Difficulty with setting IV lines is not new in the state, as medical teams in the majority of inmates executed between 2010 and 2025 struggled to properly insert IVs in both arms and resorted to insertion in places like the hand, or the femoral artery, located near the groin.
Though the autopsy revealed failure with the injections, Djerf showed no signs of acute pulmonary edema, a sudden build-up of fluid in the lungs causing a sensation akin to drowning, which is common in lethal injection and a key constitutional concern for capital defense attorneys and death penalty scholars.
Execution protocol and procedure remain at the forefront as the state moves to execute a third inmate in March.
“Arizona’s secrecy around the execution process, specifically the qualifications of the executioners and the source of the lethal injection drugs, prevents any definitive conclusions about ADCRR’s current practices,” Dale Baich, former capital defender, said.
Djerf, the 2nd death row inmate to be executed after another pause on executions, was convicted for the 1993 murder of 4 members of the Luna family. He was executed on Oct. 17, 2025.
According to witnesses, the execution process started with some difficulty inserting the IV, with medical personnel having to make a handful of punctures to start.
Despite this, witnesses said there were no obvious signs of pain and described the execution as “clinical.”
The autopsy report, signed and submitted by Pinal County’s chief medical examiner, Dr. John Hu, found 4 needle puncture marks on the left arm and 3 on the right.
Examiners found the needle tip in the left arm “does not appear to be in the vein” and there was a “small amount of clear fluid present” in the layer of fat just below the skin.
Dale Baich, a former capital defense attorney, noted the multiple IV insertion attempts and the apparent failure to puncture a vein were “problematic and consistent with ADCRR’s history of having difficulty setting IV lines for executions.”
Baich noted that in 11 of the 16 executions between 2010 and 2022, medical teams, after multiple failed attempts to place IVs in the arm, resorted to the femoral artery, located near the groin.
“In at least 6 of those cases, the femoral line itself required multiple attempts. These difficulties continued during the three executions conducted in 2022, and they continue today,” Baich said.
In the 2022 execution of Clarence Dixon, the 1st inmate put to death since the botched execution of Joseph Wood in 2014, media witnesses reported medical staff spending 25 minutes to insert IVs, while Dixon’s attorneys put the time closer to 40 minutes.
After failure to insert IVs in his arms, the medical team resorted to the femoral artery.
In Frank Atwood’s case, witnesses reported Atwood advised the executioners to try inserting the IV into his hand after they failed to secure a connection in his right arm.
Murray Hooper also had to have an IV inserted into his femoral artery.
But in a departure, Aaron Gunches, the 1st inmate executed after another pause on capital punishment, saw no trouble with IV insertion into both of his arms.
Beyond insertion, acute pulmonary edema remained a key concern as the state resumed executions.
Ahead of Gunches’ execution, Corinna Barrett Lain, a professor of law at the University of Richmond, flagged the potential for lethal injection giving way to acute pulmonary edema, which she described as “excruciatingly painful, causing individuals to experience the sensation of being waterboarded as they drown in their own fluids.”
Examinations of both Gunches and Djerf showed no excess fluid in their lungs, and the examiner concluded there was no significant pulmonary edema in either case.
“Either ADCRR was unusually fortunate, or it changed its execution practices during last year’s executions,” Baich said.
According to a letter from the department to the governor in November 2024, there have, in fact, been some changes.
Before the state resumed capital punishment and before the governor cut short an external review by a former federal judge, Thornell briefed Gov. Katie Hobbs on internal changes to department orders and the current level of preparedness for an execution.
For one, the department doubled the size of the medical and IV team from 2 to 4, with 2 medical doctors and one phlebotomist, and increased training from a minimum of one training session to quarterly training, with live insertion of an IV catheter.
The department also added health assessments of inmates in holding cells and provided the medical and IV team with necessary health information ahead of the execution.
In his letter to the governor, Thornell acknowledged that the department had “faced criticism in relation to the medical decisions made and differing communication between the Director and medical/IV team throughout the execution process, including types of IV placements and reasons for medical protocols.”
Thornell addressed the femoral cut in particular.
There is inconsistency in the record about if and why this procedure was used in the last 3 executions, indicating unclear documentation, inconsistent expectations, and differing communication between the previous Director and the medical/IV team,” Thornell wrote. “Nonetheless, the Department has now clearly identified the Director’s role in decision-making and the role of the medical/IV team leader in informing the Director to aid this.”
Thornell said he would not make decisions without the advice of a trained and qualified medical and IV team.
The state’s next execution will soon get underway, with a motion for a warrant of execution for Leroy McGill, a man convicted of murder and attempted murder, due from the state on Jan. 16.
Source: Arizona Capitol Times, Kiera Riley, January 16, 2026
"One is absolutely sickened, not by the crimes that the wicked have committed,
but by the punishments that the good have inflicted."
but by the punishments that the good have inflicted."
— Oscar Wilde
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