Surviving a lethal injection is extremely rare, but it has happened. When an execution fails midway through, the process is halted, the person is returned to their cell, and a legal and medical scramble begins. The physical aftermath depends on how far the drugs got into the body and whether they reached the bloodstream at all. In most cases, the person suffers significant pain, tissue damage, and psychological trauma before any question of “what next” even arises.
Why Lethal Injections Fail
The most common reason a lethal injection goes wrong is failed intravenous access. The three-drug protocol requires drugs to flow directly into a vein: a sedative to render the person unconscious, a paralytic to stop breathing, and potassium chloride to stop the heart. If the IV line isn’t properly placed, the drugs leak into surrounding soft tissue instead of the bloodstream. This is called infiltration, and it changes everything about how the drugs behave.
Prison execution teams typically have no formal training in anesthesia. A 2005 study published in The Lancet found that personnel responsible for carrying out executions delivered drugs remotely with no monitoring, no data recording, and no peer review. Many inmates on death row have a history of intravenous drug use, which damages and collapses veins, making access even harder. In some cases, teams have spent over an hour searching for a usable vein before giving up entirely.
In 2022, botched execution attempts made up more than a third of all execution attempts in the United States, a record high. Researchers called even that figure conservative, since it only counted incidents where the prisoner had already entered the execution chamber. Several additional executions were called off before reaching that point due to failures to follow state protocols.
What Happens to the Body During a Botched Attempt
When drugs infiltrate soft tissue instead of entering the bloodstream, the effects are dramatically different from what the protocol intends. During the 2006 execution of Angel Diaz in Florida, both IV catheters were improperly positioned in the soft tissue of his arms. None of the drugs reached his circulation as intended. Diaz took 34 minutes to die while witnesses observed him wincing, shuddering, and gasping for air. An autopsy revealed 30-centimeter chemical burns on both inner arms where the drugs had pooled under the skin.
The 2014 execution of Clayton Lockett in Oklahoma followed a similar pattern. The IV was placed in his groin, but the drugs infiltrated into surrounding tissue. Ten minutes after receiving the sedative midazolam, Lockett was assessed as unconscious, and the paralytic and potassium chloride were injected. He then began moving and speaking. The execution team realized the drugs had not entered his bloodstream properly. As staff scrambled to place a new IV line, Lockett’s heart rate gradually slowed, and he died from cardiac arrest several minutes later. An autopsy found high concentrations of midazolam pooled in his groin tissue, confirming the infiltration. Toxicology showed some of each drug had been absorbed into his blood, meaning he likely died from the potassium chloride reaching his heart through slow, uncontrolled absorption. Whether he was conscious during his final moments remains unknown.
The paralytic drug in the protocol creates a particularly disturbing possibility. It paralyzes all voluntary muscles, including those used for breathing and facial expression. If the sedative fails but the paralytic works, a person could be fully conscious, suffocating, and feeling the burning pain of potassium chloride stopping their heart, all while appearing calm and still to observers. Researchers have raised concerns that this may have occurred in multiple executions where witnesses noted inmates continuing to breathe after the sedative was administered.
The Case of Doyle Lee Hamm
One of the clearest cases of someone surviving a lethal injection attempt is Doyle Lee Hamm in Alabama. In February 2018, the execution team spent hours attempting to establish IV access. They probed his legs, feet, and groin searching for viable veins. His attorney described the process as torture. The execution was ultimately called off when the team could not find a usable vein.
Hamm was returned to his cell with puncture wounds across his lower body. He was never executed again. Alabama reached a legal settlement in which the state agreed not to attempt another lethal injection on him. Hamm remained in prison, where he died of natural causes in 2021 at age 64. His case became a landmark example of what critics call cruel and unusual punishment in the execution process itself, not just in the death that follows.
Legal Consequences of a Failed Execution
There is no universal rule in the United States that prevents a state from trying again. Historically, courts have allowed second attempts. The legal question centers on whether a repeated attempt constitutes double jeopardy (being punished twice for the same crime) or cruel and unusual punishment under the Eighth Amendment. Courts have generally ruled that a failed execution is not the same as serving a sentence, so the state retains the right to carry out the original order.
In practice, though, a failed attempt often triggers litigation that can delay or prevent a second try. Hamm’s case ended in a settlement. Other cases have prompted governors to issue moratoriums or led to reviews of state execution protocols. After Angel Diaz’s prolonged death, Florida’s governor suspended all executions and convened a commission to review the state’s lethal injection procedures.
Physical and Psychological Aftermath
The physical damage from a failed attempt depends on which drugs entered the body and how. Subcutaneous injection of the chemicals causes severe tissue burns and localized damage. If potassium chloride partially reaches the bloodstream, it can cause intense pain along the veins and potentially damage the heart without stopping it. Partial doses of the sedative can leave a person in a confused, semiconscious state rather than fully anesthetized.
The psychological toll is harder to quantify but widely acknowledged. People who have been strapped to a gurney, had needles inserted repeatedly, and felt the initial effects of execution drugs before the process was stopped report lasting trauma. The anticipation of death followed by survival, combined with the knowledge that the state may try again, creates a form of psychological suffering that legal scholars and human rights organizations have compared to torture.
States Turning to Alternative Methods
Repeated failures with lethal injection have pushed some states toward other execution methods. Alabama carried out its first execution using nitrogen gas in 2024, replacing the oxygen a person breathes with pure nitrogen to cause death by oxygen deprivation. As of late 2024, nitrogen had been used three times for executions. United Nations human rights experts have called for an urgent ban on the method, and other states have begun exploring nitrogen as a backup when lethal injection proves unworkable.
The shift reflects a broader pattern: each execution method eventually generates enough documented failures and legal challenges that states begin searching for alternatives. Lethal injection itself was introduced in the 1970s as a supposedly more humane replacement for electrocution, gas chambers, and hanging. The cycle of adoption, failure, and replacement has repeated across more than a century of American capital punishment.