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Democratic hopes of retaining control of the US Senate were dealt a blow on Tuesday after John Fetterman, the party’s nominee in Pennsylvania who suffered a stroke earlier this year, struggled to speak clearly during a prime time debate and at times appeared to find it difficult to respond to questions.

The Pennsylvania race, where Fetterman’s polling lead against Republican rival Mehmet Oz all but disappeared in recent weeks, has become one of the most expensive in congressional history as both parties have identified it as a contest that could become key to a majority in the 50-50 Senate.

The debate, which the Fetterman camp had resisted in the weeks following the lieutenant governor’s stroke, was seen as key to reassuring voters that the charismatic Democratic nominee was back in full political form.

But Fetterman struggled from the outset, when he opened his remarks by saying: “Good night”.

Throughout the debate, Fetterman’s answers were often punctuated by long pauses, including a stilted exchange in which he was asked to clarify his stance on fracking.

In some cases he struggled to construct full sentences. When asked about his refusal to release medical records: “My doctors, the real doctors that I believe, they all believe that I am ready to be serve.”

Asked how he would make college more affordable, he said: “I just believe, just making it that much more . . . it costs too much and I believe providing the resources to reduce the tuition allow families to be able to afford it.”

After the debate, the Fetterman campaign claimed that closed captioning technology, which aides had requested to help their candidate with his auditory processing, was “filled with errors”.

“We are thrilled with John’s performance. He did remarkably well tonight — especially when you consider that he’s still recovering from a stroke and was working off of delayed captions filled with errors,” Joe Calvello, Fetterman’s communications director, said in a statement.

But Nexstar, the broadcaster that aired the debate, denied there had any problems with the live captioning system.

“The closed captioning process functioned as expected during rehearsal and again during tonight’s debate,” said Gary Weitman, chief communications officer at Nexstar Media Group. “We regret that Mr Fetterman and his campaign feel otherwise.”

Tuesday’s broadcast was the sole head-to-head debate between Fetterman and Oz, the former cardiothoracic surgeon and television personality backed by former president Donald Trump, ahead of next month’s US midterm elections.

Pennsylvania has long been viewed as a crucial swing state and a bellwether of the national mood. Joe Biden defeated Trump in the state in the 2020 presidential election by a razor-thin margin of just over one point.

For much of this year, Fetterman, an outspoken progressive Democratic candidate who gained national recognition in the aftermath of the 2020 election for his pushback against Trump’s false claims of voter fraud in Pennsylvania, had been seen as the frontrunner.

But recent polls have shown the race tightening. The RealClearPolitics average of the latest opinion polls — based on surveys conducted before Tuesday night’s debate — showed Fetterman leading Oz by just 1.3 points, within the margin of error.

Fetterman sought to address his medical condition at the start of Tuesday’s debate, calling it the “elephant in the room”.

“I had a stroke,” the Democratic candidate said in his opening statement. “He’s never let me forget that.”

While his team published a letter last week from the candidate’s primary care doctor saying the lieutenant-governor “has no work restrictions and can work full duty in public office”, Fetterman has rejected the Oz campaign’s demands for him to release his medical records.

The Fetterman campaign has worked to paint Oz as a fraud, pointing to pseudoscience that the retired doctor peddled on his long-running daytime TV show.

Fetterman has repeatedly tied Oz to Trump, as well as Doug Mastriano, the far-right Republican candidate for governor in Pennsylvania who has stoked controversy with his references to QAnon and participation in the January 6 2021 attack on the US Capitol.

After campaigning with Trump in a hotly contested Republican primary earlier this year, Oz has tried to distance himself from the former president in an effort to drum up support with more centrist voters, especially in the affluent suburbs of Philadelphia.

But on Tuesday night, Oz conceded he would back Trump should he be the Republican nominee for president in 2024, saying: “I’ll support whoever the Republican party puts up . . . I would support Donald Trump if he decided to run for president.”

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