:52.960
Um, he died of cancer in 2021.
00:44:53.199 --> 00:44:55.760
Thomas Creech in 2024 in Idaho.
00:44:55.920 --> 00:44:58.880
They attempted IV placement, couldn't establish access.
00:44:59.039 --> 00:45:02.639
After an hour, they abandoned the execution and they went back to litigation again.
00:45:02.719 --> 00:45:05.119
It's like the lawyers were like, is it constitutional to try again?
00:45:05.280 --> 00:45:10.719
It's been stayed indefinitely uh while the courts decide if another attempt is cruel and unusual.
00:45:10.960 --> 00:45:13.679
And then Kenneth Eugene Smith in Alabama.
00:45:13.920 --> 00:45:16.800
Alabama tried to execute Smith by lethal injection in 2022.
00:45:16.880 --> 00:45:20.480
They couldn't establish IV access before the death warrant expired at midnight.
00:45:20.559 --> 00:45:21.519
So they had to call it off.
00:45:21.599 --> 00:45:25.440
It was just, it was like 11:55, and they're trying to get an IV in, and they're like, can't do it.
00:45:25.599 --> 00:45:27.760
So Alabama said, we got to try something else.
00:45:27.920 --> 00:45:32.159
And two years later, he was the first person in the US executed by nitrogen hypoxia.
00:45:33.199 --> 00:45:34.239
This is controversial as well.
00:45:34.320 --> 00:45:35.519
It is legal in five states.
00:45:35.679 --> 00:45:38.320
Since then, eight people have been executed via these means.
00:45:38.480 --> 00:45:42.559
But in execution gas, this sounds actually to me like a lovely way to go in theory.
00:45:42.719 --> 00:45:42.960
Okay.
00:45:43.119 --> 00:45:45.199
I've been in an altitude chamber, right?
00:45:45.280 --> 00:45:55.679
You just get sort of like if you're in high high altitude and you lose pressurization, you get like hypoxic, but you don't really know what you're not like oxygen-starved, right?
00:45:55.840 --> 00:45:59.519
So you just kind of get loopy and euphoric, and then you eventually lose consciousness.
00:45:59.679 --> 00:46:03.039
And I was like, that actually sounds like a pretty good way to die.
00:46:03.280 --> 00:46:06.239
Except that's not quite how it works when it's done.
00:46:07.039 --> 00:46:15.280
The five witnesses from the press reported that um this particular patient, Smith, thrashed violently on the gurney for nearly 10 minutes before he died.
00:46:15.360 --> 00:46:31.199
Uh, because they're they're arguing that since they're delivering this via a mask, like usually when you're in an airplane or if you go into like uh an altitude chamber, you're in this enclosed area and everything around you is right, the pressure, your fishbowl on it.
00:46:31.440 --> 00:46:32.000
Correct.
00:46:32.159 --> 00:46:49.280
This these patients have a mask on, so there's probably some leakage, and which they're like, so first of all, now we've got leakage and we have witnesses, so that's kind of putting them them at risk, but also it's less insidious and it actually triggers the air hunger that that you don't achieve in like an airplane.
00:46:49.440 --> 00:46:53.039
So it's kind of not as painless as uh as thought.
00:46:53.119 --> 00:46:56.159
So that's kind of a hot topic right now that people are debating.
00:46:56.480 --> 00:47:02.000
And then the last one I have happened in Tennessee just a few months ago.
00:47:02.320 --> 00:47:09.599
Tony Carruthers in May of 2026, he was supposed to be executed, but they were unable to place a peripheral IV.
00:47:09.840 --> 00:47:13.199
So he ended up getting a one-year reprieve, and he's still going to be executed.
00:47:13.519 --> 00:47:19.119
This is, I think, what came out of their kind of review of this really pertains to what happened to Krista.
00:47:19.519 --> 00:47:21.599
So the on-call doctor, Dr.
00:47:21.679 --> 00:47:27.360
Fowler, was asked to place a central line because they couldn't get a peripheral in him, which again is how the protocol is supposed to go.
00:47:27.519 --> 00:47:32.719
After an hour of failed central line placement attempts, they had to call off the execution.
00:47:32.880 --> 00:47:35.360
And when they investigated, it was discovered that Dr.
00:47:35.519 --> 00:47:40.719
Fowler had not placed a central line since 2013 when he worked in the ED.
00:47:41.119 --> 00:47:41.199
Okay.
00:47:41.360 --> 00:47:46.159
So I'm wondering if the way this went down is what impacted them not try to central line for Krista.
00:47:47.519 --> 00:47:52.400
So it went, it was investigated that he had not placed a central line since 2013 when he worked at an ED.
00:47:52.559 --> 00:48:02.320
He had only placed about a dozen in his career, which is crazy because usually you have to do like five to ten just to be like checked off for your credentials.
00:48:02.639 --> 00:48:16.000
You did five to ten observed procedures with someone watching you do this, and then it gets submitted to the hospital credentialing, and the whole little group powwows and reviews it and says, Okay, check they are capable of doing this procedure.
00:48:16.159 --> 00:48:19.360
So it's like he probably did just enough to get credentialed, and that was it.
00:48:19.599 --> 00:48:21.679
And he currently has no hospital privileges.
00:48:21.760 --> 00:48:23.519
So what kind of anyway?
00:48:24.079 --> 00:48:27.039
This is the physician who was overseeing Krista's case.
00:48:27.199 --> 00:48:29.360
Oh, so I'm wondering fire him after that.
00:48:29.679 --> 00:48:30.800
No, so I'm one no.
00:48:30.960 --> 00:48:33.599
So I'm wondering if how does he still have a job?
00:48:33.760 --> 00:48:39.679
The reason he didn't do a central line is because it went so poorly last time, and so they didn't want to go down that route.
00:48:39.840 --> 00:48:40.320
I'm so sorry.
00:48:40.400 --> 00:48:41.760
How does he still have a job?
00:48:41.920 --> 00:48:44.719
Or how is he still the person in charge of that?
00:48:45.039 --> 00:48:47.119
Sounds like there's gonna be a lot of reform after this.
00:48:47.280 --> 00:48:48.000
That's all I have.
00:48:48.159 --> 00:48:55.039
The quick update uh from today uh at the time of this recording, it's been about a week since Tennessee gave Krista Pike those two doses.
00:48:55.199 --> 00:48:56.800
The Breaking Tube came out yesterday.
00:48:56.960 --> 00:48:58.000
She is awake and talking.
00:48:58.079 --> 00:49:01.519
I'm not sure how like articulate she is, you know.
00:49:01.679 --> 00:49:04.639
So the medical mystery isn't whether she's gonna survive, because that was the first question.
00:49:04.719 --> 00:49:05.760
Is she gonna survive this?
00:49:06.000 --> 00:49:09.280
The medical mystery is an idiotic system with core planning.
00:49:09.440 --> 00:49:13.599
Yes, and and the next question is should the state attempt to execute her again?
00:49:13.840 --> 00:49:15.599
Well, she's still competent to be executed.
00:49:15.760 --> 00:49:15.920
I know.
00:49:16.400 --> 00:49:20.880
Well, we don't know if she's competent to be executed, we don't know how much brain damage is done.
00:49:21.039 --> 00:49:27.280
I think too, all those other cases I listed, like those people they couldn't get a peripheral IV, right?
00:49:27.360 --> 00:49:32.639
But no one had actually like received the drugs and then failed.
00:49:32.800 --> 00:49:35.920
So yeah, like why did they not stop for her?
00:49:36.400 --> 00:49:39.920
What got them to stop for the other people, but not her?
00:49:40.880 --> 00:49:42.719
And they must have they placed their IVs.
00:49:42.800 --> 00:49:43.199
Yeah, right.
00:49:43.280 --> 00:49:46.320
Yeah, they said, okay, we've got we've got trying some IVs.
00:49:46.480 --> 00:49:55.840
And yeah, I think the other thing I touched on, I think all this also what's come out is just that that that we don't know what happened for those 50 minutes, and then the curtains were closed and the witnesses left.
00:49:56.159 --> 00:50:01.679
But the protocol does not go beyond if they don't respond, you may give a second dose, and then that's it.
00:50:01.840 --> 00:50:05.599
So it was probably still out of everybody looking at each other.
00:50:05.840 --> 00:50:06.239
Oh shit.
00:50:06.320 --> 00:50:07.199
Why do we well?
00:50:07.280 --> 00:50:13.280
It sounds like that's what was going on in the witness room, and then I guess in the separate medical room, they probably were I bet they were calling people.
00:50:13.679 --> 00:50:17.440
How long did it take for them to actually start resuscitating her in any way?
00:50:17.760 --> 00:50:22.480
I'm not even sure that they it was 50 minutes, they closed the blinds, they said please leave.
00:50:22.800 --> 00:50:25.760
And then 20 minutes later, EMS was there.
00:50:26.000 --> 00:50:26.159
Right.
00:50:26.480 --> 00:50:29.760
And they are the microphones were on for a while.
00:50:30.000 --> 00:50:34.239
It sounds like there was no sounds of like resuscitation.
00:50:34.480 --> 00:50:36.320
Sounds like there was a lot of like agonal breathing.
00:50:36.400 --> 00:50:38.400
It looks like they were when she die.
00:50:38.800 --> 00:50:46.480
And uh no, I bet they were in the other room watching in their private medical room, going oh shit and scrambling and calling people.
00:50:46.719 --> 00:50:52.000
Yeah, but but all we have is a guy who hasn't has no privileges, who hasn't really practiced for a while, and this is what he does.
00:50:52.079 --> 00:50:56.159
And we have no pharmacist because all we have to consult is the is the rep.
00:50:56.400 --> 00:50:59.840
And we have like a bunch of again, what's wrong with healthcare, right?
00:50:59.920 --> 00:51:05.679
A bunch of non-medical people making the decisions, right, who aren't, you know, at the bedside.
00:51:05.840 --> 00:51:09.440
So it feels rushed, or it feels more planned.
00:51:09.840 --> 00:51:17.199
And if you spend an hour getting a PIV, I personally would not feel confident in anything I place if it took me an hour to even try to get one.
00:51:17.440 --> 00:51:29.119
Rushed, they have they should have stopped decades to plan these, but yet they don't have the appropriate contingency plan, don't have the appropriate pharmacist, they don't even have appropriate provider on board.
00:51:29.360 --> 00:51:34.400
I think the even more embarrassing thing is that in May, you already had this embarrassing moment.
00:51:34.639 --> 00:51:35.280
Exactly.
00:51:35.440 --> 00:51:41.280
And you've again had had five months you did nothing to get a better plan in place.
00:51:42.960 --> 00:51:44.559
That's embarrassing, Tennessee.
00:51:44.800 --> 00:51:50.159
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00:52:20.800 --> 00:52:22.079
Kate, what should the people do?
00:52:22.239 --> 00:52:30.480
Yeah, the people, they should take out their phone right now and text this to three different people if you think that they are gonna be interested in this case.
00:52:30.639 --> 00:52:38.559
And then scroll on down, leave us a five-star review, share it on your social media platforms, interact with us on our social media platforms.
00:52:38.800 --> 00:52:39.280
Yeah.
00:52:39.599 --> 00:52:41.119
See you guys next Tuesday.
00:52:41.440 --> 00:52:43.199
See you next Tuesday.