By Jon Herskovitz
AUSTIN, Texas, July 25 (Reuters) - Troubled lethal injections in Oklahoma and Arizona have raised questions whether medical personnel are skilled enough to humanely put an inmate to death, and if things go wrong, expert enough to revive one if an order is given.
Almost all of the 32 states that use the death penalty either require or permit a physician to attend executions, which often are carried out by lesser-trained medical personnel, but doctors who participate risk losing their license to practice medicine if they are discovered to have helped.
Among the reasons for the recent problems include that medical personnel in the death chamber may not be familiar with mixing or administering new lethal cocktails being used after traditional supplies of execution drugs dried up, nor treating any side effects.
"If the only thing you know how to do is insert into a vein, then what happens if that person stays conscious? You are not the expert who is needed at that time," said Richard Dieter, executive director of the Death Penalty Information Center.
Corrections officials say their protocols are designed to conduct executions as humanely as possible with personnel being thoroughly trained for the roles they perform.
The U.S. lethal injection process underwent a fundamental change in 2011, when drug company Hospira stopped making short-acting barbiturate and general anesthetic sodium thiopental, due to concerns about its widespread use in executions. It was the lone U.S. manufacturer of the drug.
Since then, states have developed new drug combinations and turned to new suppliers, usually in secret. A number of death row inmates have sued, arguing that untested drugs of questionable quality could cause undo harm and suffering in violation of the U.S. Constitution.
There was a doctor present at the execution in Oklahoma in April, where an IV popped out when rapist and murderer Clayton Lockett was being executed. Prison officials halted the execution, but Lockett died of a heart attack about 40 minutes after the procedure started.
Similarly in Arizona, a doctor was present on Wednesday when it took at least two doses of a lethal drug cocktail to execute double murderer Joseph Wood. The Arizona Department of Corrections said the IVs were properly placed, and that Wood was fully sedated throughout the procedure.
Arizona has promised an internal review but disputes that the execution was botched even as lawyers for the inmate said he gasped and struggled for breath for more than 90 minutes before dying.
The two hours it took between when the injection started and when the inmate was declared dead was far longer than the three to 15 minutes it has typically taken inmates to die in other executions in recent years.
The typical protocol for states requires that a medically trained person - such as a paramedic, military corpsman or certified medical assistant - administer the IV. Names are kept secret, including of any doctor who may assist.
Under guidelines set by the American Medical Association, a physician can confirm the death of an executed inmate. But a physician cannot declare death, administer drugs, monitor vital signs, select injection sites, start an IV, supervise drug injections or consult with a person carrying out the injection.
"A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution," the AMA said.
A separate paper from its journal said those who violate the code of ethics on executions risk having their licenses revoked by state medical boards.
The few physicians who take the risk usually do it out of circumstance and not necessarily because they have expertise in the drug protocol, according to a 2006 paper from the New England Journal of Medicine.
It said one doctor, board certified in internal medicine and critical care, told the Journal he was asked to help by a local warden and did so because the sentence was society's order and because the punishment did not seem wrong.
Another doctor, a prison physician, said he participated to make sure the execution was done correctly.
"I think that if I had to face someone I loved being put to death, I would want that done by lethal injection, and I would want to know that it is done competently," the doctor said. (Reporting by Jon Herskovitz; Additional reporting by Heide Brandes in Oklahoma City and Kevin Murphy in Kansas City; Editing by Cynthia Johnston and Eric Beech)