A man had his arm cut open and had his hands and wrists "burst by needles" so he could be executed by lethal injection, an investigation has said.
Joe Nathan James was executed on July 28 and staff were unable to find a vein in his hands, elbows and wrists as they tried repeatedly to find a place to put in the deadly toxins, causing multiple puncture wounds.
Experts in an independent investigation believe James may have undergone several painful attempts to find a vein and were unable to confirm if local anaesthetic was used as his arm was cut into by a blade.
They say the profile of his wounds may indicate he struggled during the execution in Alabama, in the US.
An incision in James' arm, according to a review of his body, was subjected to a "cutdown".
This is when a part of the arm is sliced open in order for a vein to be accessed.
Despite the grim reports of James' death, authorities said it was "nothing out of the ordinary".
A spokesperson for the Alabama Department of Corrections (ADOC) Kelly Betts, said: "ADOC’s execution team strictly followed the established protocol.
"The protocol states that if the veins are such that intravenous access cannot be provided, the team will perform a central line procedure. Fortunately, this was not necessary and with adequate time, intravenous access was established."
An independent autopsy was done after his death and funded by the human rights group Reprieve US.
An unresponsive James met the watching media's eyes and offered no last words despite being known for being outspoken.
A reporter by Atlantic staff writer Elizabeth Bruenig said: "My initial impression of James was of someone whose hands and wrists had been burst by needles."
She added: "The state seems to have attempted to insert IV catheters into each of his hands just above the knuckles, resulting in broad smears of violet bruising.
"Then it looked as though the execution team had tried again, forcing needles into each of his wrists, with the same bleeding beneath the skin and the same indigo mottling around the puncture wounds.
"On the inside of James’s left arm, another puncture site, another pool of deep bruising, and then, a scant distance above, a strange, jagged incision, at James’s inner elbow. "
James was convicted for the murder of former girlfriend Faith Hall in 1994 and sentenced to death five years later.
In a twist in the months leading up to his death, the family of Hall campaigned with Governor Kay Ivey for Hall's life to be spared.
Media witnesses only appear to have been led into the viewing gallery in the execution chamber around three hours after his scheduled execution time.
At the time, ADOC Commissioner John Hamm told journalists: "[I can't] overemphasise this process. We’re carrying out the ultimate punishment, the execution of an inmate.
"And we have protocols and we’re very deliberate in our process, and making sure everything goes according to plan. So if that takes a few minutes or a few hours, that’s what we do."
The death penalty in the US is already controversial, but even more so is the use of lethal injection as a means of execution.
It remains a common form of the death penalty in the US despite a number of botched attempts reported.
