LITTLE ROCK — A doctor who specializes in anesthesiology and critical care testified in federal court Monday that he has concerns about Arkansas’ plan to execute seven inmates this month using a three-drug cocktail including the sedative midazolam.

“I’m concerned about the qualifications of the individuals that are to perform these sorts of things, I’m concerned about the combination of the medications and how they’ll be prepared and how they’ll be injected, I’m concerned about the way that they’ll be handled and mixed, and I have serious concerns that if this is done as it’s described that an inmate may not die, or death will be part of a very painful experience for the inmate,” Dr. Joel Zivot said via live link from Atlanta.

Zivot, a professor at Emory University in Atlanta, was the first person to testify in a hearing that is expected to last through Thursday in U.S. District Court in Little Rock. Judge Kristine Baker is considering a motion for a preliminary injunction in a lawsuit by the inmates alleging that the state’s execution protocols and accelerated execution schedule will violate their constitutional rights.

The state’s execution protocols call for each inmate to be injected first with midazolam, then with the paralytic vecuronium bromide, and finally with potassium chloride, which stops the heart.

Midazolam has been used in executions in Oklahoma and Alabama during which inmates appeared to struggle on the gurney. The U.S. Supreme Court upheld the use of the drug in executions in a 5-4 decision in 2015, but several states have stopped using the drug because of the controversy surrounding it.

Zivot testified Monday that being injected with potassium chloride would be “extremely painful” and that midazolam would not block the pain.

“It’s not simply that it’s painful. It’s painful because it’s destroying the vein as it passes along its length,” he said. “Midazolam will not prevent the destruction of the vein by potassium, nor will it block the pain.”

Zivot said an inmate may not be able to move if injected with a paralytic before the potassium chloride, but he said that would not mean the inmate was not experiencing everything that was happening.

Cross-examination of Zivot by the state is scheduled for Thursday.

Among the other witnesses testifying Monday were Jennie Lancaster, a former North Carolina prison warden who talked about the stress that an execution places on prison staff, and Carol Wright, an Ohio-based federal public defender, who talked about the heavy workload involved in defending a client in a death-penalty case.

The suit alleges that Arkansas’ execution protocols are inadequate and will subject the inmates to cruel and unusual punishment. It also alleges that the accelerated execution schedule will create a high risk of accidents and deny the inmates adequate access to counsel.

State Solicitor General Lee Rudofsky told Baker the inmates have not offered a reasonable, readily available alternative to the state’s planned execution method that is certain not to inflict cruel and unusual punishment.

He also said the inmates’ lawyers should be able to handle their workloads and said the prison staff can handle carrying out seven executions in a short space of time.

“Such stress is part of the job,” he said.

Rudofsky noted that the inmates have been challenging the state’s method of execution since 2006.

“At some point, even death is at issue, enough really is enough,” he said.

Arkansas has not executed an inmate since 2005 because of legal challenges and difficulty obtaining execution drugs. It is rushing to carry out executions this month before its supply of one execution drug expires April 30.

The hearing is scheduled to resume at 8:30 a.m. Tuesday.