Tennessee Reduced Training in IV Placement in New Lethal Injection Protocol

The protocol that took effect in 2025 sheds new light on Tony Carruthers’ botched execution, when Dr. Mark Fowler spent nearly an hour trying, and failing, to place a secondary IV line

Tennessee’s lethal injection protocol adopted a year and a half ago appears to include reduced training in IV placement. That’s the part of the process prison staff failed to complete last month before aborting the execution of Tony Carruthers. Filings from ongoing litigation over the protocol show concerns about the executioners’ training and qualifications aren’t new. 

Under the protocol in place from 2018 to 2022, execution team members were required to hold monthly mock executions including “all steps of the execution process” with three explicitly listed exceptions: a volunteer would play the role of the person being executed, saline solution would be substituted for the lethal injection chemicals, and a body would not be placed in a body bag. The new protocol, which went into place in January 2025 after an independent review ordered by Gov. Bill Lee, also includes monthly rehearsals of each step of the execution process but with an additional exception: “No IV is inserted into the person playing the role of the inmate.” 

In response to questions from the Banner about the protocol, Tennessee Department of Correction Communications Director Dorinda Carter said only, “we are unable to comment.” 

Carruthers would have been the fourth person executed using the current lethal injection protocol. His May 21 execution was called off after prison staff spent more than an hour attempting to place a secondary IV line. Maria DeLiberato, the American Civil Liberties Union attorney who was by Carruthers’ side in the death chamber, told reporters that the would-be executioners “tortured him trying to find a vein,” puncturing his left arm, feet, hand, jugular vein and right shoulder. The execution was finally halted after Dr. Mark Fowler, a physician contracted for executions by the state, failed to establish a central line in Carruthers’ chest. The protocol includes that procedure as a last resort. 

In the aftermath, Fowler has come under scrutiny for the apparent ethical contradictions in his participation as well as his qualifications. In a 2025 deposition taken as part of a lawsuit challenging the lethal injection protocol, Fowler said that he hadn’t placed a central IV line since he stopped working as an emergency room doctor in 2013. State records show Fowler has an active medical license but no hospital privileges. 

The American Medical Association’s Code of Ethics says explicitly that physicians “must not participate in a legally authorized execution,” including by “starting intravenous lines as a port for a lethal injection device.” Fowler told NBC News earlier this month that he participates in executions to reduce suffering.

“Every attempt was made to minimize the defendant’s discomfort in the case at hand,” he said, according to the report. “No one wants Carruthers to suffer.”

Documents from the ongoing lawsuit over Tennessee’s lethal injection protocol show that concerns were raised about the execution team’s ability to place IV lines well before Carruthers went to the death chamber.

The 2025 protocol states that team members are to receive “training in vascular access / IV therapy by a qualified third party” and the case file includes redacted certificates from a four-hour workshop in those areas. But in an expert opinion filed in March by attorneys representing the death row prisoners challenging the protocol, pharmacist and professor Dr. Michaela Almgren wrote that “this instruction is not sufficient to ensure proficiency.” The TDOC did not answer a question from the Banner about the third party training provider. 

The 2025 protocol also states that the IV team for executions “consists of at least two members who are either physicians, physician assistants, nurses, emergency medical technicians (‘EMTs’), paramedics, military corpsman with relevant medical training, or other certified or licensed personnel including those trained in the United States Military.” 

But in another expert opinion on behalf of the death row plaintiffs, Dr. Rebecca Weintraub, a physician and Associate Professor at Harvard Medical School, cited multiple red flags including the lack of required IV placement rehearsals.  

“It is unclear from the protocol who is responsible for ensuring that IV Team Members are qualified or how the Tennessee Department of Corrections defines ‘qualified,’” Weintraub wrote. “Further, the selected team members are not shared externally, nor is any third party checking their licensure or verifying credentials. In fact, one factor that determines their selection is their ‘ability to maintain confidentiality.’” 

Source: nashvillebanner.com, Steven Hale, June 30, 2026

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