Nevada has a new chief medical officer after its top doctor suddenly resigned last week, but that hasn’t quelled concerns about how the state plans to carry out an execution this month or questions about why the previous chief resigned in the first place.

Officials with the attorney general’s office revealed during a court hearing Monday that Dr. Leon Ravin has been named acting chief medical officer, while Dr. John Scott is set to be the “attending physician” at the execution. Department of Health and Human Services spokeswoman Chrystal Main confirmed that Ravin, who most recently served as the state psychiatric medical director, was appointed on Oct. 31, the day after Dr. John DiMuro resigned.

But the state still hasn’t released a copy of the resignation letter DiMuro would have submitted to state officials, with Main saying the letter is confidential. An away message that users receive when they email DiMuro’s old state account indicates the letter was filed with the governor, but Gov. Brian Sandoval’s office still hasn’t provided the document, citing Nevada Administrative Code, even though it typically does so.

Letters were provided to the media upon request when Paul Thomsen resigned from the Public Utilities Commission, when Mary Beth Scow resigned from the Clark County Commission and when Mark Manendo resigned from the state Senate, for example.

“NV deserves to know why its Chief Medical Officer suddenly resigned so close to an execution that he designed!” the American Civil Liberties Union of Nevada said in a tweet after former Las Vegas Review-Journal reporter Bethany Barnes described her unsuccessful efforts to obtain the letter.

The Nevada Independent’s attempts to reach DiMuro this week and last have not been successful. An affidavit filed with the court, dated Oct. 31 and signed by DiMuro, says "my resignation was completely unrelated to the execution of Scott Dozier."

But the resignation came at a critical moment for the state, which is set to execute the 46-year-old Dozier on Nov. 14. It will mark the first time Nevada has put someone to death in 11 years and comes amid a national shortage of lethal injection drugs because pharmaceutical companies have taken a stand against supplying medications for executions.

In consultation with DiMuro, Nevada Department of Corrections chief James Dzurenda approved an alternate drug combination that includes the opioid fentanyl, the drug known by the brand name Valium and the paralytic cisatracurium. The final drug has come under scrutiny by the defense’s expert witness, pediatric anesthesiologist David Waisel, who testified Friday that using it would not have any added benefit to the cocktail but could have the downside of hiding signs that the other two drugs were not administered properly.

The consequence could be that the inmate is aware and feeling himself suffocating to death, which would be a horrifying experience, Waisel said. The defense is asking for the third drug to be removed from the combination; Judge Jennifer Togliatti said she expects to rule on the matter Wednesday.

In the meantime, Dozier’s lawyers raised concerns that they don’t know “who’s in charge” now that DiMuro is gone and whether he’s advised his successors on how to properly carry out the protocol he designed. While DiMuro is an anesthesiologist and a pain doctor, Ravin is a psychiatrist and Scott, who works at a state psychiatric facility, is a family doctor, according to the prosecution.

Federal Public Defender David Anthony said he wasn’t sure whether either of those doctors would be able to tell whether the inmate is thoroughly anesthetized by the first two drugs before a third is administered. Waisel testified that detecting “anesthetic depth” through subtle body cues is a skill developed from years of specialized training and experience.

Jordan Smith of the Nevada Attorney General’s Office, who’s defending DiMuro’s original three-drug prescription, insisted that the state is well-prepared to carry out the execution and fought back allegations from Anthony that “things are falling apart” on the state’s end. Smith said the defense is just trying to delay.

In spite of his concerns about the third drug and few details about DiMuro’s replacements, Anthony did not directly ask Monday for a stay of the execution although he stressed that there would be no shame in “pushing the pause button” on it. He told the judge that he had committed to Dozier, who has voluntarily given up further appeals but could stop the impending execution if he wants, that he wouldn’t seek a stay without Dozier’s prior authorization.

“As a defense attorney, I try to help people and save people,” Anthony told reporters after the hearing. “And so it creates a moral dilemma. That’s the best I can say.”

Updated at 5:10 p.m. on Nov. 6, 2017 to add information about confidentiality rules and DiMuro's affidavit.

Riley Snyder contributed to this report.