Private Autopsy Documents ​‘Carnage’ Experienced by Alabama Death-Row Prisoner Joe Nathan James During Longest Botched Lethal-Injection Execution in History

A pri­vate autop­sy of Alabama death-row pris­on­er Joe Nathan James, Jr. sug­gests that unqual­i­fied cor­rec­tions per­son­nel sub­ject­ed him to a tor­tur­ous, hours-long exe­cu­tion process in a botched exe­cu­tion that experts say was the longest since the advent of lethal injec­tion forty years ago.

The autop­sy find­ings, described by reporter Elizabeth Bruenig in an August 15, 2022 exposé in The Atlantic, doc­u­ment mul­ti­ple failed attempts to set an intra­venous exe­cu­tion line, punc­ture wounds in Mr. James arm mus­cles that appear to be unre­lat­ed to efforts to insert the IV, mul­ti­ple unex­plained inci­sions, and bleed­ing and bruis­ing around Mr. James’ wrists where he was strapped to the gur­ney. Bruenig called the exe­cu­tion ​“lengthy and painful,” and a doc­tor who attend­ed the autop­sy said the exe­cu­tion team that car­ried it out ​“was unqual­i­fied for the task in a most dramatic way.”

The report belies the rep­re­sen­ta­tion by ADOC Commissioner John Hamm that ​“noth­ing out of the ordi­nary” occurred dur­ing the three-hour peri­od between the sched­uled start of James’ exe­cu­tion at 6:00 p.m. on July 28, 2022 and the time the cur­tain to the exe­cu­tion cham­ber was opened at 9:02 p.m. to reveal a motion­less and non­re­spon­sive James on the execution gurney.

The autop­sy, which was con­duct­ed August 2, 2022, sev­er­al days after the offi­cial post mortem exam­i­na­tion, was fund­ed by the human rights orga­ni­za­tion Reprieve US on behalf of James’ fam­i­ly. Bruenig, who wit­nessed the pri­vate autop­sy, along with not­ed Emory University anes­the­si­ol­o­gist Joel Zivot, wrote that James’ ​“hands and wrists had been burst by nee­dles, in every place one can bend or flex” dur­ing a ​“lengthy and painful death.” The ​“car­nage” on his body, she said, indi­cat­ed that “[s]omething ter­ri­ble had been done to James while he was strapped to a gur­ney behind closed doors with­out so much as a lawyer present to protest his treat­ment or an advo­cate to observe it.”

Reprieve exec­u­tive direc­tor Maya Foa esti­mat­ed that the exe­cu­tion took between three and three and a half hours to car­ry out from the time the exe­cu­tion team first attempt­ed to insert the intra­venous exe­cu­tion line. Reprieve’s review of 275 botched U.S. exe­cu­tions since 1890 found that it was the longest botched exe­cu­tion on record.

Death Penalty Information Center exec­u­tive direc­tor Robert Dunham said in a state­ment that ​“There is no ques­tion that this is anoth­er botched exe­cu­tion, and it is among the worst botch­es in the mod­ern his­to­ry of the U.S. death penal­ty.” It is the longest botched lethal-injec­tion exe­cu­tion in the 40-year his­to­ry of that exe­cu­tion method, fol­lowed by Alabama’s 2½-hour fail­ure to estab­lish an exe­cu­tion line in the abort­ed February 2018 exe­cu­tion of Doyle Ray Hamm.

Physical mark­ers of a botched execution

To med­ical pro­fes­sion­als who have exam­ined the body, the dam­age on James’s arm — punc­ture wounds, bruis­ing, a deep inci­sion, and shal­low lac­er­a­tions — sug­gest James’s expe­ri­enced a tor­tur­ous few hours before dying.

The pri­vate autop­sy was con­duct­ed by inde­pen­dent pathol­o­gist Boris Datnow and assist­ed by Jay Glass and Dr. Zivot. The doc­tors found punc­ture wounds, accom­pa­nied by bruis­es, through­out James’ arms. Puncture wounds and bruis­ing around the knuck­les and wrists, they say, sug­gest­ed that exe­cu­tion team mem­bers tried and failed to insert IV lines in those loca­tions. They also found punc­ture wounds in James’ mus­cu­la­ture, ​“not in the anatom­i­cal vicin­i­ty of a known vein,” Zivot wrote. 

“It is pos­si­ble that this just rep­re­sents gross incom­pe­tence, or some, or one, or more of these punc­tures were actu­al­ly intra­mus­cu­lar injec­tions,” Zivot explained. On the night of the exe­cu­tion, Commission Hamm specif­i­cal­ly denied that the exe­cu­tion team had sedat­ed James, a rep­re­sen­ta­tion lat­er repeat­ed to the media by an ADOC spokesper­son. However, Zivot said, ​“An intra­mus­cu­lar injec­tion in this set­ting would only be used to deliv­er a sedating medication.” 

On the inside of James’s left arm, exam­in­ers found a jagged inci­sion, which Zivot con­clud­ed was like­ly from a ​“cut­down” —a med­ical pro­ce­dure in which a deep cut is made to expose a vein. ​“I can’t tell if local anes­thet­ic was first infused into the skin, as slic­ing deep into the skin with a sharp sur­gi­cal blade in an awake per­son with­out local anes­the­sia would be extreme­ly painful,” Zivot explained. 

“In a med­ical set­ting, ultra­sound has vir­tu­al­ly elim­i­nat­ed the need for a cut­down,” Zivot said, ​“and the fact that a cut­down was uti­lized here is fur­ther evi­dence that the IV team was unqual­i­fied for the task in a most dramatic way.”

Mayo Clinic pathol­o­gist Mark Edgar also reviewed pho­tographs of the autop­sy pro­vid­ed by The Atlantic. Edgar said he believed a jagged inci­sion on James’ arm was like­ly caused by sud­den move­ment of the arm while the exe­cu­tion team was attempt­ing to cut it. Edgar said the shal­low lac­er­a­tions through­out James’ arms were like­ly not part of the pro­ce­dure, but were more like­ly incurred ​“dur­ing a strug­gle that took place dur­ing the pro­longed efforts to gain access to a vein.”

“Subjecting a pris­on­er to three hours of pain and suf­fer­ing is the def­i­n­i­tion of cru­el and unusu­al pun­ish­ment,” Foa said. ​“States can­not con­tin­ue to pre­tend that the abhor­rent prac­tice of lethal injec­tion is in any way humane.”

ADOC’s Refusal to Disclose the Truth About the Execution

ADOC offi­cials have repeat­ed­ly pro­vid­ed unin­for­ma­tive or eva­sive answers in response to media ques­tions about James’ botched exe­cu­tion. After ini­tial­ly stat­ing that the three-hour delay involved ​“noth­ing out of the ordi­nary,” ADOC ulti­mate­ly admit­ted that they had dif­fi­cul­ty set­ting an IV line, but said it could not con­firm whether James was ​“ful­ly con­scious” when the exe­cu­tion cur­tain opened. Prison offi­cials stat­ed that James had not been sedat­ed before the exe­cu­tion cur­tain was opened. ADOC has con­tin­u­ous­ly refused to explain what hap­pened to James in the three hours before the media wit­ness­es were admit­ted to view the execution.

The exe­cu­tion was sched­uled for 6 p.m. local time. Media wit­ness­es were slowed from enter­ing the exe­cu­tion cham­bers by cor­rec­tions offi­cials, who sub­ject­ed two vet­er­an reporters who had cov­ered numer­ous exe­cu­tions with­out inci­dent in the past to cloth­ing inspec­tions. After deter­min­ing that Associated Press reporter Kim Chandler’s cloth­ing sat­is­fied the dress code, prison offi­cials deemed a skirt that AL​.com reporter Ivana Hrynkiw had worn to wit­ness sev­er­al pri­or exe­cu­tions too short to gain admit­tance to the prison. After Hrynkiw changed clothes to sat­is­fy that edict, the offi­cials fur­ther delayed media entry to the prison by the telling Hrynkiw that she could not wear open toed shoes into the facility.

The media wit­ness­es report­ed that they final­ly left the media room by prison trans­port van at 6:33 p.m. for the two-mile dri­ve to the exe­cu­tion cham­ber at the Holman Correctional Facility. They then were left in the trans­port van for more than two hours before being per­mit­ted entry to the exe­cu­tion view­ing room at 8:57 p.m. When the cur­tain to the exe­cu­tion cham­ber was raised at 9:02 p.m., mul­ti­ple reporters not­ed that James’s eyes were closed and that he lay motion­less and non­re­spon­sive on the gur­ney. He remained non­re­spon­sive when the death war­rant was read to him at 9:03 and he was asked whether he had any final words to offer. Alabama Attorney General Steve Marshall cleared the admin­is­tra­tion of the drugs at 9:04 p.m. Reporters indi­cat­ed that ​“James blinked and his eyes flut­tered briefly” after the drugs were inject­ed. He was pro­nounced dead at 9:27 p.m.

Jim Ranson, James’s for­mer defense lawyer said that ADOC’s asser­tion that James had not been sedat­ed was a ​“red flag.” According to Ranson, The Atlantic report­ed, it ​“didn’t ring true” that James would have laid on the gur­ney still and mute. James would have fought until the end against the exe­cu­tion, Ranson said.

“Joe always had some­thing to say,” Ranson said. ​“Joe would’ve said no.” 

“First, [it was] a tor­tur­ous pro­ce­dure behind closed doors, then a the­atri­cal per­for­mance for wit­ness­es,” Foa said.

After the exe­cu­tion, the Montgomery Advertiser sub­mit­ted a pub­lic records request for records relat­ed to James’ exe­cu­tion and what tran­spired dur­ing the three-hour delay. On August 11, 2022, ADOC denied that request. In a let­ter received by the Advertiser on August 15, an offi­cial in ADOC’s Research and Planning Division assert­ed that the paper was seek­ing ​“pro­tect­ed and con­fi­den­tial, secu­ri­ty sen­si­tive infor­ma­tion that does not rea­son­ably need to be viewed by the pub­lic and would be detri­men­tal to the pub­lic’s best interest.”

“Every media wit­ness to the exe­cu­tion observed that Mr. James was already non­re­spon­sive when the cur­tain was opened,” Dunham said. ​“The autop­sy results tell us a lot — but not enough — about what ADOC was doing over the course of the three-hour ​‘delay.’ Unfortunately, one of the most impor­tant things the results tell us is that the ADOC exe­cu­tion team was not com­pe­tent to prop­er­ly car­ry out this exe­cu­tion and that ADOC prison offi­cials can­not be trust­ed to tell the truth.”