Standing in a room in north Birmingham, Dr. Boris Datnow prepared to find out what happened to a man recently executed by the state of Alabama. Everyone knew how it ended, but Datnow was set to do a second and private autopsy to shed light on what happened to the man just before he died, what his body looked like immediately after, and if there were any physical signs of contributing causes of death.

The doctor who did the autopsy has something to say. The problem is, it’s different than what another doctor concluded.

The other doctor, Dr. Joel Zivot, an Atlanta-based physician and associate professor at Emory University, attended that private autopsy of Joe Nathan James, Jr. He just observed the procedure—didn’t perform it—but said he believed Alabama sliced James’ arm open in his final hours, trying to find a vein for the fatal three-drug cocktail to run through. The invasive procedure is known as a cutdown, and is occasionally used when traditional methods to find a vein don’t work.

But Datnow, the autopsy pathologist performing the exam and creating the report, said that did not happen, that there’s no question the two parallel marks on James’ forearm are not the result of a cutdown.

Alabama’s prison system has been in the national spotlight, as hundreds of inmates die each year inside the overcrowded facilities set to contain them, drawing criticism from the federal government. But the system more recently has drawn national headlines for its handling of executions. Experts and groups across the country have called multiple of the state’s executions botched, for reasons ranging from the time it took to establish an intravenous line for the lethal injection, to a lack of transparency, to two men who weren’t killed after attempts to prepare them for their executions failed.

Now, the reports of what happened to James are popping up in court filings in multiple other death penalty cases. Lawyers for other Alabama Death Row inmates are citing the second autopsy, arguing they don’t want their clients to go through similar struggles or to suffer when it’s their client’s time to die.

In the case of Kenneth Eugene Smith, who is set to die on Nov. 17, his attorneys argued in a federal lawsuit that “impermissible means include(ing) cutdown procedures and intramuscular sedation” were used during James’ execution.

Zivot, the Atlanta physician, worked with an England-based group called Reprieve to set up a second, private autopsy for James after his July 28 execution. They contacted Datnow, a Birmingham-based private autopsy pathologist, to perform the autopsy. Reprieve describes itself as “defend(ing) marginalized people who are facing human rights abuses, often at the hands of powerful governments.”

The state autopsy was done prior to the independent one, but those results have not been made public. Datnow said he hasn’t spoken with anyone involved in this case, aside from Zivot and Reprieve, and has not seen the state’s autopsy report.

During the private exam, Zivot stood as an observer and noted several marks on James’ arms, in addition to puncture marks and bruising. He’s since been quoted in national press saying Alabama “tortured” the man in his final hours. But Datnow, the doctor performing the exam, said there is no evidence of a cutdown or “torture.” Datnow wrote the final report of the exam’s findings, and that report is clear as to Datnow’s findings.

“If there’s a cutdown, it’s pretty damn obvious,” said Datnow. “Of course, we would have seen that. Any first-year resident would have seen that.”

Datnow contacted AL.com to dispute claims made by Zivot in the national press. “If it was there, I would have reported it,” Datnow said. “There were no signs of a struggle.”

Zivot, contacted for this article, stands by his assessment. He added that there would be no way to tell if a cutdown on James was successful—meaning, he isn’t sure if that’s how the state found a vein.

“Poorly done cutdown or well done cutdown, that’s really beside the point isn’t it?” Zivot said. He said the Alabama Department of Corrections and Alabama Attorney General’s Office could release its autopsy to compare notes.

“If it was a poorly down cutdown or an unsuccessful cutdown, someone took a knife to his forearm. And that was not part of the protocol,” Zivot said. “And why that was done, we don’t know why.”

“What we do know is it’s not part of the protocol… There would be no reason to cut into his arm.”

Datnow said he’s disappointed that the cutdown claims have become part of the narrative of this execution. Lawyers who are citing the cutdown in unrelated federal lawsuits haven’t ever called him to corroborate the claims. No one from the ADOC or Alabama Attorney General’s Office has called him either, Datnow said. He hasn’t been subpoenaed in any court case related to this exam.

The ADOC has never revealed the qualifications of the people who are tasked with setting up IV lines for executions.

James was 50 years old at the time of his execution, which happened at Alabama’s William C. Holman Correctional Facility in Atmore on July 28. He was put to death for the 1994 slaying of his ex-girlfriend.

The statements about a cutdown being done on James come after the state admittedly spent hours searching for a vein to start an IV for his lethal injection. A cutdown would allow someone to surgically expose the vein and insert an IV directly, although Datnow says that did not happen.

Datnow said his final report includes no excess bruising, injuries, nor signs of a struggle or abuse. He added there were not an abnormal number of pinpricks or attempts to start an intravenous line. The bruising that was present, depicted in photographs, would be typical of a person who had undergone an attempt to set up in IV, he said. There were just two puncture sites on James’ body, Datnow said.

“We have a detailed description of our findings,” he said. “As far as we could see from an autopsy point of view, (there were) absolutely no signs of abuse.”

The two pinpricks are not surprising, considering the redacted version of ADOC’s execution protocol states there must be a backup line set up for every execution. An Oct. 21 filing by the Alabama Attorney General’s Office in another case said, “to minimize the risk of unnecessary pain should an IV line infiltrate or become unusable, ADOC protocol provides for intravenous access at two different locations before lethal injection is administered.”

Datnow, who is originally from South Africa but has lived in Birmingham for over four decades, reiterated that his job is to perform an examination and report the findings—nothing more. “You provide facts… not impressions,” he said.

Zivot disputes Datnow’s report that only notes two puncture wounds.

James’ execution began around 9 p.m. that night, several hours after it was scheduled to begin. James’ eyes were closed for the entire procedure, and he had no last words when briefly asked by the warden.

At 9:12 p.m., James appeared to stop breathing. The official time of death was 9:27 p.m.

ADOC Commissioner John Hamm did not provide a reason for the lengthy delay. When asked which process or part of the process was taking the extra time, he did not elaborate. He said James was not sedated, but the department later said they could not confirm that James was fully conscious when he was executed.

The following day, a prison spokesperson released the following statement: “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.”

Hamm said at the time, “We’re carrying out the ultimate punishment…. and we have protocols and we are 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. So, there was nothing out of the ordinary, but we just made sure we carried out the court order.”

The second autopsy was done at the request of Zivot and the James family. James’ brother signed paperwork allowing the procedure to happen, and Reprieve paid for the exam. Datnow said the only person who has been given a copy of the report is Zivot; the family never requested a copy, nor did any attorneys for the James family or for the state.

Datnow’s final report was finished on August 15. The report shows lethal injection as the cause of death, cited with pulmonary edema and multiple needle puncture sites. Both of those factors were expected, Datnow said.

Reprieve, who paid for the exam, issued a statement for this story. Reprieve US Director Maya Foa said, “There is no disputing that the autopsy report found Joe James’ body covered in bruises, lacerations and puncture wounds consistent with repeated attempts to establish an IV line – none of which should be the norm for an execution or for a routine IV insertion. Alabama cannot continue to pretend that stabbing prisoners with needles for hours is in any way humane.”

But Datnow’s report doesn’t include excess bruises and lacerations, according to a portion of the report viewed by AL.com.

There have been documented issues in starting an IV in at least three recent Alabama executions: The failed execution attempt of Doyle Lee Hamm in 2018, the controversial execution of Joe Nathan James Jr. on July 28, and the failed execution attempt of Alan Eugene Miller on Sept. 22.

Hamm has since died of cancer, and a judge has ordered state officials to preserve evidence from Miller’s failed execution attempt.

Smith is set to die next month, also by lethal injection. While the Alabama Attorney General’s Office denies that either a cutdown procedure or intramuscular sedation happened during James’ execution, they agreed in Smith’s federal lawsuit to “stipulate that such procedures will not be employed in the execution of Smith.” The Alabama AG’s Office also said in the same lawsuit that Smith’s allegations all come “third-hand, being based on a press account of a second autopsy performed some days after James’ execution.”