For about an hour in May, healthcare workers repeatedly tried to establish IV access so Tennessee could inject death row inmate Tony Carruthers with a lethal dose of sedative at Riverbend Maximum Security Institution in Nashville.

Maria DeLiberato, an attorney for Carruthers who witnessed the attempt, said workers punctured his arms and feet without successfully placing the lines. Physician Mark Fowler then attempted to place a central line through Carruthers’ collarbone and shoulder, but that effort also failed.

Carruthers groaned as blood seeped from the puncture wounds, according to DeLiberato. After more than an hour, Gov. Bill Lee instructed the warden to stop the execution attempt and later granted Carruthers a one year reprieve.

The ordeal has intensified demands from Tennessee doctors and nurses who want medical professionals removed from executions. They have joined defense attorneys and nine Republican state lawmakers in calling for a death penalty moratorium and an overhaul of Tennessee’s execution methods.

More than 40 doctors and nurses sent Lee a letter two months after the halted injection. They argued that Tennessee rules requiring pharmacists, physicians, and other healthcare workers to participate in executions conflict with medical ethics and guidance from organizations including the American Medical Association.

The AMA code says physicians must preserve life when there is hope of doing so and bars their participation in executions. The healthcare workers’ letter delivered a blunt assessment of professionals who agree to participate.

“This means that the health care professionals who agree to take part in Tennessee’s executions are those willing to set aside their professional ethics,” the letter reads. “The problems that we have seen, such as in Mr. Carruthers’s case, are the predictable result of working with such unscrupulous actors.”

Under Tennessee’s protocol, the IV team abandoned its effort to place a typical line after several unsuccessful attempts. Fowler, a contractor for the state prison system, then used several syringes while trying to insert a central line into a deeper vein.

In an October 2025 deposition, Fowler said he had not performed the procedure during the 12 years since leaving emergency room work. He also said he had not known that placing a central line could be part of his execution duties.

Fowler told NPR by phone on Sept. 24 that “the doctor does not participate in the execution. The only thing the doctor does is declare the person dead.” He offered no further comment.

Retired Nashville hematologist John Greer said placing a central line requires reaching a large vessel above the heart. He said mistakes can cause a collapsed lung or heavy bleeding, and only people with specific training and routine practice should attempt the procedure.

“Placing a central line is not just sticking a needle in a person’s arm,” Greer said during a news conference about the healthcare workers’ letter. He added, “And I cannot imagine that there would be someone who’s doing these routinely who would be involved in this procedure.”

Lee rejected calls for a pause during the summer. “The Department of Correction did exactly what they should,” he said. “It should not affect executions in the future.”

The state’s protocol requires a curtain to cover the media witnesses’ viewing window until IV access has been established. The Reporters Committee for Freedom of the Press and news organizations including NPR member station WPLN filed a lawsuit arguing that this secrecy conceals problems such as those in Carruthers’ case.

Tennessee is among 27 states where capital punishment remains legal, according to the Death Penalty Information Center. Since the beginning of 2020, 170 people have been executed in 17 states, while six states have experienced botched lethal injections involving unexpected protocol departures and more pain than anticipated.

The dispute gained urgency as Tennessee prepared to execute Christa Pike on Sept. 30. Pike’s attorneys argued that her platelet disorder made it likely she would require a central line and that Fowler’s involvement placed her at risk of needless suffering.

Senior Judge Mark Ward, appointed as a special investigator, held hearings in Knoxville and reported that he did not believe the process would violate Pike’s rights. The Tennessee Supreme Court denied her requested stay on Sept. 23, and Lee announced on Sept. 28 that he would not grant clemency.

On Sept. 30, a federal appeals court halted Pike’s execution about an hour before it was scheduled. The U.S. Supreme Court later allowed it to continue, but Pike was transported to a hospital after receiving what was intended to be a lethal injection.