Over the course of two hours, witnesses watched and listened as Christa Pike cried, whimpered and snored through Tennessee’s attempt to execute her. By the end of it, executioners had given her two doses of the state’s lethal injection drugs. Her arms were swollen and blistered, and one had turned purple, her attorneys said. And she was still alive, marking what legal experts say is the first time a prisoner in the U.S. has survived one dose — let alone two — of lethal injection drugs.

Even if the outcome was unprecedented, what went wrong was not. Pike’s was the third Tennessee execution in 14 months to go awry. But as a reporter who has covered death row for nearly a decade and witnessed several executions, I know the state is not alone. The factors behind the breakdowns in Tennessee have popped up again and again across the country — and show how easily another botched execution could occur, even as soon as the ones planned Wednesday in Texas and next week in Florida.

Here’s what we know about Tennessee’s attempt to execute Pike: The procedure started more than nine hours late, delayed by last-minute legal fights. Then, inside the death house, executioners struggled to find a vein, jabbing Pike with at least seven needles, according to her lawyers, one of whom watched in dismay. As the caustic barbiturate finally started flowing into the IV lines, Pike did not fall into sedation quickly. Instead, witnesses said, she sang with her spiritual adviser. Then she said her arm felt like it was about to burst open. “Does this happen like that?” she asked.

Like Pike, many aging death row prisoners have medical problems that can complicate efforts to kill them, potentially turning what are supposed to be relatively quick deaths into agonizing, drawn-out procedures. Even when prisoners are healthy, several states have faced questions about the competence of their execution teams, as both the American Medical Association and American Nurses Association have strongly opposed their members taking part in death penalty procedures. And death penalty states across the country shroud their executions in such secrecy that it is often difficult or impossible to confirm the age, source or sterility of the drugs.

“The types of failures that went into this botch happen all the time,” said Robert Dunham, director of the Death Penalty Policy Project. “There is nothing in the execution process that states are incapable of getting wrong.”

The Tennessee Department of Correction declined to comment, though hours after the attempted execution the agency said in a statement that it had “followed every step” of the state’s established protocol, which “has been consistently effective.” On Saturday, the head of the agency resigned. Meanwhile, Gov. Bill Lee said in a statement that he had ordered “a comprehensive, third-party review to determine exactly what occurred” and that the execution previously scheduled for December would no longer take place this year. His office didn’t respond to a request for comment.

On Friday, Pike’s lawyers filed a motion asking a court to order the agency to preserve any evidence related to the state’s failed effort to kill their client. In a statement, they said the filing “details the serious complications that occurred during the execution attempt, many of which Christa and her attorneys had warned the State and the courts about months earlier.”

Pike remains in the hospital where she is receiving critical medical care, they said. After several days on a ventilator, intubated and unconscious, on Tuesday afternoon her attorneys said she was awake and speaking. “Her prognosis remains unclear but, at a minimum, we expect a long recovery,” they wrote in a statement. “We continue to ask the Governor of Tennessee to commute Christa Pike’s sentence to life imprisonment without the possibility of parole.”

Unhealthy Prisoners

By the time the Tennessee Department of Correction strapped her to the gurney last week, Pike had been on death row for 30 years. She had been sentenced to death for the 1995 murder of 19-year-old Colleen Slemmer, a fellow Job Corps student in Knoxville. Pike was 18 at the time and, like many people on death row, had a history of mental illness and childhood sexual abuse.

Now 50 years old, Pike has faced an array of health problems, which her legal team had repeatedly warned could lead to a bungled execution. During a three-day hearing in August, Pike’s attorneys argued that her small veins and a blood disorder would make it harder and more painful to put in the IV lines to administer the lethal dose. The........

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