An emergency court hearing in the US state of Arizona has revealed details of how a convicted murderer took nearly two hours to die after receiving a lethal injection.
The procedure prompted a series of phone calls involving the state governor's office, the prison director, lawyers and judges as Joseph Rudolph Wood gasped for more than 90 minutes following the lethal dose.
They discussed the brain activity and heart rate of Wood, who was seen to gasp repeatedly by witnesses to his execution at the state prison in Florence, Arizona, on Wednesday.
The judge was concerned that no monitoring equipment showed whether the inmate had brain function, and officials talked about whether to stop the execution while it was so far along.
Wood's defence lawyers had pleaded on the grounds that he could be suffering while strapped down, breathing in and out and snorting.
Nearly two hours after he was sedated on Wednesday, 55-year-old Wood finally died.
A transcript of an emergency court hearing was released on Thursday amid debate over whether the execution was botched reveals the behind-the-scenes drama and early questions about whether something was going wrong.
This is the third US execution to develop problems in six months, and it has rekindled the debate over the death penalty and handed potentially new evidence to those building a case against lethal injection as cruel and unusual punishment.
Department of Corrections director Charles Ryan read a statement outside his office dismissing any notion that the execution was botched, calling it an "erroneous conclusion" and "pure conjecture".
He said IV lines in the inmate's arms were "perfectly placed" and insisted that Wood felt no pain.
But he also said the Arizona attorney general's office will not seek any new death warrants while his office completes a review of execution practices.
Defence lawyer Dale Baich called the procedure a "horrifically botched execution" that should have taken 10 minutes.
US District Judge Neil V Wake convened the urgent hearing at the request of one of Wood's lawyers, who was notified by her colleagues at the execution that problems were occurring.
A lawyer for the state, Jeffrey Zick, assured Mr Wake that Wood was comatose and not feeling pain.
He spoke to the Arizona Department of Corrections director on the phone and was given assurances from medical staff at the prison that Wood was not in any pain. Mr Zick also said the governor's office was notified of the situation.
Mr Zick said that at one point, a second dose of drugs was given, but he did not provide specifics.
The participants then discussed Wood's brain activity and heart rate.
"I am told that Mr Wood is effectively brain dead and that this is the type of reaction that one gets if they were taken off of life support. The brain stem is working but there's no brain activity," he said, according to the transcript.
The judge then asked: "Do you have the leads connected to determine his brain state?"
The lawyer said he did not think so.
"Well if there are not monitors connected with him, if it's just a visual observation, that is very concerning as not being adequate," the judge said.
Wood died at 3.49pm, and judges were notified of his death while they were still considering whether to stop it.
Mr Zick later informed the judge that Wood had died.
Anaesthesiology experts say they are not surprised that the combination of drugs took so long to kill Wood.
"This doesn't actually sound like a botched execution. This actually sounds like a typical scenario if you used that drug combination," said Karen Sibert, an anaesthesiologist and associate professor at Cedars-Sinai Medical Centre.
Ms Sibert said the sedative midazolam would not completely render Wood incapacitated. If he had felt pain or been conscious, he would have been able to open his eyes and move, she said.
The other drug was the painkiller hydromorphone.
"It's fair to say that those are drugs that would not expeditiously achieve (death)," said Daniel Nyhan, a professor and interim director at the anaesthesiology department at Johns Hopkins medical school.
An Ohio inmate gasped in similar fashion for nearly 30 minutes in January. An Oklahoma inmate died of a heart attack in April, minutes after prison officials halted his execution because the drugs were not being administered properly.
Arizona Governor Jan Brewer has ordered a review of the state's execution process, saying she is concerned by how long it took for the drug protocol to kill Wood.
Family members of Wood's victims in a 1989 double murder said they had no problems with the way the execution was carried out.
"This man conducted a horrific murder and you guys are going: 'let's worry about the drugs,'" said Richard Brown, the brother-in-law of Debbie Dietz.
"Why didn't they give him a bullet? Why didn't we give him Drano (a US cleaning product)?"
Arizona uses the same drugs that were used in the Ohio execution, although a different drug combination was used in the Oklahoma case.
States have refused to reveal details such as which pharmacies are supplying lethal injection drugs and who is administering them out of concerns the drugmakers could be harassed.
Wood had filed several appeals that were denied by the US Supreme Court. He argued that he and the public have a right to know details about the state's method for lethal injections, as well as the qualifications of the executioner and who makes the drugs.
Such demands for greater transparency have become a legal tactic in death penalty cases.
Wood was convicted of fatally shooting Dietz and her father, 55-year-old Gene Dietz, at their car repair shop in Tucson, 25 years ago.