Monday October 17, 2011 session has been postponed due to death in Dr. Shafer's family. It's currently unclear when the testimony will resume. Court officials say that resumption of the trial will be announced when further information is available
Latest on MJJC
- Latest Michael Jackson News
- Click Here to Join Our Community
- Follow us on Twitter
- Wanna talk Michael? Come join the chat rooms
- The Michael Jackson Chart Watch
- Become an MJJC Patron
- Join the Premium Member Group and Get Lot's of Extra's
- Major Love Prayer - Worldwide Monthly Prayer Every 25th
- MJJC Exclusive Q&A - We talk to the family and those in and around Michael
- Join us in the Chat Rooms
- Find us on Facebook
English Summaries - Easy reference for the Translator Teams
- Thread starter ivy
- Start date
Murray Trial will not be in session on Tuesday October 18 because of a new test done on Michael Jackson stomach content. DA Walgren told Judge Pastor that coroner's office re-tested for lorazepam levels and found that they were lower than the defense analysis suggested. DA Walgren said the real amount of the drug Lorazepam found in Michael Jackson's stomach is "inconsistent with oral consumption".
Murray Trial Day 13 , October 19, 2011
Dr. Shafer Testimony continued
Walgren Direct continued
Walgren goes over again the credentials of Dr. Shafer by showing the journal he's editor in chief and multiple research articles written by Dr. Shafer. Research articles examine the differences in regards to gender, age. Dr. Shafer also had research done on Lorazepam, Midazolam and Lidocaine. DA Walgren says that he will ask about these topics during testimony.
Walgren mentions difference between intensive care sedation and procedure related sedation (MAC). Dr. Shafer tells that intensive care sedation would be for longer time, MAC would be shorter.
Dr. shafer says that all the work he has done on this case was for free. He says he never charged money for testimony because he feels it's inappropriate and unethical to benefit from medical misadventures. Shafer says he doesn't want his integrity to be questionned as well Shafer also says he wanted to get involved in this case to restore general public's confidence in anesthesia and doctors. Dr. Shafer says that he's asked daily by his patients " Are you going to give me that drug that killed Michael Jackson?". He says that he hopes to alleviate this unneeded fear with his testimony.
mid morning break
Dr. Shafer has brought several medical items for demonstration. First he starts with explaining Saline bag and it's ports. Later Shafer tells what and IV is. Infusion(Drip) when drug drips in slowly. Shafer explains that Propofol comes in a glass vial, there's an aliminium seal and a rubber stopper on top. To get the drug out you need to go through with a slow needle or a large spike to get the drug out.
Walgren asks Shafer to demonstrate to get Propofol out of the bottle.
Shafer demonstrates to get out Propofol with a syringe / needle. Shafer tells to get Propofol out you need to replace Propofol with air so that Propofol will go into the needle.
Walgren asks Dr. Shafer to examine 100 ml Propofol bottle from the scene. Shaffer says that it has a spike hole and not a needle hole.
Dr Shafer has made a video for his case, to demonstrate what is necessary for sedation, even for 25mg propofol. Playing the video : «*an over view of safe administration of sedation*»
The doctor first prepares the room, checks the equipment. Video shows multiple equipment for airway management such a tube for the throat, a tube for the nose, an equipment for intibation, a throat mask for air. Organizes these items.
Then the doctor checks the oxygen equipment. Doctor checks if the oxygen supply work, checks nasal cannula, checks to see if nasal cannula is measuring carbon dioxide by capnometer. Doctor tests anesthesia breathing circuit. This is the equipment used if the patient stops breathing and the doctor needs to push oxygen into the lungs. Doctor then checks the back up oxygen. This is used if for some reason the breathing circuit fails.
Doctor then checks suction apparatus. This is important because if the contents of the stomach gets into the lungs or if the vomit (bile) gets into the lung, it would destroy the lungs. This is why patients are told to not to eat or drink prior to anesthesia. if the patient vomits or the contents of the stomach come to the mouth, the doctor has to be very quick to clean them with the suction equipment before it goes into the lungs and destroys the lungs.
Next step is to set up the infusion pump. It takes a few minutes to set it up. In the video they use a syringe pump. Doctor first draws Propofol into the syringe. As Dr. Shafer demonstrated this is not easy. You need to draw air into the syringe and do multiple draws to fill the syringe. Dr. Shafer tells a narrow tubing has to be used in the infusion pump as the wide tubing could be problematic. Then the doctor programs the pump, putting the patients weight, correct drug name, infusion rate. Doctor verifies the information for a second time.
Next step is to assess the patient. Anesthesiologist is repsonsible for knowing his patient. Makes a physical examination, first thing is airway, listens to the lungs, checks the heart. Always done for each procedure, for every patient. No exception.
Doctor also gets the informed consent of the patient. Doctor informs the patient of risks and explains what the procedure entails, asks the patient if he has any questions, then patient signs the informed consent form. Dr. Shafer says oral consent is not binding, and is not recognized.
Some steps are not shown on the video. These are: patient put on table, monitoring equipment such as blood pressure cuff, pulse oximeter, ECG are put on patient. Oxygen in place, intravenous catheter is put into the patient. Afther these doctor pauses to verify again. Doctor does one last check before injecting the propofol.
Propofol infusion pump is started. Anesthesiologist is close to the patient, monitors the patient. Doctor keeps records of the vitals. Chart is a necessity to track the patient and the patterns. It's a responsibility to the patient.
In this part of the video, we are shown examples of what can go wrong.
First example is when blood pressure drops. Dr. Shafer says this is very common and they see it everyday. Propofol lowers blood pressure especially if the patient is dehydrates. Doctor gives ephedrine through the IV line. Generally blood pressure comes to normal levels.
Second example is carbon dioxide. The monitor shows that carbon dioxide stopped. It means the patient is not exhaling and the airway is obstructed. Doctor immediately does chin lift and jaw thrust. Dr. Shafer this is also done very routinely. Shafer says the most common reason is because the tongue is blocking the airway and by doing a chin lift and jaw thrust you can move the tongue.
Third example is apnea. This is when the patient doesn't even try to breath. In this instance you need to take over for the patient and force air into the lungs. Doctor removes the nasal cannula, places the mask on the patient's mouth and nose and squeeze the bag to push oxygen into the lungs.
Fourth example is aspiration (not shown on video). This is when the patient vomits and/or stomach contents come to the mouth. Patient is turned sideways and before the next breath you need to suction everything.
Fifth example is cardiac arrest. Heart stops beathing and the patient stops breathing. Doctor does a 2-3 second assesment to make sure that the monitor has not failed. Then the doctor calls for help. First thing is always to call for help. One person begins CPR, one person is ventilating the patient and other person gives resuscitation drugs. Alls of this is done to keep the patient alive for enough time to fix the problem that caused the arrest. These efforts are continued until the patient is revived, or is pronouced dead.
Lunch break
Dr. Shafer Testimony continued
Walgren Direct continued
Walgren goes over again the credentials of Dr. Shafer by showing the journal he's editor in chief and multiple research articles written by Dr. Shafer. Research articles examine the differences in regards to gender, age. Dr. Shafer also had research done on Lorazepam, Midazolam and Lidocaine. DA Walgren says that he will ask about these topics during testimony.
Walgren mentions difference between intensive care sedation and procedure related sedation (MAC). Dr. Shafer tells that intensive care sedation would be for longer time, MAC would be shorter.
Dr. shafer says that all the work he has done on this case was for free. He says he never charged money for testimony because he feels it's inappropriate and unethical to benefit from medical misadventures. Shafer says he doesn't want his integrity to be questionned as well Shafer also says he wanted to get involved in this case to restore general public's confidence in anesthesia and doctors. Dr. Shafer says that he's asked daily by his patients " Are you going to give me that drug that killed Michael Jackson?". He says that he hopes to alleviate this unneeded fear with his testimony.
mid morning break
Dr. Shafer has brought several medical items for demonstration. First he starts with explaining Saline bag and it's ports. Later Shafer tells what and IV is. Infusion(Drip) when drug drips in slowly. Shafer explains that Propofol comes in a glass vial, there's an aliminium seal and a rubber stopper on top. To get the drug out you need to go through with a slow needle or a large spike to get the drug out.
Walgren asks Shafer to demonstrate to get Propofol out of the bottle.
Shafer demonstrates to get out Propofol with a syringe / needle. Shafer tells to get Propofol out you need to replace Propofol with air so that Propofol will go into the needle.
Walgren asks Dr. Shafer to examine 100 ml Propofol bottle from the scene. Shaffer says that it has a spike hole and not a needle hole.
Dr Shafer has made a video for his case, to demonstrate what is necessary for sedation, even for 25mg propofol. Playing the video : «*an over view of safe administration of sedation*»
The doctor first prepares the room, checks the equipment. Video shows multiple equipment for airway management such a tube for the throat, a tube for the nose, an equipment for intibation, a throat mask for air. Organizes these items.
Then the doctor checks the oxygen equipment. Doctor checks if the oxygen supply work, checks nasal cannula, checks to see if nasal cannula is measuring carbon dioxide by capnometer. Doctor tests anesthesia breathing circuit. This is the equipment used if the patient stops breathing and the doctor needs to push oxygen into the lungs. Doctor then checks the back up oxygen. This is used if for some reason the breathing circuit fails.
Doctor then checks suction apparatus. This is important because if the contents of the stomach gets into the lungs or if the vomit (bile) gets into the lung, it would destroy the lungs. This is why patients are told to not to eat or drink prior to anesthesia. if the patient vomits or the contents of the stomach come to the mouth, the doctor has to be very quick to clean them with the suction equipment before it goes into the lungs and destroys the lungs.
Next step is to set up the infusion pump. It takes a few minutes to set it up. In the video they use a syringe pump. Doctor first draws Propofol into the syringe. As Dr. Shafer demonstrated this is not easy. You need to draw air into the syringe and do multiple draws to fill the syringe. Dr. Shafer tells a narrow tubing has to be used in the infusion pump as the wide tubing could be problematic. Then the doctor programs the pump, putting the patients weight, correct drug name, infusion rate. Doctor verifies the information for a second time.
Next step is to assess the patient. Anesthesiologist is repsonsible for knowing his patient. Makes a physical examination, first thing is airway, listens to the lungs, checks the heart. Always done for each procedure, for every patient. No exception.
Doctor also gets the informed consent of the patient. Doctor informs the patient of risks and explains what the procedure entails, asks the patient if he has any questions, then patient signs the informed consent form. Dr. Shafer says oral consent is not binding, and is not recognized.
Some steps are not shown on the video. These are: patient put on table, monitoring equipment such as blood pressure cuff, pulse oximeter, ECG are put on patient. Oxygen in place, intravenous catheter is put into the patient. Afther these doctor pauses to verify again. Doctor does one last check before injecting the propofol.
Propofol infusion pump is started. Anesthesiologist is close to the patient, monitors the patient. Doctor keeps records of the vitals. Chart is a necessity to track the patient and the patterns. It's a responsibility to the patient.
In this part of the video, we are shown examples of what can go wrong.
First example is when blood pressure drops. Dr. Shafer says this is very common and they see it everyday. Propofol lowers blood pressure especially if the patient is dehydrates. Doctor gives ephedrine through the IV line. Generally blood pressure comes to normal levels.
Second example is carbon dioxide. The monitor shows that carbon dioxide stopped. It means the patient is not exhaling and the airway is obstructed. Doctor immediately does chin lift and jaw thrust. Dr. Shafer this is also done very routinely. Shafer says the most common reason is because the tongue is blocking the airway and by doing a chin lift and jaw thrust you can move the tongue.
Third example is apnea. This is when the patient doesn't even try to breath. In this instance you need to take over for the patient and force air into the lungs. Doctor removes the nasal cannula, places the mask on the patient's mouth and nose and squeeze the bag to push oxygen into the lungs.
Fourth example is aspiration (not shown on video). This is when the patient vomits and/or stomach contents come to the mouth. Patient is turned sideways and before the next breath you need to suction everything.
Fifth example is cardiac arrest. Heart stops beathing and the patient stops breathing. Doctor does a 2-3 second assesment to make sure that the monitor has not failed. Then the doctor calls for help. First thing is always to call for help. One person begins CPR, one person is ventilating the patient and other person gives resuscitation drugs. Alls of this is done to keep the patient alive for enough time to fix the problem that caused the arrest. These efforts are continued until the patient is revived, or is pronouced dead.
Lunch break
Murray Trial Day 13 , October 19, 2011
Afternoon session
Dr. Shafer Testimony continued
Walgren Direct continued
Dr. Shafer says that the safeguards and requirements apply to all doctors who perform sedation, for any type of IV sedatives. Some nurses are also trained about sedation. These guidelines apply to them as well.
Walgren asks if CM's intent were to give 25mg would these standards still apply. Shafer says yes and continues to say the patient (MJ) had other IV sedatives, profound inability to sleep, he was exhausted, dehydrated; and he had been given sedatives for some time and he could have saome elements of dependency or withdrawal.
Walgren asks if it possible to go in saying I'll only give a small amount so I don't need these guidelines. Dr. Shafer says it's a trap. Even for a little sedation , it's a slippery slope, you may have to give more. You never know how the patient will react. Shafer says there's no such thing as a little sedation and the worst disasters happen when people cut corners.
Facts in this case suggest that virtually none of the safeguards for sedation were in place when propofol was administered to MJ.
Walgren asks Shafer explain how patients reacts different to the same dose of sedatives. Shafer says that some patients will need half the usual dose and some patients will need double the dose. Shafer says 25 mg is the limit when a patient migh stop breathing. Shafer says you can't assume that this will be an average patient. Shafer says you always assume your patient is at the edge of sensitivity and prepare for the worst case scenario.
Shafer did a report about this case dated April 15th, 2011. In his report he used some terms.
Minor violation : not consistent with standard of care, but would not expect to cause harm for the patient unless there are several other violations
Serious violation : expected to cause harm to the patient, in combination of other violations
Egregious violation : These should never happen in the hand of comptent doctors. An egeregious violation can alone be catastrophic for the patient. Competent doctors know that bad outcome is a high possibility
Unconscionable vioation : It goes beyond the standard of care. It's an ethical and moral violation as well as a medical violation.
Walgren goes over Dr. Shafer's report and 17 egregious violations he identified.
Lack of basic airway equipment, egregious violation. MJ died because he stopped breathing which is expected when you give IV sedatives. It must be there without question.
Walgren asks Dr. Shafer assume that CM had left only for 2 minutes and CM had the equipment if MJ could have been saved? Dr. Shafer says yes and probably MJ had an obstructed airway and even a simple chin lift might have been required to save MJ. Shafer says that CM says he didn't use the ambu bag. Shafer says mouth to mouth is less effective and gives used air.
Lack of advanced airway equipment. Those are eqipment such as laryngeal mask, or laryngoscope and endotracheal tube. Shafer had described it a a serious deviation originally but changed his mind to en egregious because of the setting. CM had no help.
Shafer says that it's his view that CM had anticipated to give 100 ml vials. CM had purchased at least 130 100 ml vials, Shafer believes that's at least one per night. Shafer says it's an extraordinary amount for one patient; between april – to 25th june, that 80 nights, 1937 mg/night. Walgren asks how he came to this determination. Shafer says Propofol is an environment for bacteria dveelopment. Once a bottle is opened with a needle, it has to be used within 6 hours. Shafer says this suggests CM planned to use 100ml, if he didn't he would purchase smaller vials.
Lack of suction apparatus, egregious violation. Shafer reminds the jury that any stomach content and/or vomit has to be suctioned so that it won't go into the lungs. Shafer says there's no evidence that MJ was asked to fast for 8 hours prior being given Propofol. Due to this MJ was at greatly higher risk. Therefore a suction equipment was needed.
Lack of infusion pump, egregious violation . There was no infusion pump. Without it the rate can not be precisely controled and the risk of overdose is very high. Shafer says in his opinion this is likely contributed to MJ's death.
Walgren asks without an infusion pump how can one person control the drip. Shafer answers by roller clamp. It's a plastic wheel that pinches the tubing to decrease the amount . Shafer says it's extremely imprecise and that was the only thing available to CM when he gave propofol.
Lack of pulse oximetry, egregious violation . The pulse oxieter that CM used was completely inappropriate. It's not intended to be used for continuous care as it had no alarm. Shafer says that on monitors in hospital they can see it on the screen and there is a tone. Doctors will hear the tone changes which alerts them that there's a problem. In MJ's case only way to monitor was to take his hand and continoiusly look to it. If there was a proper equipment, there would be a monitor showing the vital signs from distance and there would be an alarm that could have saved MJ's life.
Lack of blood pressure cuff,egregious violation. Propofol lowers everyone's blood pressure. Doctors would treat it with additional saline solution or with less propofol. MJ was dehydrated, the risk are higher for exagerated response. If blood pressure falls the body shuts down the flow to the arms and legs and concentrates on providing blood to heart and the brain. The drug becomes more potent. Dr. Shafer says the manual blood pressure cuff that CM had in his bag in the cabinet is useless.
Lack of ECG, egregious violation . ECG allows you te see he heart rate, the heart rythm. This is routine monitoring. In this case CM couldn't know what kind of therapy to use when MJ went into arrest.
Lack of capnography, an egregious violation. Dr. Shafer initially thought that it was not a violation as other specialist doesn't use it. However in MJ's environment it was a disaster. If CM had it he would have known immediately that MJ had stopped breathing.
Lack of emergency drugs, serious violation. Dr. Shafer doesn't think lack of emergency drugs contributed to MJ's death. Shafer says if MJ had a low blood pressure as he wasn't going through surgery, MJ could have been woken up and hydration and stopping propofol would have been enough.
Lack of charts, egregious violation as well as unethical. Shafer says a doctor needs charts to asses what's going on and the changes. Shafer says the patient or if the patient doesn't survive the family has a right to know what happened and what the doctor did.
Dr. Shafer gives an example and Dr. Shafer looks clearly upset. Dr. Shafer says he knows how he would feel if his father , brother or son went to a medical facility for 80 days and died and the doctors told him they don't know what happened because they have no reports. Dr.Shafer says it's unbelieveable that after 80 days of treatment there's not a single record of treatment. Dr.Shafer says that not keeping records is also illegal in California. Dr. Shafer says that doctors has to keep records even if the patient doesn't want them and confidentiality cannot be an excuse.
Shafer says that in CM's interview he mentioned MJ could have been dependent on Propofol and that would require a referral but he can't do that referral as he had no records.
Obligation to get information about the patient. Shafer says it's doctors responsability to know everything about their patient to provide care. Shafer says CM mentions IV sites but didn't follow it through and asked what's happening. Walgren asks what if the patient says it's none of your business, Shafer says that then he would say "Then I can not be your doctor".
Dr. Shafer the only physical evidence of Michael was done months ago. Shafer says CM mentioning MJ being dehydrated but yet he do a simple blood pressure check. Shafer says there's no history, not even a simple recording of the vital signs. Shafer calls this serious violation and that no doctor does that.
Failure to maintain a doctor patient relationship , egregious violation. In this relationship doctor would put the patient first. It doesn't meean to do what the patient asks, it's to do what's best for patient. If patient asks for something foolish or dangerous, doctor should have said no. Dr. Shafer describes the relation between Cm and MJ as employer employee relationship. Patient stated what he wanted, CM says yes. Shafer compares CM to a housekeeper that does what she's told. That's what an employee does. Shafer says CM was not exercising his medical judgement and he was not acting in MJ's best interest. CM completely abandonned medical judgement.Shafer says the very first time MJ asked for propofol, CM should have sent MJ to a sleep specialist.
Lack of Inormed consent , egregious and unconscinable. An informed consent would have involved that propofol is not a treatment for insomnia, It woud have explained risk of death and alternative treatments. Dr. Shafer says there's no proof that MJ knew that he was putting his life at risk. Shafer again mentions that the consent has to be written. MJ was denied his right o make an informed decision.
Need to continuously observe the mental satus, egregious and unconscinable. Dr. Shafer says that doctors need to stay with the patient and CM abadonned his patient. Shafer compares giving sedation to driving a motor home. Shafer says you cannot leave the steering wheel on a highway to relieve yourself. If you do it would be an disaster. Dr. Shafer says in 25 years he has been a physician he have never walked out of the room.
Continious monitoring / observation, egregious violation . CM left MJ alone and he was on the phone. Shafer says youcan't multi task especially if you have no monitoring equipment. Dr. Shafer a patient who is about to die, doesn't look that different from a patient that is okay. Dr. Shafer says from a distance you can't tell if a person is breathing. Shafer says he believes Murray may have been in the room and have not realised MJ stopped breathing.
Shafer says resuciation would have been easy as all needed is to stop propofol and make MJ beathe. Shafer once ahain reminds that it's common that patients would stop breathing during anesthesia and it's expected. Shafer says all CM was monitoring all he needed to do was to lift the chin and ventilate.
mid afternoon break
Lack of continuous documentions, egregius and unconscionable violation. Dr. Shafer says documentation is part of giving care. Shafer says if CM had the reports he would have seen that the oxygen saturation lowered or the heart rythm changed.
Failure to call 911 timely, egregious violation. Shafer says in that setting MJ could not have been revived without assistance. Shafer says calling 911 was the highest priority given the lack of help and equipment. Shafer says if calling 911 was not possible, Propofol should not been given at all.
Shafer says assuming CM realised there was a problem at 12:00 he doesn't understand that CM left a voice message to MAW and how it took 20 mn to call 911. Shafer calls it unconceivable and completely and utterly inexcusable.
Shafer says if CM left only for 2 minutes and called paramedics immediately MJ would be alive with some brain damage. If CM realized MJ was in trouble in 2 minutes and had the airway equipment MJ would be alive and uninjured.
Walgren asks how effective is a one handed CPR on a bed. Shafer says the patient sinks into the bed and it's ineffective. Even if CM had his hand behind Mj's back it's ineffective because you need your body weight to do effective CPR. Shafer says you need 2 hands, one hand is not enough. Shafer says CM hould have called 911 first and then moved Mj to the floor. Shafer also says based on CM's interview the issue here was not that the heart stopped; MJe stopped breathing. CM said there was pulse. If there was a pulse what he needed to do was to have oxygen into his lungs. There was no need for CPR if there was a pulse. Shafer says a lay person would use mouth to mouth as they have no other means. For a doctor it shows that the doctor doesn't have equipment needed.
Shafer says that he doesn't understand why CM raised MJ's legs. Shafer calls it a waste of time. Shafer says raising the legs is done when you thing there's not enough blood in the heart but that wasn't MJ's problem. His breathing had stopped. Shafer says that it shows CM was clueless about what to do.
Walgren asks what is flumazenil. Shafer explains it's a frug that reverses the effects of lorazepam and midazolam. Dr. Shafer says he's curious why CM gave it. Shafer says it doesn't fit with only giving 2 doses of 2 mg several hours before. Dr. Shafer says he believes that CM knew that there was a lot more lorazepam.
Dr. Shafer talks about deception of paramedics and UCLA doctors and not mentionning propofol, egregious and unconscionable violation. Dr. Shafer says a person's life was in the balance, it's inexcusable. Shafer says he also mischaracterized this event as a witnessed arrest. Shafer says a witnessed arrest is not an arrest for lack of breathing, it is usually something like a heart attack. So the therapy of the paramedics and ER doctors was not appropriate. In an arrest you have only seconds to choose a treatment, paramedics and ER doctors were not given the corect information. Shafer says witholding information is a violation of patient's trust.
Walgren asks what is polypharmacy. Shafer explains it's administering many drugs at once and it's a serious violation. Shafer says what CM gave to MJ didn't make any sense. Shafer says Midazolam and lorazepam are very similar drugs and the only difference is how long they stay in the system. Shafer says he doesn't understand why CM switched from midazolam to lorazepam and back. Shafer says that he thinks that CM did not understand the drugs he was giving.
Walgren asks if 25mg Propofol is a safe dose. Shafer says in this setting there was no safe dose. Midazolam an lorazepam were given. MJ had received benzos for 80 nights, he could have been dependant or in withdrawal from the benzos or propofol. Dr. Shafer says he never heard a person given propofol for 80 nights and doesn't know what would happen.
Walgren asks about the Taiwan study. Shafer says there are over 13000 medical articles about propofol, 2500 articles about propofol and sedation and there's only one article on Propofol and insomnia. It's this study done in 2010. Dr. Shafer says that he wouldn't published the Taiwan study because the dose of Propofol that was given is not mentioned. Dr. Shafer also says that the conditions of the study doesn't apply here. That study was done in a hospital, by anesthesiolgists, patients had fasted for 8 hours, they were monitored, an infusion pump was used, propofol was used for 2 hours for 5 days during two weeks. There was no other medication. The patients were treated within the standard of care. Shafer says the article actually highlights CMs deviations from standard of care.
Walgren asks even if MJ had taken Lorazepam and/or Propofol would these 17 deviations would still be relevant and if Shafer would consider CM responsible for MJ's death. Dr. Shafer answers yes.
Walgren asks about doctor patient relationship. Dr. Shafer says it's dated back centuries ago. Dr. Shafer says that doctors have power to give drugs and cut open a patient etc and this is because they are entrusted to do that because they are supposed put the patient first. Dr. Shafer reads hippocratic oath. Shafer says when Cm agreed to give propofol to MJ, he put CM first. When CM was showing up every night with propofol and saline bags, he was putting CM first. When Cm withheld info from paramedics and ER doctors, he put CM first.
Afternoon session
Dr. Shafer Testimony continued
Walgren Direct continued
Dr. Shafer says that the safeguards and requirements apply to all doctors who perform sedation, for any type of IV sedatives. Some nurses are also trained about sedation. These guidelines apply to them as well.
Walgren asks if CM's intent were to give 25mg would these standards still apply. Shafer says yes and continues to say the patient (MJ) had other IV sedatives, profound inability to sleep, he was exhausted, dehydrated; and he had been given sedatives for some time and he could have saome elements of dependency or withdrawal.
Walgren asks if it possible to go in saying I'll only give a small amount so I don't need these guidelines. Dr. Shafer says it's a trap. Even for a little sedation , it's a slippery slope, you may have to give more. You never know how the patient will react. Shafer says there's no such thing as a little sedation and the worst disasters happen when people cut corners.
Facts in this case suggest that virtually none of the safeguards for sedation were in place when propofol was administered to MJ.
Walgren asks Shafer explain how patients reacts different to the same dose of sedatives. Shafer says that some patients will need half the usual dose and some patients will need double the dose. Shafer says 25 mg is the limit when a patient migh stop breathing. Shafer says you can't assume that this will be an average patient. Shafer says you always assume your patient is at the edge of sensitivity and prepare for the worst case scenario.
Shafer did a report about this case dated April 15th, 2011. In his report he used some terms.
Minor violation : not consistent with standard of care, but would not expect to cause harm for the patient unless there are several other violations
Serious violation : expected to cause harm to the patient, in combination of other violations
Egregious violation : These should never happen in the hand of comptent doctors. An egeregious violation can alone be catastrophic for the patient. Competent doctors know that bad outcome is a high possibility
Unconscionable vioation : It goes beyond the standard of care. It's an ethical and moral violation as well as a medical violation.
Walgren goes over Dr. Shafer's report and 17 egregious violations he identified.
Lack of basic airway equipment, egregious violation. MJ died because he stopped breathing which is expected when you give IV sedatives. It must be there without question.
Walgren asks Dr. Shafer assume that CM had left only for 2 minutes and CM had the equipment if MJ could have been saved? Dr. Shafer says yes and probably MJ had an obstructed airway and even a simple chin lift might have been required to save MJ. Shafer says that CM says he didn't use the ambu bag. Shafer says mouth to mouth is less effective and gives used air.
Lack of advanced airway equipment. Those are eqipment such as laryngeal mask, or laryngoscope and endotracheal tube. Shafer had described it a a serious deviation originally but changed his mind to en egregious because of the setting. CM had no help.
Shafer says that it's his view that CM had anticipated to give 100 ml vials. CM had purchased at least 130 100 ml vials, Shafer believes that's at least one per night. Shafer says it's an extraordinary amount for one patient; between april – to 25th june, that 80 nights, 1937 mg/night. Walgren asks how he came to this determination. Shafer says Propofol is an environment for bacteria dveelopment. Once a bottle is opened with a needle, it has to be used within 6 hours. Shafer says this suggests CM planned to use 100ml, if he didn't he would purchase smaller vials.
Lack of suction apparatus, egregious violation. Shafer reminds the jury that any stomach content and/or vomit has to be suctioned so that it won't go into the lungs. Shafer says there's no evidence that MJ was asked to fast for 8 hours prior being given Propofol. Due to this MJ was at greatly higher risk. Therefore a suction equipment was needed.
Lack of infusion pump, egregious violation . There was no infusion pump. Without it the rate can not be precisely controled and the risk of overdose is very high. Shafer says in his opinion this is likely contributed to MJ's death.
Walgren asks without an infusion pump how can one person control the drip. Shafer answers by roller clamp. It's a plastic wheel that pinches the tubing to decrease the amount . Shafer says it's extremely imprecise and that was the only thing available to CM when he gave propofol.
Lack of pulse oximetry, egregious violation . The pulse oxieter that CM used was completely inappropriate. It's not intended to be used for continuous care as it had no alarm. Shafer says that on monitors in hospital they can see it on the screen and there is a tone. Doctors will hear the tone changes which alerts them that there's a problem. In MJ's case only way to monitor was to take his hand and continoiusly look to it. If there was a proper equipment, there would be a monitor showing the vital signs from distance and there would be an alarm that could have saved MJ's life.
Lack of blood pressure cuff,egregious violation. Propofol lowers everyone's blood pressure. Doctors would treat it with additional saline solution or with less propofol. MJ was dehydrated, the risk are higher for exagerated response. If blood pressure falls the body shuts down the flow to the arms and legs and concentrates on providing blood to heart and the brain. The drug becomes more potent. Dr. Shafer says the manual blood pressure cuff that CM had in his bag in the cabinet is useless.
Lack of ECG, egregious violation . ECG allows you te see he heart rate, the heart rythm. This is routine monitoring. In this case CM couldn't know what kind of therapy to use when MJ went into arrest.
Lack of capnography, an egregious violation. Dr. Shafer initially thought that it was not a violation as other specialist doesn't use it. However in MJ's environment it was a disaster. If CM had it he would have known immediately that MJ had stopped breathing.
Lack of emergency drugs, serious violation. Dr. Shafer doesn't think lack of emergency drugs contributed to MJ's death. Shafer says if MJ had a low blood pressure as he wasn't going through surgery, MJ could have been woken up and hydration and stopping propofol would have been enough.
Lack of charts, egregious violation as well as unethical. Shafer says a doctor needs charts to asses what's going on and the changes. Shafer says the patient or if the patient doesn't survive the family has a right to know what happened and what the doctor did.
Dr. Shafer gives an example and Dr. Shafer looks clearly upset. Dr. Shafer says he knows how he would feel if his father , brother or son went to a medical facility for 80 days and died and the doctors told him they don't know what happened because they have no reports. Dr.Shafer says it's unbelieveable that after 80 days of treatment there's not a single record of treatment. Dr.Shafer says that not keeping records is also illegal in California. Dr. Shafer says that doctors has to keep records even if the patient doesn't want them and confidentiality cannot be an excuse.
Shafer says that in CM's interview he mentioned MJ could have been dependent on Propofol and that would require a referral but he can't do that referral as he had no records.
Obligation to get information about the patient. Shafer says it's doctors responsability to know everything about their patient to provide care. Shafer says CM mentions IV sites but didn't follow it through and asked what's happening. Walgren asks what if the patient says it's none of your business, Shafer says that then he would say "Then I can not be your doctor".
Dr. Shafer the only physical evidence of Michael was done months ago. Shafer says CM mentioning MJ being dehydrated but yet he do a simple blood pressure check. Shafer says there's no history, not even a simple recording of the vital signs. Shafer calls this serious violation and that no doctor does that.
Failure to maintain a doctor patient relationship , egregious violation. In this relationship doctor would put the patient first. It doesn't meean to do what the patient asks, it's to do what's best for patient. If patient asks for something foolish or dangerous, doctor should have said no. Dr. Shafer describes the relation between Cm and MJ as employer employee relationship. Patient stated what he wanted, CM says yes. Shafer compares CM to a housekeeper that does what she's told. That's what an employee does. Shafer says CM was not exercising his medical judgement and he was not acting in MJ's best interest. CM completely abandonned medical judgement.Shafer says the very first time MJ asked for propofol, CM should have sent MJ to a sleep specialist.
Lack of Inormed consent , egregious and unconscinable. An informed consent would have involved that propofol is not a treatment for insomnia, It woud have explained risk of death and alternative treatments. Dr. Shafer says there's no proof that MJ knew that he was putting his life at risk. Shafer again mentions that the consent has to be written. MJ was denied his right o make an informed decision.
Need to continuously observe the mental satus, egregious and unconscinable. Dr. Shafer says that doctors need to stay with the patient and CM abadonned his patient. Shafer compares giving sedation to driving a motor home. Shafer says you cannot leave the steering wheel on a highway to relieve yourself. If you do it would be an disaster. Dr. Shafer says in 25 years he has been a physician he have never walked out of the room.
Continious monitoring / observation, egregious violation . CM left MJ alone and he was on the phone. Shafer says youcan't multi task especially if you have no monitoring equipment. Dr. Shafer a patient who is about to die, doesn't look that different from a patient that is okay. Dr. Shafer says from a distance you can't tell if a person is breathing. Shafer says he believes Murray may have been in the room and have not realised MJ stopped breathing.
Shafer says resuciation would have been easy as all needed is to stop propofol and make MJ beathe. Shafer once ahain reminds that it's common that patients would stop breathing during anesthesia and it's expected. Shafer says all CM was monitoring all he needed to do was to lift the chin and ventilate.
mid afternoon break
Lack of continuous documentions, egregius and unconscionable violation. Dr. Shafer says documentation is part of giving care. Shafer says if CM had the reports he would have seen that the oxygen saturation lowered or the heart rythm changed.
Failure to call 911 timely, egregious violation. Shafer says in that setting MJ could not have been revived without assistance. Shafer says calling 911 was the highest priority given the lack of help and equipment. Shafer says if calling 911 was not possible, Propofol should not been given at all.
Shafer says assuming CM realised there was a problem at 12:00 he doesn't understand that CM left a voice message to MAW and how it took 20 mn to call 911. Shafer calls it unconceivable and completely and utterly inexcusable.
Shafer says if CM left only for 2 minutes and called paramedics immediately MJ would be alive with some brain damage. If CM realized MJ was in trouble in 2 minutes and had the airway equipment MJ would be alive and uninjured.
Walgren asks how effective is a one handed CPR on a bed. Shafer says the patient sinks into the bed and it's ineffective. Even if CM had his hand behind Mj's back it's ineffective because you need your body weight to do effective CPR. Shafer says you need 2 hands, one hand is not enough. Shafer says CM hould have called 911 first and then moved Mj to the floor. Shafer also says based on CM's interview the issue here was not that the heart stopped; MJe stopped breathing. CM said there was pulse. If there was a pulse what he needed to do was to have oxygen into his lungs. There was no need for CPR if there was a pulse. Shafer says a lay person would use mouth to mouth as they have no other means. For a doctor it shows that the doctor doesn't have equipment needed.
Shafer says that he doesn't understand why CM raised MJ's legs. Shafer calls it a waste of time. Shafer says raising the legs is done when you thing there's not enough blood in the heart but that wasn't MJ's problem. His breathing had stopped. Shafer says that it shows CM was clueless about what to do.
Walgren asks what is flumazenil. Shafer explains it's a frug that reverses the effects of lorazepam and midazolam. Dr. Shafer says he's curious why CM gave it. Shafer says it doesn't fit with only giving 2 doses of 2 mg several hours before. Dr. Shafer says he believes that CM knew that there was a lot more lorazepam.
Dr. Shafer talks about deception of paramedics and UCLA doctors and not mentionning propofol, egregious and unconscionable violation. Dr. Shafer says a person's life was in the balance, it's inexcusable. Shafer says he also mischaracterized this event as a witnessed arrest. Shafer says a witnessed arrest is not an arrest for lack of breathing, it is usually something like a heart attack. So the therapy of the paramedics and ER doctors was not appropriate. In an arrest you have only seconds to choose a treatment, paramedics and ER doctors were not given the corect information. Shafer says witholding information is a violation of patient's trust.
Walgren asks what is polypharmacy. Shafer explains it's administering many drugs at once and it's a serious violation. Shafer says what CM gave to MJ didn't make any sense. Shafer says Midazolam and lorazepam are very similar drugs and the only difference is how long they stay in the system. Shafer says he doesn't understand why CM switched from midazolam to lorazepam and back. Shafer says that he thinks that CM did not understand the drugs he was giving.
Walgren asks if 25mg Propofol is a safe dose. Shafer says in this setting there was no safe dose. Midazolam an lorazepam were given. MJ had received benzos for 80 nights, he could have been dependant or in withdrawal from the benzos or propofol. Dr. Shafer says he never heard a person given propofol for 80 nights and doesn't know what would happen.
Walgren asks about the Taiwan study. Shafer says there are over 13000 medical articles about propofol, 2500 articles about propofol and sedation and there's only one article on Propofol and insomnia. It's this study done in 2010. Dr. Shafer says that he wouldn't published the Taiwan study because the dose of Propofol that was given is not mentioned. Dr. Shafer also says that the conditions of the study doesn't apply here. That study was done in a hospital, by anesthesiolgists, patients had fasted for 8 hours, they were monitored, an infusion pump was used, propofol was used for 2 hours for 5 days during two weeks. There was no other medication. The patients were treated within the standard of care. Shafer says the article actually highlights CMs deviations from standard of care.
Walgren asks even if MJ had taken Lorazepam and/or Propofol would these 17 deviations would still be relevant and if Shafer would consider CM responsible for MJ's death. Dr. Shafer answers yes.
Walgren asks about doctor patient relationship. Dr. Shafer says it's dated back centuries ago. Dr. Shafer says that doctors have power to give drugs and cut open a patient etc and this is because they are entrusted to do that because they are supposed put the patient first. Dr. Shafer reads hippocratic oath. Shafer says when Cm agreed to give propofol to MJ, he put CM first. When CM was showing up every night with propofol and saline bags, he was putting CM first. When Cm withheld info from paramedics and ER doctors, he put CM first.
Murray Trial Day 14 , October 20 2011
Morning Session
Dr. Shafer Testimony continued
Walgren direct continued
Walgren starts talking about Propofol. Walgren asked Dr. Shafer if he would provide his opinion in this case around March 2011 and gave Shafer LAPD and toxicology reports. Walgren also gave Dr. Shafer a report from Dr. White. Dr. White had written that MJ could have orally digested Propofol. Dr. Shafer says that he was disappointed because oral Propofol cannot get pass liver. Shafer says by the first pass effect liver would almost remove all of the Propofol.
(Dr. White is shown in the picture)
Dr. Shafer has prepared a presentation called "Propofol not orally bio-available"
Slide 1 is the title.
Slide 2 shows the digestive track of human body. Dr. Shafer identifies the organs. Shafer says oral Propofol would come to the stomach, it would pass into the blood and all of that blood would go into the liver and only after it passes the liver it would go back to the blood vessels.
Slide 3 is a close up of the digestive track. It shows all the veins from the digestive track goes into the liver. Shafer explains first pass effect of Propofol. 99% of the drug would have been removed and there's no reason to expect that oral propofol would have any effect. Dr. Shafer wrote in his report there is 0 possibility that MJ died because of oral Propofol.
Slide 4 is a 1985 article by Dr.Glen (doctor to developed Propofol - Dr. Shafer says that he deserves to be called Father of Propofol)about Propofol. In this study propofol was given to mice, they found that IV doses was effective but even 20 times the IV dose is given to animals orally would not produce general anesthesia.
Slide 5 1991 Study on piglets. This research shows that less than 1% of Propofol would be bio available in the piglets. This shows that Propofol would be cleaned out the system by the liver.
Slide 6 1996 research done on rats. In this study they found out that 10% of the Propofol was available in rats. Dr. Shafer says it's because rats are a different species. It still shows that a majority of Propofol (90%) is cleaned out of the system.
Slide 7 - US Patent dated June 23,2009. The research findings in this study was done in rats and the bio availability of Propofol was less than 1%.
Slide 8 - US Patent dated Nov 17, 2009. Another research done on dogs and monkeys and the bio availability was less than 1%. All of these information was available when Dr. White and Dr. Shafer wrote their reports.
Rest of the slides - Dr.Shafer then did a research about the oral bio availability in humans. Dr. Shafer says there was nothing published as humans as subjects. Dr. Shafer participated in a study done on human volunteers in Chile. 6 students volunterred. First 3 volunteers drank 20 ml/200mg of Propofol and other 3 drank twice that dose (400mg). they mesasured pulse, blood pressure and sedation was measured. They regularly took blood from the arm and measured for Propofol. None of the volunteers was sedated after orally digesting Propofol. Level of the oxygen never dropped, blood pressure never dropped. The study was presented last week in Chicago in a conference. Dr. Shafer also got a lifetime achievement award in that conference.
Last slide is the conclusion of the human study, there was no effect of oral Propofol on humans.
Shafer says he did the research because of this case and DEA wanting Propofol to be a controlled substance. Shafer thinks DEA is trying to do this because they believe MJ could have drank it. Shafer says that he wants to show that the drug cannot be abused orally.
Shafer says that he told Walgren on the first phone call oral effect of Propofol was not possible and he later seek out these additional surveys and even conducted a study on humans to show that there was zero possibility.
Walgren brings another presentation. This one is about Lorazepam. (long sidebar due to objection by chernoff)
Slide 1 title.
Slide 2 A study that was done by Shafer. He looked to Lorazepam or Midazolam. They gave it to patients by a computer. Blood was gathered at regular interval from the patients artery to study the concentration. The study was done at Stanford, and they colected a huge amount of data.
Dr. Shafer reviewed toxicology levels in MJ and he's aware that CM said 2 doses of 2mg of Lorazepam. Dr. Shafer ran models to see if this dose would cause the Lorazepam levels in MJ's blood. 2 doses of 2mg of Lorazepam is not supported by the blood levels. The model shows that the concentration of 2doses of 2 mg at 2 am and 5 am is about 10% of what was found. Shafer says MJ was administered more Lorazepam.
mid morning break
If the 2 doses of 2 mg was given at 2:00 and 5:00 AM was the only amount given to MJ, the concentration the coroner should have found is 0.025, not 0.169.
Dr. Shafer shows another model to reach 0.169 level at 12:00 noon. It shows 10 doses of 4 mg between midinght and 5 am. This number is consisted with the vials found at MJ's house (10 ml bottles with 4mg per ml concentration which equals to 40mg).
Dr. Shafer explains metabolite of Lorazepam called lorazepam glucoronide. The liver attaches sugar to the lorazepam molecule so the kidneys can process the lorazepam. This process makes the drug inactive. Lorazepam glucoronide has no effect. The lorazepam will have an effect, but not its metabolite. The coroner looks for the levels of lorazepam and not its metabolite.
Walgren shows the defense test done for Lorazepam. Pacific Toxicology converted the metabolite back to the drug itself and after this analyzed for Lorazepam. So their results was inflated as it included both the drug and it's metabolite. Their results for Lorazepam and its metabolite was 0.634 concentration. Pacific Toxicology didn't seperate between Lorazepam and it's metabolite.
Walgren asks how can Lorazepam be found in the stomach. Dr. Shafer showing the digestive track explains the process. After IV injection the active drug goes to the blood. Later it goes to the liver and liver converts it to its metabolite. 25% of the metabolite goes to the bile and then the bile drains it into the intestine. At the junction between the stomach and small intestine, some of the metabolite sloshes back into the stomach. Dr.Shafer says MJ had 1/43 of a pill of Lorazepam and most of it was the metabolite and the true amount of Lorazepam was much smaller.
Dr. Shafer says that this proves that MJ did not swallow Lorazepam for at least 4 hours prior to his death (between 8 AM and 12PM). So Flanagan's hypothetical scenario of MJ taking Lorazepam pills around 10AM is not possible.
Walgren and Shafer switched to discussing Propofol. Walgren goes over several studies that Dr. Shafer has done about propofol.Dr. Shafer used the models that include age, weight and gender from those studies to run models about Propofol found in MJ.
Shafer says that Propofol acts in the brain and it's the brain makes you fall asleep or stop breathing. So it's the brain concentration that matters.
Defense witness Dr. White was a participant in one of the studies to show at what concentration of Propofol a person would stop breathing. At 2.3 mg/ml half of the patients would be expected to stop breathing. The range of apnea is 1.3mg to 3.3mg/ml . At 1.3mg, 5% of patients stop breathing, at 3.3mg 95 % stop breathing.
Another study was done on pigs to determine the the delay between apnea and the time when blood circulation stops. The result showed that there is 9 minutes between respiratory arrest and cardiac arrest.
Dr Shafer did simulations for this case. He assumed the time between respiratory arrest and cardiac arrest to be 10 minutes as a human being has more oxygen than a pig and MJ was on supplemental oxygen. Propofol concentration found by the coroner in Mj's in femoral blood was 2.6 , that's the concentration when blood circulation stopped. Shafer is trying different scenarios to reach to that number. Concentrations of Propofol rises quickly and also falls very quickly. This is because of the liver and propofol goes to other tissues.
Scenario 1 : Only 25 mg Propofol bolus injection
MJ would have been below the point where half of the patients would stop breathing (2.3) but above the 5% limit (1.3). He would have stopped breathing from 1minutes to 2 and half minutes after the injection. After 3 minutes everyone would be expected to breathe again. So even with a small dose there's a risk for short period of time. As MJ was given other drugs he would have a higher risk.
Shafer doesn't think this is what happened to MJ. MJ would be apneic for 2minutes and his blood circulation would have lasted at least 10minutes and propofol would have been metabolised. So the femerol amount would have been much smaller than the coroner had found. Shafer rules out this scenario.
Scenario 2 : 50mg Propofol bolus (half of the needle is filled with Propofol and other half with Lidocaine)
MJ would likely have stopped breathing 1 minutes to 3 / 4minutes after he was given the dosethe dose. (not breathing for 3 minutes wouldn't cause brain damage) The heart would continue beating for 10 minutes. Again 50 mg Propofol wouldn't give the amount measured in the femoral blood. Shafer rules out this scenario as well.
Scenario 3 : 100 mg Propofol bolus (All the syringe is filled with Propofol)
Patient would stop within 1 minutes and heart would have stopped after 10minutes. Femoral blood level would have been under what coroner found. Shafer rules out this scenario.
Multiple Self Injection Scenarios
Scenario 4 : 6 self injections 50mg each over 90mn
Self injection would involve drawing propofol and injection through the port . It takes time and requires coordination. Based on CM's intervew MJ had poor veins so self injection is unlikely and would be extremely painful without lidocaine. 50mg would put MJ sleep and make him sleep about 10 minutes and it would get a little longer with each injectionas there would be a little propofol left in the blood. Circulation would stop after 10 minutes. Femoral blood level would be well under the numbers found by coroner. Shafer rules out this scenario.
Scenario 5 : 6 injections 100 mg each over 3 hours.
This is an anesthetic dose. MJ would stop breathing and the circulation would stop after 10 minutes. Again the blood level of Propofol would be well below than what was measured in femoral blood. Shafer says MJ would have probably died after first or second injection ,but coroner would have found a lower femoral level of Propofol.
Lunch break
Morning Session
Dr. Shafer Testimony continued
Walgren direct continued
Walgren starts talking about Propofol. Walgren asked Dr. Shafer if he would provide his opinion in this case around March 2011 and gave Shafer LAPD and toxicology reports. Walgren also gave Dr. Shafer a report from Dr. White. Dr. White had written that MJ could have orally digested Propofol. Dr. Shafer says that he was disappointed because oral Propofol cannot get pass liver. Shafer says by the first pass effect liver would almost remove all of the Propofol.
(Dr. White is shown in the picture)
Dr. Shafer has prepared a presentation called "Propofol not orally bio-available"
Slide 1 is the title.
Slide 2 shows the digestive track of human body. Dr. Shafer identifies the organs. Shafer says oral Propofol would come to the stomach, it would pass into the blood and all of that blood would go into the liver and only after it passes the liver it would go back to the blood vessels.
Slide 3 is a close up of the digestive track. It shows all the veins from the digestive track goes into the liver. Shafer explains first pass effect of Propofol. 99% of the drug would have been removed and there's no reason to expect that oral propofol would have any effect. Dr. Shafer wrote in his report there is 0 possibility that MJ died because of oral Propofol.
Slide 4 is a 1985 article by Dr.Glen (doctor to developed Propofol - Dr. Shafer says that he deserves to be called Father of Propofol)about Propofol. In this study propofol was given to mice, they found that IV doses was effective but even 20 times the IV dose is given to animals orally would not produce general anesthesia.
Slide 5 1991 Study on piglets. This research shows that less than 1% of Propofol would be bio available in the piglets. This shows that Propofol would be cleaned out the system by the liver.
Slide 6 1996 research done on rats. In this study they found out that 10% of the Propofol was available in rats. Dr. Shafer says it's because rats are a different species. It still shows that a majority of Propofol (90%) is cleaned out of the system.
Slide 7 - US Patent dated June 23,2009. The research findings in this study was done in rats and the bio availability of Propofol was less than 1%.
Slide 8 - US Patent dated Nov 17, 2009. Another research done on dogs and monkeys and the bio availability was less than 1%. All of these information was available when Dr. White and Dr. Shafer wrote their reports.
Rest of the slides - Dr.Shafer then did a research about the oral bio availability in humans. Dr. Shafer says there was nothing published as humans as subjects. Dr. Shafer participated in a study done on human volunteers in Chile. 6 students volunterred. First 3 volunteers drank 20 ml/200mg of Propofol and other 3 drank twice that dose (400mg). they mesasured pulse, blood pressure and sedation was measured. They regularly took blood from the arm and measured for Propofol. None of the volunteers was sedated after orally digesting Propofol. Level of the oxygen never dropped, blood pressure never dropped. The study was presented last week in Chicago in a conference. Dr. Shafer also got a lifetime achievement award in that conference.
Last slide is the conclusion of the human study, there was no effect of oral Propofol on humans.
Shafer says he did the research because of this case and DEA wanting Propofol to be a controlled substance. Shafer thinks DEA is trying to do this because they believe MJ could have drank it. Shafer says that he wants to show that the drug cannot be abused orally.
Shafer says that he told Walgren on the first phone call oral effect of Propofol was not possible and he later seek out these additional surveys and even conducted a study on humans to show that there was zero possibility.
Walgren brings another presentation. This one is about Lorazepam. (long sidebar due to objection by chernoff)
Slide 1 title.
Slide 2 A study that was done by Shafer. He looked to Lorazepam or Midazolam. They gave it to patients by a computer. Blood was gathered at regular interval from the patients artery to study the concentration. The study was done at Stanford, and they colected a huge amount of data.
Dr. Shafer reviewed toxicology levels in MJ and he's aware that CM said 2 doses of 2mg of Lorazepam. Dr. Shafer ran models to see if this dose would cause the Lorazepam levels in MJ's blood. 2 doses of 2mg of Lorazepam is not supported by the blood levels. The model shows that the concentration of 2doses of 2 mg at 2 am and 5 am is about 10% of what was found. Shafer says MJ was administered more Lorazepam.
mid morning break
If the 2 doses of 2 mg was given at 2:00 and 5:00 AM was the only amount given to MJ, the concentration the coroner should have found is 0.025, not 0.169.
Dr. Shafer shows another model to reach 0.169 level at 12:00 noon. It shows 10 doses of 4 mg between midinght and 5 am. This number is consisted with the vials found at MJ's house (10 ml bottles with 4mg per ml concentration which equals to 40mg).
Dr. Shafer explains metabolite of Lorazepam called lorazepam glucoronide. The liver attaches sugar to the lorazepam molecule so the kidneys can process the lorazepam. This process makes the drug inactive. Lorazepam glucoronide has no effect. The lorazepam will have an effect, but not its metabolite. The coroner looks for the levels of lorazepam and not its metabolite.
Walgren shows the defense test done for Lorazepam. Pacific Toxicology converted the metabolite back to the drug itself and after this analyzed for Lorazepam. So their results was inflated as it included both the drug and it's metabolite. Their results for Lorazepam and its metabolite was 0.634 concentration. Pacific Toxicology didn't seperate between Lorazepam and it's metabolite.
Walgren asks how can Lorazepam be found in the stomach. Dr. Shafer showing the digestive track explains the process. After IV injection the active drug goes to the blood. Later it goes to the liver and liver converts it to its metabolite. 25% of the metabolite goes to the bile and then the bile drains it into the intestine. At the junction between the stomach and small intestine, some of the metabolite sloshes back into the stomach. Dr.Shafer says MJ had 1/43 of a pill of Lorazepam and most of it was the metabolite and the true amount of Lorazepam was much smaller.
Dr. Shafer says that this proves that MJ did not swallow Lorazepam for at least 4 hours prior to his death (between 8 AM and 12PM). So Flanagan's hypothetical scenario of MJ taking Lorazepam pills around 10AM is not possible.
Walgren and Shafer switched to discussing Propofol. Walgren goes over several studies that Dr. Shafer has done about propofol.Dr. Shafer used the models that include age, weight and gender from those studies to run models about Propofol found in MJ.
Shafer says that Propofol acts in the brain and it's the brain makes you fall asleep or stop breathing. So it's the brain concentration that matters.
Defense witness Dr. White was a participant in one of the studies to show at what concentration of Propofol a person would stop breathing. At 2.3 mg/ml half of the patients would be expected to stop breathing. The range of apnea is 1.3mg to 3.3mg/ml . At 1.3mg, 5% of patients stop breathing, at 3.3mg 95 % stop breathing.
Another study was done on pigs to determine the the delay between apnea and the time when blood circulation stops. The result showed that there is 9 minutes between respiratory arrest and cardiac arrest.
Dr Shafer did simulations for this case. He assumed the time between respiratory arrest and cardiac arrest to be 10 minutes as a human being has more oxygen than a pig and MJ was on supplemental oxygen. Propofol concentration found by the coroner in Mj's in femoral blood was 2.6 , that's the concentration when blood circulation stopped. Shafer is trying different scenarios to reach to that number. Concentrations of Propofol rises quickly and also falls very quickly. This is because of the liver and propofol goes to other tissues.
Scenario 1 : Only 25 mg Propofol bolus injection
MJ would have been below the point where half of the patients would stop breathing (2.3) but above the 5% limit (1.3). He would have stopped breathing from 1minutes to 2 and half minutes after the injection. After 3 minutes everyone would be expected to breathe again. So even with a small dose there's a risk for short period of time. As MJ was given other drugs he would have a higher risk.
Shafer doesn't think this is what happened to MJ. MJ would be apneic for 2minutes and his blood circulation would have lasted at least 10minutes and propofol would have been metabolised. So the femerol amount would have been much smaller than the coroner had found. Shafer rules out this scenario.
Scenario 2 : 50mg Propofol bolus (half of the needle is filled with Propofol and other half with Lidocaine)
MJ would likely have stopped breathing 1 minutes to 3 / 4minutes after he was given the dosethe dose. (not breathing for 3 minutes wouldn't cause brain damage) The heart would continue beating for 10 minutes. Again 50 mg Propofol wouldn't give the amount measured in the femoral blood. Shafer rules out this scenario as well.
Scenario 3 : 100 mg Propofol bolus (All the syringe is filled with Propofol)
Patient would stop within 1 minutes and heart would have stopped after 10minutes. Femoral blood level would have been under what coroner found. Shafer rules out this scenario.
Multiple Self Injection Scenarios
Scenario 4 : 6 self injections 50mg each over 90mn
Self injection would involve drawing propofol and injection through the port . It takes time and requires coordination. Based on CM's intervew MJ had poor veins so self injection is unlikely and would be extremely painful without lidocaine. 50mg would put MJ sleep and make him sleep about 10 minutes and it would get a little longer with each injectionas there would be a little propofol left in the blood. Circulation would stop after 10 minutes. Femoral blood level would be well under the numbers found by coroner. Shafer rules out this scenario.
Scenario 5 : 6 injections 100 mg each over 3 hours.
This is an anesthetic dose. MJ would stop breathing and the circulation would stop after 10 minutes. Again the blood level of Propofol would be well below than what was measured in femoral blood. Shafer says MJ would have probably died after first or second injection ,but coroner would have found a lower femoral level of Propofol.
Lunch break
Murray Trial Day 14, October 20 2011
Afternoon Session
Dr. Shafer Testimony continued
Walgren Direct continued
Multiple Injections by Murray Scenarios
Scenario 6: 6 injections 50mg each
In this scenario MJ would have stopped breathing multiple times and under this scenario MJ wouldn't be alive and the femoral blood level would be achieved. Dr. Shafer says this doesn't make sense as CM had to reinject repeatedly and the injections needed to continue after the breathing and the heart stopped. So Shafer rules out this scenario.
Scenario 7 : 100ml infusion, 1000 mg
In this model an infusion is started at 9:00AM and there was a bolus before the drip. When you give a drip , there is not much difference between blood and brain concentration. Levels first raise quickly. Later the liver would start to metabolize the propofol and the levels would slowly rise. When the patient approached to the apneic threshold breathing would have slowed down at a slow pace and carbon dioxide would have gone up. If there had been capnometry you would have seen the carbon dioxide go up.
At 10:00 am MJ continues breathing but without capnometry CM doesn't see that there is a problem. Around 11:30 to 11 :45 breathing would have stopped as there is no oxygen in the lungs. MJ died at about noon with the infusion still running. This is the only scenario Dr Shafer could generate that produces the femoral level found at MJ consistent with CM 's explanations of how he gave propofol. This scenario fits all the data in this case. This what Dr Shafer thinks happened .
CM could have detected there was a problem with capnometry, pulse oximetry. If CM was with MJ he would have seen slow breathing and could have turned off Propofol. CM might have thought everything was okay and walked out of the room. Shafer again mentions that CM bought 130 100ml vials which Shafer thinks measn 1 vial per night.
mid afternoon break
Walgren and Shafer starts working on a IV setup demonstration. Dr. Shafer brought same/similar equipment of what CM used or bought.
Shafer hangs a bag od saline on the IV pole. He attaches the infusion set tubing to the saline bag. In the infusion set there's an injection port with a rubber stopper where you can stick a needle to give mediciation.
Shafer shows a 22 gauge catheter (same size as what's used on MJ). Catheter remains in the vein (needle doesnt). Dr. Shafer attached the catheter to the saline tubing and shows that the fluid goes through very quickly. Saline bag has a non-vented tubing as there's no need for a vented tubing with the saline (the saline bag will shrink).
For Propofol you'll need a vented tubing. CM bought vented infusion sets from Sea Coast. Dr. Shafer shows the vented infusion set that CM bought. It has a apparatus on top that allow the air to come in. This tubing is designed to be used with an infusion pump but there was no pump.
Spike from Propofol tubing woul have been stuck into the bottle and this would be consistent with the tear found at the 100ml Propofol bottle from MJ's house. Shafer sticks the spike into the Propofol bottle and hangs it on the pole with the plastic handle on the bottle.
Walgren shows that the 100ml bottle found in MJ's home also had the same handle. Objection by the defense.
After the sidebar the following stipulation is entered to the record : the handle of the bottle was lifted for demonstration by Walgren. When the bottle was found, it was still attached to the bottle and unused.
CM in his statement to the police said that he turned of the saline before giving Propofol with a syringe. Shafer shows the rubber clamp and how you can stop the flow with the clamp. Shafer demonstrates infusing 25mg of Propofol with syringe as CM mentioned in his interview. Propofol doesn't come out of the tube as the saline is turned off and not coming to push Propofol out. So CM's description of infusing it over 3 to 5 minutes is impossible if the turned off the saline. You need to unclamp the saline for Propofol to come out.
Dr. Shafer demonstrates the vent on the propofol tubing. If he closes the vent Propofol stops, if he opens the vent Propofol runs through. Shafer then hook the vented tubing with a needle to the y connector. Dr. Shafer says that this is an extremely unsafe setup that is all based on gravity. If one bag is lifted there will be more force in that bag and it would slow the other one. If saline stops, propofol speeds up. If the rate of the saline is changed, it would change the rate of the Propofol. This is why this system is very dangerous. The only way to control the speed is the clamps.
Walgren asks about the IV bag with a slit. Shafer says perhaps murray didn't know there was a hanging handle or didn't want to use it. Shafer puts the Propofol bottle with the spike into the cut IV bag to demonstrate it's possible.
Shafer says this system explains why the long tubing found at the house didn't test positive for propofol, but the short tubing did. There was another long tube which was connected to the popofol bottle.
Shafer empties the Propofol bottle quickly and removes the long vented tubing that had Propofol in it. It fits in his hand. Walgren asks if that tubing would fit into a pocket. Dr. Shafer says yes.
Walgren does a recap of Dr. Shafer's testimony: 17 egregious deviations of care, 4 of them are also unetical, has shown a video about the way propofol is safely given, has explained that oral consumption propofol was impossible, that MJ received more than 4mg lorazepam, that at 10 am it was impossible that MJ swalllowed lorazepam,scenarios suggested an IV drip, demonstrated the IV set up and that the infusion line could be compacted in one hand and fit into a pocket.
Walgren asks if CM was the direct cause of MJ's death if MJ self injected/ digested Propofol/Lorazepam. Shafer says yes as CM was the one that brought the propofol, left patient with access to the drugs and started the IV line. Shafer says CM is responsible for every drop of propofol or lorazepam.
Walgren finishes his direct examination of Dr. Shafer.
Due to scheduling issues testimony would start at 12:45PM PST on Friday October 21, 2011.
Afternoon Session
Dr. Shafer Testimony continued
Walgren Direct continued
Multiple Injections by Murray Scenarios
Scenario 6: 6 injections 50mg each
In this scenario MJ would have stopped breathing multiple times and under this scenario MJ wouldn't be alive and the femoral blood level would be achieved. Dr. Shafer says this doesn't make sense as CM had to reinject repeatedly and the injections needed to continue after the breathing and the heart stopped. So Shafer rules out this scenario.
Scenario 7 : 100ml infusion, 1000 mg
In this model an infusion is started at 9:00AM and there was a bolus before the drip. When you give a drip , there is not much difference between blood and brain concentration. Levels first raise quickly. Later the liver would start to metabolize the propofol and the levels would slowly rise. When the patient approached to the apneic threshold breathing would have slowed down at a slow pace and carbon dioxide would have gone up. If there had been capnometry you would have seen the carbon dioxide go up.
At 10:00 am MJ continues breathing but without capnometry CM doesn't see that there is a problem. Around 11:30 to 11 :45 breathing would have stopped as there is no oxygen in the lungs. MJ died at about noon with the infusion still running. This is the only scenario Dr Shafer could generate that produces the femoral level found at MJ consistent with CM 's explanations of how he gave propofol. This scenario fits all the data in this case. This what Dr Shafer thinks happened .
CM could have detected there was a problem with capnometry, pulse oximetry. If CM was with MJ he would have seen slow breathing and could have turned off Propofol. CM might have thought everything was okay and walked out of the room. Shafer again mentions that CM bought 130 100ml vials which Shafer thinks measn 1 vial per night.
mid afternoon break
Walgren and Shafer starts working on a IV setup demonstration. Dr. Shafer brought same/similar equipment of what CM used or bought.
Shafer hangs a bag od saline on the IV pole. He attaches the infusion set tubing to the saline bag. In the infusion set there's an injection port with a rubber stopper where you can stick a needle to give mediciation.
Shafer shows a 22 gauge catheter (same size as what's used on MJ). Catheter remains in the vein (needle doesnt). Dr. Shafer attached the catheter to the saline tubing and shows that the fluid goes through very quickly. Saline bag has a non-vented tubing as there's no need for a vented tubing with the saline (the saline bag will shrink).
For Propofol you'll need a vented tubing. CM bought vented infusion sets from Sea Coast. Dr. Shafer shows the vented infusion set that CM bought. It has a apparatus on top that allow the air to come in. This tubing is designed to be used with an infusion pump but there was no pump.
Spike from Propofol tubing woul have been stuck into the bottle and this would be consistent with the tear found at the 100ml Propofol bottle from MJ's house. Shafer sticks the spike into the Propofol bottle and hangs it on the pole with the plastic handle on the bottle.
Walgren shows that the 100ml bottle found in MJ's home also had the same handle. Objection by the defense.
After the sidebar the following stipulation is entered to the record : the handle of the bottle was lifted for demonstration by Walgren. When the bottle was found, it was still attached to the bottle and unused.
CM in his statement to the police said that he turned of the saline before giving Propofol with a syringe. Shafer shows the rubber clamp and how you can stop the flow with the clamp. Shafer demonstrates infusing 25mg of Propofol with syringe as CM mentioned in his interview. Propofol doesn't come out of the tube as the saline is turned off and not coming to push Propofol out. So CM's description of infusing it over 3 to 5 minutes is impossible if the turned off the saline. You need to unclamp the saline for Propofol to come out.
Dr. Shafer demonstrates the vent on the propofol tubing. If he closes the vent Propofol stops, if he opens the vent Propofol runs through. Shafer then hook the vented tubing with a needle to the y connector. Dr. Shafer says that this is an extremely unsafe setup that is all based on gravity. If one bag is lifted there will be more force in that bag and it would slow the other one. If saline stops, propofol speeds up. If the rate of the saline is changed, it would change the rate of the Propofol. This is why this system is very dangerous. The only way to control the speed is the clamps.
Walgren asks about the IV bag with a slit. Shafer says perhaps murray didn't know there was a hanging handle or didn't want to use it. Shafer puts the Propofol bottle with the spike into the cut IV bag to demonstrate it's possible.
Shafer says this system explains why the long tubing found at the house didn't test positive for propofol, but the short tubing did. There was another long tube which was connected to the popofol bottle.
Shafer empties the Propofol bottle quickly and removes the long vented tubing that had Propofol in it. It fits in his hand. Walgren asks if that tubing would fit into a pocket. Dr. Shafer says yes.
Walgren does a recap of Dr. Shafer's testimony: 17 egregious deviations of care, 4 of them are also unetical, has shown a video about the way propofol is safely given, has explained that oral consumption propofol was impossible, that MJ received more than 4mg lorazepam, that at 10 am it was impossible that MJ swalllowed lorazepam,scenarios suggested an IV drip, demonstrated the IV set up and that the infusion line could be compacted in one hand and fit into a pocket.
Walgren asks if CM was the direct cause of MJ's death if MJ self injected/ digested Propofol/Lorazepam. Shafer says yes as CM was the one that brought the propofol, left patient with access to the drugs and started the IV line. Shafer says CM is responsible for every drop of propofol or lorazepam.
Walgren finishes his direct examination of Dr. Shafer.
Due to scheduling issues testimony would start at 12:45PM PST on Friday October 21, 2011.
Murray Trial Day 15 , October 21 2011
Dr. Shafer Testimony continued
Hearing starts with 221 - A stipulation . The term "tab handle" on Propofol bottleis defined.
Walgren direct continued
Walgren asks if Shafer reviewed 8 page toxicology report by the coroner. Shafer says yes and that it showed pure true level of drugs , it doesn't include the metabolites. Shafer evaluated the procedures that is used by the coroner.
Shafer mentions that he made his simulations available to the defense and volunteered to help
Walgren asks if dying eyes open mean anything. Shafer says it doesn't mean slow or quick death.
After Walgren's question Shafer says it's a possibility that MJ woke up and manipulated the infusion line and that would mean CM left MJ alone. Shafer also wrote this in his report.
Walgren asks if this had happened would Shafer's opinion change about CM. Shafer says no and even if MJ woke up and opened the rubber clamp, it will still be CM's responsibility and CM wasn't available and let this happen. It's still considered abondonment.
Chernoff cross
Chernoff goes over what Dr. Shafer does and his models. Shafer can determine concentration from dosage. Shafer says he usually knows what dose is given.
Shafer says that as people are different his models are built to give ranges. The median is the representative of the half of the people's response to a particular drug.
In this case Shafer only had the concentration and he had the calculate the dose from the concentration.
Chernoff mentions that there was only one IV line found at the scene. Chernoff asks if Shafer's theory of what happened is a bold statement. Shafer responds as he believes it to be an honest statement.
Chernoff asks if there's any particular reason Shafer brought a different IV line for the saline bag. Shafer contacted Sea Coast medical to get theexact line but the shipping would have taken 2-3 weeks so he brought the other line. Chernoff shows the exact IV line to Dr. Shafer. (The IV line Chernoff shows is dirty and has brown stuff on it. Shafer wonders if it's blood, Chernoff says it's not).
Chernoff then asks why Shafer brought a vented IV line for the Propofol. Shafer says that a vented line is needed to get Propofol out. Chernoff asks why Shafer assumed CM used that IV line. Shafer says that SeaCoast reports shows that Murray ordered that line and it shows he intended to use it.
Chernoff asks how Shafer could know if CM used it in MJ's room. Shafer says because he needed a vented IV line. Shafer says the bottle had a spike tear but there was no needle hole in the Propofol bottle. If there had been a needle hole, CM could have used another IV tubing. Shafer says that as this bottle only had a spike tear, there had to be a vented IV line. Shafer says that this is the only vented IV line he saw in CM's orders and he had it shipped to California.
Chernoff says perhaps there was no tubing at all. Shafer responds how would you draw the Propofol then? Chernoff says that LAPD did not find a vented line. Shafer says it's easy to hide and take with a person. Chernoff asks why wouldn't a person also take the bottle and the needles. Shafer says that needles can hurt and bottles are bulky.
Chernoff tries to emphasize that this is all Dr. Shafer's opinion. They discuss back and forth about what's an opinion. Shafer says what he says is based on medical knowledge and some are facts and some are his opinions. Shafer says "It's my opinion that one should not lie to UCLA doctors".
Chernoff mentions that CM said that he used a 10cc syringe but Shafer used a 20cc syringe. Shafer says the size of the syringe was irrelevant. Chernoff again goes over that Shafer used a different IV tubing for saline bag, a different shape Propofol bottle and a larger syringe. Shafer answers yes. Chernoff asks about the tear on the saline bag. Shafer says it peaked his interest and he bought 3 IV bags for $150 and estimated the tear on the bag.
Chernoff mentions that Walgren called Shafer on March 31st and then sent him statements and reports. Chernoff goes over Dr. Shafer's report and that he used "might" to describe what happened. Shafer also referenced Alberto Alvarez's statatement and that he saw a propofol bottle in a bag. Chernoff asks if Shafer ever met or talked with AA and if he made the assumption that AA was telling the truth.
Chernoff says that the handle on the 100ml Propofol bottle found on the scene was not used. Shafer says it's irrelevant and that whether the bottle was in the bag or hung on the pole it wouldn't make a difference. Chernoff asks if it's reasonable that rather than hanging the Propofol bottle by the handle, CM would go all the steps to empty and cut the bag and put the propofol bottle inside it. Shafer says it's reasonable.
Chernoff says that CM is on trial for his life and there's a sidebar.
Chernoff asks about the medical malpractice lawsuit that Dr. Shafer testified 10 years go and if he didn't like the doctor in that case. Shafer says he didn't like the doctor. Shafer says he testified once before but he consults on trials twice a year.
Chernoff goes over Dr. Shafer's resume. When Shafer was a medical student at Stanford University, Dr. White was an assistant professor in anesthesia. Shafer published papers with Dr. White. Shafer wrote the software and helped with mathematical models for Dr. White's study in 1888.
Chernoff goes over the Propofol insert and asks Shafer to show which parts was his contribution. Shafer circles and underlines the parts he did.
mid afternoon break
Chernoff goes over other studies / articles and books Dr. Shafer worked on. Chernoff mentions the work Shafer and White did together. Shafer and White has known each other for almost 30 years and in 2009 Shafer nominated White for an award.
Chernoff mentions Dr. Shafer's statement when he said "he was disappointed" with White about saying oral consumption. Shafer says he was disappointed and that's how he felt. Chernoff asks if Shafer knows this trial is on TV and shown internationally. Walgren objects. Chernoff asks if Shafer knows the circumstances of the letter Dr. White sent to Flanagan and that it was rushed in 2 days due to threats of contempt. Objection and Sidebar.
Chernoff talks about Propofol found in MJ's stomach. Shafer sent the piglets study to Walgren and told Walgren there's was no human study. Shafer then contacted Chilean professors for the human study but Walgren didn't ask for that study.
Chernoff says that defense paid for a study on beagles and White did that study.
Chernoff asks who paid for the Chilean study. Shafer says he paid $600 for the propofol and the students volunteered. The study was also presented in an international conference. Chernoff asks why would he do a 2 month student, write a paper and present it at a conference if Propofol not being orally bio-available was something that 1st year student will know. Shafer says it's better to have human data because it's not ambiguous and there would be no question about humans.
During questioning we learn that Dr. Shafer himself swallowed 20 ml Propofol before he did the study.
Chernoff asks if Shafer knew White wouldn't say MJ swallowed Propofol. Shafer says he didn't and stull doesn't know what Dr. White is going to say.
Chernoff shows the 40 mg Lorazepam graph. Shafer says that it shows repeated bolus injections (10 injections) for every 30 minutes frim midnight till 5 AM. Chernoff says in his model the first shot was at midnight but MJ was still at rehearsal then. Shafer offers to do another simulation.
Chernoff asks why he removed the "responsive to painful stimulus" , "not responsive to painful stimulus" lines from his graphs. Shafer says he wanted to make it as easy as possible for the jurors.
Chernoff says based on his simulation MJ would be sleeping from 2:30 AM to 11:00AM. Shafer says as MJ was exposed to benzos for 80 nights, it's impossible to predict MJ's reaction to Lorazepam. Chernoff asks how he knows MJ had benzos for 80 nights. Shafer answers based on Murray's statement and pharmacy orders. Chernoff says that benzos being bought doesn't mean that they are used. Shafer says that he stand by his statement that says "information suggests a higher dose possibly 40 mg".
Chernoff asks if Shafer did a simulation for oral Lorazepam. Shafer didn't do a simulation for it. Chernoff asks Shafer to tell what happens if a person swallow a tablet. It goes to the stomach, half of the pill absorbtion is in 22 minutes, it would then go to the liver subject to first pass, it would have 92% bioavailability and then it would go to the blood and to the tissues and brain. Metabolite would go to the bile and to intestines and stomach. The process is same for the IV lorazepam as well.
Chernoff shows a graph that combines 2 injections of 2mg Lorazepam injections and 40 mg dose graph. Chernoff and Shafer goes over that MJ could not have swallowed Lorazepam in his last 4 hours.
Chernoff mentions the Midazolam simulation and the numbers match to what CM said he gave.
Chernoff shows the 25mg Propofol injection graph and another graph that Shafer did for White. This second graph shows 25 mg being given over 5 minutes. Shafer says the induction dose is given over 2 minutes because it's less painful to the patient.
Chernoff asks what's the danger of a rapid infusion. It's apnea.
Chernoff tries to go over the graph using the blood level, Shafer says he need to look to brain levels. Chernoff asks what was MJ's brain concentration of propofol. There was no measurement for that in coroner's report.
Dr. Shafer Testimony continued
Hearing starts with 221 - A stipulation . The term "tab handle" on Propofol bottleis defined.
Walgren direct continued
Walgren asks if Shafer reviewed 8 page toxicology report by the coroner. Shafer says yes and that it showed pure true level of drugs , it doesn't include the metabolites. Shafer evaluated the procedures that is used by the coroner.
Shafer mentions that he made his simulations available to the defense and volunteered to help
Walgren asks if dying eyes open mean anything. Shafer says it doesn't mean slow or quick death.
After Walgren's question Shafer says it's a possibility that MJ woke up and manipulated the infusion line and that would mean CM left MJ alone. Shafer also wrote this in his report.
Walgren asks if this had happened would Shafer's opinion change about CM. Shafer says no and even if MJ woke up and opened the rubber clamp, it will still be CM's responsibility and CM wasn't available and let this happen. It's still considered abondonment.
Chernoff cross
Chernoff goes over what Dr. Shafer does and his models. Shafer can determine concentration from dosage. Shafer says he usually knows what dose is given.
Shafer says that as people are different his models are built to give ranges. The median is the representative of the half of the people's response to a particular drug.
In this case Shafer only had the concentration and he had the calculate the dose from the concentration.
Chernoff mentions that there was only one IV line found at the scene. Chernoff asks if Shafer's theory of what happened is a bold statement. Shafer responds as he believes it to be an honest statement.
Chernoff asks if there's any particular reason Shafer brought a different IV line for the saline bag. Shafer contacted Sea Coast medical to get theexact line but the shipping would have taken 2-3 weeks so he brought the other line. Chernoff shows the exact IV line to Dr. Shafer. (The IV line Chernoff shows is dirty and has brown stuff on it. Shafer wonders if it's blood, Chernoff says it's not).
Chernoff then asks why Shafer brought a vented IV line for the Propofol. Shafer says that a vented line is needed to get Propofol out. Chernoff asks why Shafer assumed CM used that IV line. Shafer says that SeaCoast reports shows that Murray ordered that line and it shows he intended to use it.
Chernoff asks how Shafer could know if CM used it in MJ's room. Shafer says because he needed a vented IV line. Shafer says the bottle had a spike tear but there was no needle hole in the Propofol bottle. If there had been a needle hole, CM could have used another IV tubing. Shafer says that as this bottle only had a spike tear, there had to be a vented IV line. Shafer says that this is the only vented IV line he saw in CM's orders and he had it shipped to California.
Chernoff says perhaps there was no tubing at all. Shafer responds how would you draw the Propofol then? Chernoff says that LAPD did not find a vented line. Shafer says it's easy to hide and take with a person. Chernoff asks why wouldn't a person also take the bottle and the needles. Shafer says that needles can hurt and bottles are bulky.
Chernoff tries to emphasize that this is all Dr. Shafer's opinion. They discuss back and forth about what's an opinion. Shafer says what he says is based on medical knowledge and some are facts and some are his opinions. Shafer says "It's my opinion that one should not lie to UCLA doctors".
Chernoff mentions that CM said that he used a 10cc syringe but Shafer used a 20cc syringe. Shafer says the size of the syringe was irrelevant. Chernoff again goes over that Shafer used a different IV tubing for saline bag, a different shape Propofol bottle and a larger syringe. Shafer answers yes. Chernoff asks about the tear on the saline bag. Shafer says it peaked his interest and he bought 3 IV bags for $150 and estimated the tear on the bag.
Chernoff mentions that Walgren called Shafer on March 31st and then sent him statements and reports. Chernoff goes over Dr. Shafer's report and that he used "might" to describe what happened. Shafer also referenced Alberto Alvarez's statatement and that he saw a propofol bottle in a bag. Chernoff asks if Shafer ever met or talked with AA and if he made the assumption that AA was telling the truth.
Chernoff says that the handle on the 100ml Propofol bottle found on the scene was not used. Shafer says it's irrelevant and that whether the bottle was in the bag or hung on the pole it wouldn't make a difference. Chernoff asks if it's reasonable that rather than hanging the Propofol bottle by the handle, CM would go all the steps to empty and cut the bag and put the propofol bottle inside it. Shafer says it's reasonable.
Chernoff says that CM is on trial for his life and there's a sidebar.
Chernoff asks about the medical malpractice lawsuit that Dr. Shafer testified 10 years go and if he didn't like the doctor in that case. Shafer says he didn't like the doctor. Shafer says he testified once before but he consults on trials twice a year.
Chernoff goes over Dr. Shafer's resume. When Shafer was a medical student at Stanford University, Dr. White was an assistant professor in anesthesia. Shafer published papers with Dr. White. Shafer wrote the software and helped with mathematical models for Dr. White's study in 1888.
Chernoff goes over the Propofol insert and asks Shafer to show which parts was his contribution. Shafer circles and underlines the parts he did.
mid afternoon break
Chernoff goes over other studies / articles and books Dr. Shafer worked on. Chernoff mentions the work Shafer and White did together. Shafer and White has known each other for almost 30 years and in 2009 Shafer nominated White for an award.
Chernoff mentions Dr. Shafer's statement when he said "he was disappointed" with White about saying oral consumption. Shafer says he was disappointed and that's how he felt. Chernoff asks if Shafer knows this trial is on TV and shown internationally. Walgren objects. Chernoff asks if Shafer knows the circumstances of the letter Dr. White sent to Flanagan and that it was rushed in 2 days due to threats of contempt. Objection and Sidebar.
Chernoff talks about Propofol found in MJ's stomach. Shafer sent the piglets study to Walgren and told Walgren there's was no human study. Shafer then contacted Chilean professors for the human study but Walgren didn't ask for that study.
Chernoff says that defense paid for a study on beagles and White did that study.
Chernoff asks who paid for the Chilean study. Shafer says he paid $600 for the propofol and the students volunteered. The study was also presented in an international conference. Chernoff asks why would he do a 2 month student, write a paper and present it at a conference if Propofol not being orally bio-available was something that 1st year student will know. Shafer says it's better to have human data because it's not ambiguous and there would be no question about humans.
During questioning we learn that Dr. Shafer himself swallowed 20 ml Propofol before he did the study.
Chernoff asks if Shafer knew White wouldn't say MJ swallowed Propofol. Shafer says he didn't and stull doesn't know what Dr. White is going to say.
Chernoff shows the 40 mg Lorazepam graph. Shafer says that it shows repeated bolus injections (10 injections) for every 30 minutes frim midnight till 5 AM. Chernoff says in his model the first shot was at midnight but MJ was still at rehearsal then. Shafer offers to do another simulation.
Chernoff asks why he removed the "responsive to painful stimulus" , "not responsive to painful stimulus" lines from his graphs. Shafer says he wanted to make it as easy as possible for the jurors.
Chernoff says based on his simulation MJ would be sleeping from 2:30 AM to 11:00AM. Shafer says as MJ was exposed to benzos for 80 nights, it's impossible to predict MJ's reaction to Lorazepam. Chernoff asks how he knows MJ had benzos for 80 nights. Shafer answers based on Murray's statement and pharmacy orders. Chernoff says that benzos being bought doesn't mean that they are used. Shafer says that he stand by his statement that says "information suggests a higher dose possibly 40 mg".
Chernoff asks if Shafer did a simulation for oral Lorazepam. Shafer didn't do a simulation for it. Chernoff asks Shafer to tell what happens if a person swallow a tablet. It goes to the stomach, half of the pill absorbtion is in 22 minutes, it would then go to the liver subject to first pass, it would have 92% bioavailability and then it would go to the blood and to the tissues and brain. Metabolite would go to the bile and to intestines and stomach. The process is same for the IV lorazepam as well.
Chernoff shows a graph that combines 2 injections of 2mg Lorazepam injections and 40 mg dose graph. Chernoff and Shafer goes over that MJ could not have swallowed Lorazepam in his last 4 hours.
Chernoff mentions the Midazolam simulation and the numbers match to what CM said he gave.
Chernoff shows the 25mg Propofol injection graph and another graph that Shafer did for White. This second graph shows 25 mg being given over 5 minutes. Shafer says the induction dose is given over 2 minutes because it's less painful to the patient.
Chernoff asks what's the danger of a rapid infusion. It's apnea.
Chernoff tries to go over the graph using the blood level, Shafer says he need to look to brain levels. Chernoff asks what was MJ's brain concentration of propofol. There was no measurement for that in coroner's report.
morning summary will be added later
this is the afternoon summary
Murray Trial Day 16 October 23 2011
Afternoon session
Detective Dan Myers
Direct by Gourjian
Myers is a detective with LAPD since 1994. He was assigned to the case on June 29th, 2009. He interviewed AA on August 31,2009. They interviewed AA in an office building. MAW an FM was interviewed the same day at the same place as well but Myers doesn't know if MAW & FM was in the building when they interviewed AA.
On Agust 31st AA made several drawings. One of the the IV bag with a bottle hanging on an IV stand. The second drawing was the pulse oximeter he saw on MJ's finger. These drawing and interviews was done 4 days after coroner's press release that identified the cause of death as propofol.
On June 25th, AA never mentionned putting away medication or the bottle in the bag.
Gourjian shows another drawing - an IV bag- Myers says he has never seen it before.
No cross examination.
Detective Orlando Martinez
Direct by Gourjian
Martinez is an LAPD detective for 10.5 years. He went to UCLA on June 25th around 3:30PM. At UCLA they(Martinez and Smith) spoke different people. Martinez was present during half of AA's interview on June 25th. AA didn't mention putting away any vials or mention seeing a bottle in a bag.
Martinez went to Carolwood around 7:30PM and he didn't see AA there. He saw FM. Alex Supall , surveillance specialist for the LAPD, was at Carolwood to retrieve the security footage. Martinez made the decision to only download MJ's and CM's arrival.
Martinez was not at August 31st 2009 interview of AA but saw AA in September to take his fingerprints.
On April , 2011 Walgren called Martinez and asked him to bring certain evidence items to his office. Walgren also told him that AA will be there. AA was parked at the police building and walked to Walgren's office with Martinez. Martinez had brough a box of evidence items but only showed the saline bag, propofol bottle and pulse oximeter to AA.
Gourjian shows the drawings AA made on August 2009 and the saline bag he draw on April 2011 and says that they are significantly different.
Cross by Walgren
Walgren mentions that AA testified to the bottle in the saline bag and pulse oximeter in January.
Walgren asks Martinez to explain the April 2011 drawing of the saline bag. Martinez says when he showed the saline bag to AA, AA said there was an additional chamber. Martinez asked him to draw it to explain.
Redirect by Gourjian
Gourjian says during preliminary hearing AA didn't testify that the propofol bottle was the one he saw. Walgren objects saying that at that AA hadn't seen the evidence.
Gourjian says AA never mentioned the additional chamber on August, 2009. Martinez says he mentioned if after seeing the saline bag on April 2011.
Martinez once again mentions that AA was only shown 3 items , saline bag, propofol bottle and pulse oximeter on April, 2011.
Dr. Allan Metzger
Direct by Chernoff
Metzger met MJ 15 to 20 years ago. Metzger's relationship with MJ began professionally and later became close as friends as well. Metzger was MJ's main physician when he was in LA and he treated MJ for various things. Metzger says MJ saw other specialists as well.
Metzger has borugh 5 page medical records with him. Metzger has seen MJ in his office on 23 June 2003. Michael had called him on 12 June 2008. At 2008 call MJ mentioned sleep issues and skin problems. Metzger gave him Tylenol PM for sleep and talked about MJ's general health and back strain. Metzger told MJ when he came to LA to see him and Klein.
Metzger says he frequently talked with Grace about the kids.
Metzger visited MJ at his home on April 2009. Metzger thinks it was a weekend and early afternoon. On that day MJ, his kids and his security was at the house. Grace wasn't at the house. When they started talking the kids were in the room but later they went outside. Metzger and MJ talked privately. Metzger says the whole visit was 1 hour and 30 minutes and he talked to MJ privately around 20-30 minutes. They talked about medical issues and the stress MJ was under due to the rehearsals and upcoming tour. MJ did not mention seeing another doctor.
MJ was lucid. He was excited and was talking about creative things. Metzger says he showed both excitement and fear. His fear was about not doing a good job with 50 shows. MJ believed he was up to the task but he was fearful about staying healty. They talked about nutrition and hydration. MJ was doing well with chronic back issues. Metzger says MJ was also under stress due to his sleep disorder.
MJ was lucid, was exited, talking about creative things, he was in a state of exitement and fear. Fear was about not doing a good job with 50 shows, MJ believed he was up to the task, but he was fearful about staying healthy. They talked about nutrition,MJ had chefs for healthy food, hydration, MJ was doing well with his chronic back issues, he was also under stress due to his profound sleep disorder.
Metzger says sleep has been an issue for 15 -20 years for MJ especially during touring. Metzger says he traveled with MJ on tour.
On April 18 2009 MJ asked for "juice" intravenous sleep medication because MJ didn't believe any oral medication would be helpful. Metzger says MJ didn't mention any drugs by name.
Metzger says from experience he knows previous oral medications doesn't work. Metzger has tried Xanax, Tylenol PM before. In April 2011 he gave MJ klonapim and trazadone to try but not to be used together. He asked MJ to call him and tell him which one worked. Metzger did not speak to MJ after that day.
Chernoff asks who is Randy Rosen. Metzger says he works with him for pain management issues. Chernoff asks what kind of pain MJ was suffering from. Metzger answers chronic back sprain due to overworking and a couple of injuries. Metzger says he doesn't know Rosen's speciality and the question about what kind of medication given at Rosen's clinic is sustained.
Metzger says he also presumed MJ would see Klein for his vitiligo and some minor procedures.
MJ mentioned Metzger that he needed a doctor in London. Metzger says MJ was concerned about hydration, sleep issus and injuries and wanted a doctor with him.
Cross by Walgren
Walgren asks about IV treatment. Mezger says he told MJ it was dangerous and it should not be done outside of a hospital.
Walgren asks if any amount of money would make Metzger to give MJ IV drugs. Metzger says no.
Chernoff redirect
Chernoff asks if Metzger told MJ IV sleep medication would be dangerous. Metzger says he told MJ anything IV would be dangerous. Metzger is not sure if MJ asked him for an anesthetic, MJ said "sleep medication".
Cherilyn Lee
Direct by Chernoff
Lee is a nurse practioner that focuses on holistic nutrion. As a nurse practioner she has been doing this on and off for 15 to 20 years and has worked with athletes and entertainers.
As a nurse practioner she can write prescriptions but she choose not to. She says she doesn't like what medicines does to people, she prefer natural treatments.
On January 2009 she received a call from FM, who is the son of her friend. FM told her MJ's kids had a cold and MJ wanted her to come and see the kids. While she was looking to the kids, MJ talked with her and asked her what she does. MJ told her he felt a little tired. Lee said that she can do some blood tests on him and try to help him with nutrition.
Lee went the next day and did a physical test on MJ. She draw blood for lab tests and asked him questions to determine what caused his fatique. MJ didn't mention his sleep problems on that day. He just said he had difficulty to fall asleep. Lee says MJ was drinking "red bull" (an energy drink) and she felt red bull might be the cause. She told MJ about red bull and MJ said "whatever you tell me to do, I will stop".
Chernoff asks if MJ seemed fatigued. Lee says no. Lee also says MJ told him that he thought he could be anemic. Overall Lee thought MJ was a healthy and loving person.
Lee gave him nutritional smoothies with protein, B12 shots, myers coctail and vitamin C IV. Lee says she did blood test before she started to gove MJ IV and they were normal.
Lee goes over the dates she saw MJ and what she gave him. She saw MJ after he came from London and he told her he was tired. At the end of March MJ asked her if she would go to London with him.
On April 12 easter Sunday. Lee visited MJ. MJ told her he had a sleep problem and nothing she gave him was working. Lee offered to do a sleep study in his home and MJ said he didn't have time for that.
MJ wanted her to see he couldn't sleep and asked her to stay a night and watch him to sleep. Lee agreed. MJ had "sleepy tea" (a herbal tea), had myers cocktail and Vitamin C IV. The catheter was on his hand because MJ had very small veins. Michael had also joked that he had "squiggly veins". Other than being small he had no problems with his veins. Lee watched him to sleep for 5 hours. MJ waked up around 3 AM.
this is the afternoon summary
Murray Trial Day 16 October 23 2011
Afternoon session
Detective Dan Myers
Direct by Gourjian
Myers is a detective with LAPD since 1994. He was assigned to the case on June 29th, 2009. He interviewed AA on August 31,2009. They interviewed AA in an office building. MAW an FM was interviewed the same day at the same place as well but Myers doesn't know if MAW & FM was in the building when they interviewed AA.
On Agust 31st AA made several drawings. One of the the IV bag with a bottle hanging on an IV stand. The second drawing was the pulse oximeter he saw on MJ's finger. These drawing and interviews was done 4 days after coroner's press release that identified the cause of death as propofol.
On June 25th, AA never mentionned putting away medication or the bottle in the bag.
Gourjian shows another drawing - an IV bag- Myers says he has never seen it before.
No cross examination.
Detective Orlando Martinez
Direct by Gourjian
Martinez is an LAPD detective for 10.5 years. He went to UCLA on June 25th around 3:30PM. At UCLA they(Martinez and Smith) spoke different people. Martinez was present during half of AA's interview on June 25th. AA didn't mention putting away any vials or mention seeing a bottle in a bag.
Martinez went to Carolwood around 7:30PM and he didn't see AA there. He saw FM. Alex Supall , surveillance specialist for the LAPD, was at Carolwood to retrieve the security footage. Martinez made the decision to only download MJ's and CM's arrival.
Martinez was not at August 31st 2009 interview of AA but saw AA in September to take his fingerprints.
On April , 2011 Walgren called Martinez and asked him to bring certain evidence items to his office. Walgren also told him that AA will be there. AA was parked at the police building and walked to Walgren's office with Martinez. Martinez had brough a box of evidence items but only showed the saline bag, propofol bottle and pulse oximeter to AA.
Gourjian shows the drawings AA made on August 2009 and the saline bag he draw on April 2011 and says that they are significantly different.
Cross by Walgren
Walgren mentions that AA testified to the bottle in the saline bag and pulse oximeter in January.
Walgren asks Martinez to explain the April 2011 drawing of the saline bag. Martinez says when he showed the saline bag to AA, AA said there was an additional chamber. Martinez asked him to draw it to explain.
Redirect by Gourjian
Gourjian says during preliminary hearing AA didn't testify that the propofol bottle was the one he saw. Walgren objects saying that at that AA hadn't seen the evidence.
Gourjian says AA never mentioned the additional chamber on August, 2009. Martinez says he mentioned if after seeing the saline bag on April 2011.
Martinez once again mentions that AA was only shown 3 items , saline bag, propofol bottle and pulse oximeter on April, 2011.
Dr. Allan Metzger
Direct by Chernoff
Metzger met MJ 15 to 20 years ago. Metzger's relationship with MJ began professionally and later became close as friends as well. Metzger was MJ's main physician when he was in LA and he treated MJ for various things. Metzger says MJ saw other specialists as well.
Metzger has borugh 5 page medical records with him. Metzger has seen MJ in his office on 23 June 2003. Michael had called him on 12 June 2008. At 2008 call MJ mentioned sleep issues and skin problems. Metzger gave him Tylenol PM for sleep and talked about MJ's general health and back strain. Metzger told MJ when he came to LA to see him and Klein.
Metzger says he frequently talked with Grace about the kids.
Metzger visited MJ at his home on April 2009. Metzger thinks it was a weekend and early afternoon. On that day MJ, his kids and his security was at the house. Grace wasn't at the house. When they started talking the kids were in the room but later they went outside. Metzger and MJ talked privately. Metzger says the whole visit was 1 hour and 30 minutes and he talked to MJ privately around 20-30 minutes. They talked about medical issues and the stress MJ was under due to the rehearsals and upcoming tour. MJ did not mention seeing another doctor.
MJ was lucid. He was excited and was talking about creative things. Metzger says he showed both excitement and fear. His fear was about not doing a good job with 50 shows. MJ believed he was up to the task but he was fearful about staying healty. They talked about nutrition and hydration. MJ was doing well with chronic back issues. Metzger says MJ was also under stress due to his sleep disorder.
MJ was lucid, was exited, talking about creative things, he was in a state of exitement and fear. Fear was about not doing a good job with 50 shows, MJ believed he was up to the task, but he was fearful about staying healthy. They talked about nutrition,MJ had chefs for healthy food, hydration, MJ was doing well with his chronic back issues, he was also under stress due to his profound sleep disorder.
Metzger says sleep has been an issue for 15 -20 years for MJ especially during touring. Metzger says he traveled with MJ on tour.
On April 18 2009 MJ asked for "juice" intravenous sleep medication because MJ didn't believe any oral medication would be helpful. Metzger says MJ didn't mention any drugs by name.
Metzger says from experience he knows previous oral medications doesn't work. Metzger has tried Xanax, Tylenol PM before. In April 2011 he gave MJ klonapim and trazadone to try but not to be used together. He asked MJ to call him and tell him which one worked. Metzger did not speak to MJ after that day.
Chernoff asks who is Randy Rosen. Metzger says he works with him for pain management issues. Chernoff asks what kind of pain MJ was suffering from. Metzger answers chronic back sprain due to overworking and a couple of injuries. Metzger says he doesn't know Rosen's speciality and the question about what kind of medication given at Rosen's clinic is sustained.
Metzger says he also presumed MJ would see Klein for his vitiligo and some minor procedures.
MJ mentioned Metzger that he needed a doctor in London. Metzger says MJ was concerned about hydration, sleep issus and injuries and wanted a doctor with him.
Cross by Walgren
Walgren asks about IV treatment. Mezger says he told MJ it was dangerous and it should not be done outside of a hospital.
Walgren asks if any amount of money would make Metzger to give MJ IV drugs. Metzger says no.
Chernoff redirect
Chernoff asks if Metzger told MJ IV sleep medication would be dangerous. Metzger says he told MJ anything IV would be dangerous. Metzger is not sure if MJ asked him for an anesthetic, MJ said "sleep medication".
Cherilyn Lee
Direct by Chernoff
Lee is a nurse practioner that focuses on holistic nutrion. As a nurse practioner she has been doing this on and off for 15 to 20 years and has worked with athletes and entertainers.
As a nurse practioner she can write prescriptions but she choose not to. She says she doesn't like what medicines does to people, she prefer natural treatments.
On January 2009 she received a call from FM, who is the son of her friend. FM told her MJ's kids had a cold and MJ wanted her to come and see the kids. While she was looking to the kids, MJ talked with her and asked her what she does. MJ told her he felt a little tired. Lee said that she can do some blood tests on him and try to help him with nutrition.
Lee went the next day and did a physical test on MJ. She draw blood for lab tests and asked him questions to determine what caused his fatique. MJ didn't mention his sleep problems on that day. He just said he had difficulty to fall asleep. Lee says MJ was drinking "red bull" (an energy drink) and she felt red bull might be the cause. She told MJ about red bull and MJ said "whatever you tell me to do, I will stop".
Chernoff asks if MJ seemed fatigued. Lee says no. Lee also says MJ told him that he thought he could be anemic. Overall Lee thought MJ was a healthy and loving person.
Lee gave him nutritional smoothies with protein, B12 shots, myers coctail and vitamin C IV. Lee says she did blood test before she started to gove MJ IV and they were normal.
Lee goes over the dates she saw MJ and what she gave him. She saw MJ after he came from London and he told her he was tired. At the end of March MJ asked her if she would go to London with him.
On April 12 easter Sunday. Lee visited MJ. MJ told her he had a sleep problem and nothing she gave him was working. Lee offered to do a sleep study in his home and MJ said he didn't have time for that.
MJ wanted her to see he couldn't sleep and asked her to stay a night and watch him to sleep. Lee agreed. MJ had "sleepy tea" (a herbal tea), had myers cocktail and Vitamin C IV. The catheter was on his hand because MJ had very small veins. Michael had also joked that he had "squiggly veins". Other than being small he had no problems with his veins. Lee watched him to sleep for 5 hours. MJ waked up around 3 AM.
Murray Trial Day 16 October 24, 2011
Morning Session
Dr Shafer Testimony continued
Chernoff Cross
Chernoff asks if one of the dangers of rapid bolus injection of Propofol is apnea. Chernoff goes over the insert of Propofol and reads that slow techniques are preferred over rapid injection to avoid apnea or hypotension.
Chernoff goes over Dr. Shafer’s simulations. 25 mg rapid Propofol injection apnea is about 2 minutes. Defense’s simulation of 25 mg pushed over 3 to 5 minutes, there’s a low risk of apnea after 4 -5 minutes. Propofol would not be as risk after 10 minutes.
Chernoff asks how Dr. Shafer came up with 50mg Propofol dose. Shafer says CM in his interview said he mixed propofol 1:1 with lidocaine and the syringes were 10cc. Chernoff asks if CM gave MJ 50 mg Propofol if there would be apnea after 4-5 minutes. Shafer says it’s difficult to say as he doesn’t know MJ’s pharmaceutical state.
Chernoff shows Shafer’s 6 self injections of 50mg Propofol injections and asks if there could be indefinite number of possibilities. Shafer agrees. Shafer did self injection simulations because of Dr. White mentioned them as a hypothesis in his letter.
Chernoff asks if Shafer is aware that there are health care providers who died because of self injection of Propofol. Shafer is aware about articles mentioning that.
Chernoff goes back to the self injection and asks if the person is self injecting do they have to do it quick. Shafer agrees and says that they can’t do it over 3 minutes.
Chernoff asks if Shafer’s simulations were out of thin air. Shafer says most are based on Dr. White’s letter and hypothesis of multiple injections.
Chernoff switches to Lorazepam’s half life in stomach. It’s 22 minutes. Every 22 minutes the amount is cut in half. 8 mg swallowed 22 minutes later would be 4, another 22 minutes later it would be 2mg, another 22minutes it would be 1 mg , so in 4 hours , there would be a very low amount of free lorazepam in the stomach.
They go over Greenblack's study. Lorazepam reaches a peak concentration in 2 hours after an oral dose. Drug goes into the stomach, and is being removed by liver and distribution in the tissues. So as long as the drugs come in the levels in blood raise, the concentration rises. When fewer drugs come in, it is removed faster than it comes in, so levels drop. Chernoff argues that even if there might be small percentage in the stomach, levels could be at peak in blood.
Chernoff states that Dr. Shafer cannot remove the possibility that MJ woke up and swallowed Lorazepam. Shafer says he needs to know what time but it cannot be after 8AM.
Chernoff asks questions about the urine levels of Lorazepam and Propofol. Shafer did not do examinations / calculations based on urine levels.
Chernoff asks if urine in the bladder could be evidence for or against 100ml Propofol drip. Shafer says he doesn’t know and he needs to research and find models. For some questions Shafer says he needs information about propofol glucoronide and it wasn’t tested.
Chernoff states that Shafer’s analysis is based on repertory arrest and he did not take into cardiac arrest. Shafer says correct.
Chernoff mentions the comments Shafer wrote about Demerol on his report. Shafer had written MJ liked Demerol but was not addicted to it. Chernoff asks if he’s an expert in addiction , Shafer says he’s not an expert but seen examples and talked to other doctors about it.
Chernoff asks about rapid detox. It’s when the patient is detoxing for opiates while under sedation. Chernoff asks if Shafer knows the dangers of opiates. Shafer says they are dangerous for many organs.
Mid morning break
Walgren redirect
Walgren again mentions that Dr. Shafer’s work is pro bono (free of charge). Shafer says it’s his custom in these types of cases. Shafer says that he had worked for the defense and prosecution on different cases. Shafer says his position on any case is based on the science.
Shafer also shares his research, databases and software for free online as well. Shafer wants to promote the science and even though he can earn some money for his programs he makes them available for free.
Walgren goes over the IV lines and Shafer says he can’t say which line was used, all he knows the line had to be vented. Walgren shows People’s 157 and Excel IV line and it’s a vented line. Seacoast order shows that Murray bought 150 of those vented lines. Exel vented line is a lot smaller than the one used for demonstration.
Walgren mentions Dr Shafer's testimony was interrupted due to a death in his family
Walgren asks if there is anything extraordinary saying than MJ received more than 25 mg Propofol. Shafer says no and the defense is saying the same thing.
Shafer says that he couldn’t find any scenario that support self injection and the only scenario he could find was Propofol was still running when MJ died.
Walgren asks about Demerol. Shafer says he read Klein’s records and based on them he couldn’t say if he was an addict or not and he’s not an addiction specialist. Walgren mentions that there was no Demerol in MJ’s system.
Shafer says he has done one scenario for the defense and if they asked he would have done more.
Walgren mentions the new lab results about Lorazepam that shows 0.008mg of Lorazepam in MJ’s stomach which equals to 1/250th of a tablet and mentions that this is smaller than 1/43rd of a tablet mentioned by the defense.
Shafer says he gave his opinion based on 30 years of expertise and says CM should have monitored MJ. Shafer says his opinion is not made out of thin air. It actually comes from published studies and established standards of care.
Walgren asks if Shafer believed what CM said that MJ liked to push the drug and he was dependent on Propofol if self injection was a foreseeable risk. Shafer agrees.
Walgren shows another Lorazepam scenario of 9 doses of IV Lorazepam 4 mg each starting at 1:30 AM. This would also explain the levels found in MJ’s blood.
Recross by Chernoff
Chernoff asks if the last scenario was done this weekend, because of what Chernoff said on Friday.
Chernoff asks if 100ml IV drip Propofol was an extraordinary claim. Shafer says it’s an ordinary claim.
Chernoff argues that Shafer is changing his testimony about the IV line used for Propofol. Shafer says that Chernoff is misstating his testimony and he only said the line had to be vented. This goes on for some time.
Prosection rests their case.
Defense case starts
Donna Norris Testimony
Direct by Gourjian
Norris works at communications evidence unit Beverly Hills police department. She goes over the 911 call.
12:20:18 time 911 was called
12:20:21 begins to ring
12:20:26 called picked up
12:20:50 called transferred to LAFD
12:21:03 dispatcher at police dept hangs up.
12:21:04 911 system released the call
Duration of the call at the police department was 46 seconds
the call was made on June 25th 2009
Data shows which cell tower the call came from, the part of the cell tower, cell phone provider, and a number the police can call if they need to trace back the call.
No Cross by Walgren.
Alexander Suppal Testimony
Gourjian Direct
Suppal is a LAPD police surveillance specialist for 11 years.
On June 25th he was asked to go to Carolwood to retrieve the videos. Suppal probably went around 7:30pm on June 25th. Detective Martinez was there. Security staff couldn’t play back the videos. Suppal’s first task was to find the hard drive so he had the trace the lines back to the source. Suppal finds the DVR in the basement of the house. They get a monitor and hook it up to the DVR. Suppal was with Detective Martinez and a tall African American security guard.
They rewinded the video to the time CM and MJ came home.
Gourjian plays a 7 minute video. It’s a camera that looks at the gate. It shows time as 00:45AM. Multiple cars arrive at 00:47AM, 00:50AM and 00:58AM. A car leaves around 01:06 Video shows security guards and fans as well.
Gourjian shows another video. This is from a camera outside on the keypad. It shows 3 cars come in and close up of the driver’s face. It also show the fans waiting outside the street.
Suppal did not go back to download additional footage. No one asked him to.
No cross by Walgren
Lunch break
Morning Session
Dr Shafer Testimony continued
Chernoff Cross
Chernoff asks if one of the dangers of rapid bolus injection of Propofol is apnea. Chernoff goes over the insert of Propofol and reads that slow techniques are preferred over rapid injection to avoid apnea or hypotension.
Chernoff goes over Dr. Shafer’s simulations. 25 mg rapid Propofol injection apnea is about 2 minutes. Defense’s simulation of 25 mg pushed over 3 to 5 minutes, there’s a low risk of apnea after 4 -5 minutes. Propofol would not be as risk after 10 minutes.
Chernoff asks how Dr. Shafer came up with 50mg Propofol dose. Shafer says CM in his interview said he mixed propofol 1:1 with lidocaine and the syringes were 10cc. Chernoff asks if CM gave MJ 50 mg Propofol if there would be apnea after 4-5 minutes. Shafer says it’s difficult to say as he doesn’t know MJ’s pharmaceutical state.
Chernoff shows Shafer’s 6 self injections of 50mg Propofol injections and asks if there could be indefinite number of possibilities. Shafer agrees. Shafer did self injection simulations because of Dr. White mentioned them as a hypothesis in his letter.
Chernoff asks if Shafer is aware that there are health care providers who died because of self injection of Propofol. Shafer is aware about articles mentioning that.
Chernoff goes back to the self injection and asks if the person is self injecting do they have to do it quick. Shafer agrees and says that they can’t do it over 3 minutes.
Chernoff asks if Shafer’s simulations were out of thin air. Shafer says most are based on Dr. White’s letter and hypothesis of multiple injections.
Chernoff switches to Lorazepam’s half life in stomach. It’s 22 minutes. Every 22 minutes the amount is cut in half. 8 mg swallowed 22 minutes later would be 4, another 22 minutes later it would be 2mg, another 22minutes it would be 1 mg , so in 4 hours , there would be a very low amount of free lorazepam in the stomach.
They go over Greenblack's study. Lorazepam reaches a peak concentration in 2 hours after an oral dose. Drug goes into the stomach, and is being removed by liver and distribution in the tissues. So as long as the drugs come in the levels in blood raise, the concentration rises. When fewer drugs come in, it is removed faster than it comes in, so levels drop. Chernoff argues that even if there might be small percentage in the stomach, levels could be at peak in blood.
Chernoff states that Dr. Shafer cannot remove the possibility that MJ woke up and swallowed Lorazepam. Shafer says he needs to know what time but it cannot be after 8AM.
Chernoff asks questions about the urine levels of Lorazepam and Propofol. Shafer did not do examinations / calculations based on urine levels.
Chernoff asks if urine in the bladder could be evidence for or against 100ml Propofol drip. Shafer says he doesn’t know and he needs to research and find models. For some questions Shafer says he needs information about propofol glucoronide and it wasn’t tested.
Chernoff states that Shafer’s analysis is based on repertory arrest and he did not take into cardiac arrest. Shafer says correct.
Chernoff mentions the comments Shafer wrote about Demerol on his report. Shafer had written MJ liked Demerol but was not addicted to it. Chernoff asks if he’s an expert in addiction , Shafer says he’s not an expert but seen examples and talked to other doctors about it.
Chernoff asks about rapid detox. It’s when the patient is detoxing for opiates while under sedation. Chernoff asks if Shafer knows the dangers of opiates. Shafer says they are dangerous for many organs.
Mid morning break
Walgren redirect
Walgren again mentions that Dr. Shafer’s work is pro bono (free of charge). Shafer says it’s his custom in these types of cases. Shafer says that he had worked for the defense and prosecution on different cases. Shafer says his position on any case is based on the science.
Shafer also shares his research, databases and software for free online as well. Shafer wants to promote the science and even though he can earn some money for his programs he makes them available for free.
Walgren goes over the IV lines and Shafer says he can’t say which line was used, all he knows the line had to be vented. Walgren shows People’s 157 and Excel IV line and it’s a vented line. Seacoast order shows that Murray bought 150 of those vented lines. Exel vented line is a lot smaller than the one used for demonstration.
Walgren mentions Dr Shafer's testimony was interrupted due to a death in his family
Walgren asks if there is anything extraordinary saying than MJ received more than 25 mg Propofol. Shafer says no and the defense is saying the same thing.
Shafer says that he couldn’t find any scenario that support self injection and the only scenario he could find was Propofol was still running when MJ died.
Walgren asks about Demerol. Shafer says he read Klein’s records and based on them he couldn’t say if he was an addict or not and he’s not an addiction specialist. Walgren mentions that there was no Demerol in MJ’s system.
Shafer says he has done one scenario for the defense and if they asked he would have done more.
Walgren mentions the new lab results about Lorazepam that shows 0.008mg of Lorazepam in MJ’s stomach which equals to 1/250th of a tablet and mentions that this is smaller than 1/43rd of a tablet mentioned by the defense.
Shafer says he gave his opinion based on 30 years of expertise and says CM should have monitored MJ. Shafer says his opinion is not made out of thin air. It actually comes from published studies and established standards of care.
Walgren asks if Shafer believed what CM said that MJ liked to push the drug and he was dependent on Propofol if self injection was a foreseeable risk. Shafer agrees.
Walgren shows another Lorazepam scenario of 9 doses of IV Lorazepam 4 mg each starting at 1:30 AM. This would also explain the levels found in MJ’s blood.
Recross by Chernoff
Chernoff asks if the last scenario was done this weekend, because of what Chernoff said on Friday.
Chernoff asks if 100ml IV drip Propofol was an extraordinary claim. Shafer says it’s an ordinary claim.
Chernoff argues that Shafer is changing his testimony about the IV line used for Propofol. Shafer says that Chernoff is misstating his testimony and he only said the line had to be vented. This goes on for some time.
Prosection rests their case.
Defense case starts
Donna Norris Testimony
Direct by Gourjian
Norris works at communications evidence unit Beverly Hills police department. She goes over the 911 call.
12:20:18 time 911 was called
12:20:21 begins to ring
12:20:26 called picked up
12:20:50 called transferred to LAFD
12:21:03 dispatcher at police dept hangs up.
12:21:04 911 system released the call
Duration of the call at the police department was 46 seconds
the call was made on June 25th 2009
Data shows which cell tower the call came from, the part of the cell tower, cell phone provider, and a number the police can call if they need to trace back the call.
No Cross by Walgren.
Alexander Suppal Testimony
Gourjian Direct
Suppal is a LAPD police surveillance specialist for 11 years.
On June 25th he was asked to go to Carolwood to retrieve the videos. Suppal probably went around 7:30pm on June 25th. Detective Martinez was there. Security staff couldn’t play back the videos. Suppal’s first task was to find the hard drive so he had the trace the lines back to the source. Suppal finds the DVR in the basement of the house. They get a monitor and hook it up to the DVR. Suppal was with Detective Martinez and a tall African American security guard.
They rewinded the video to the time CM and MJ came home.
Gourjian plays a 7 minute video. It’s a camera that looks at the gate. It shows time as 00:45AM. Multiple cars arrive at 00:47AM, 00:50AM and 00:58AM. A car leaves around 01:06 Video shows security guards and fans as well.
Gourjian shows another video. This is from a camera outside on the keypad. It shows 3 cars come in and close up of the driver’s face. It also show the fans waiting outside the street.
Suppal did not go back to download additional footage. No one asked him to.
No cross by Walgren
Lunch break
Murray Trial Day 17 October 25, 2011
Morning Session
Cherilyn Lee Testimony continued
Direct by Chernoff
Lee has reviewed her charts last evening. Lee says she’s not feeling well. Judge Pastor takes a break so that she can rest.
Lee has a PhD in nutrition and she’s a certified nutritionist and believes in holistic medicines.
Chernoff goes over her records. April 12 Michael wanted products for sleep but did not tell her what he wanted. April 19 she went to MJ’s house in the morning to prepare a smoothie and gave MJ B12. MJ said he had trouble sleeping and asked her to watch him sleep. He told Lee that he had a pattern of 2 to 3 hours sleep. MJ also asked about Diprivan (Propofol), Lee didn’t know what it is. MJ told her it’s the only medication that gets him to sleep right away. Lee says she doesn’t know if MJ had received Propofol in the past, he seemed to have familiarity with it. Lee talks about natural ways to sleep and sleep hygiene with MJ.
Before coming back that evening Lee searched Diprivan and called a doctor. Doctor told Lee what Diprivan is and it’s never used at home. Lee tells this to MJ. MJ says doctors had told him it was safe and he thought he would be safe he if he had someone at home to monitor him. Lee goes to her office and gets her PDR and shows the adverse effects to MJ. MJ tells her he had Diprivan for surgery and he had fallen asleep so easily. MJ says he needed rest to work.
Lee checks her records and corrects that MJ actually slept 3 hours (not 5 hours) according to her records. When MJ woke only sleeping 3 hours on April 19th he wasn’t happy. He said only thing that would help him sleep was Diprivan and asked Lee to help him find someone that would give it to him.
Lee didn’t see MJ after that.
June 21st she received a call from FM. FM called to say that MJ wanted to see her. Lee heard MJ in the background saying “tell her what's wrong with me, one half of my body is hot, one half is cold”. Lee told FM that someone needed to take MJ to hospital. Lee was in Florida when she got the call.
Lee mentioned the June 21st phone call to the police and said that it could be a central nervous system problem. Lee says this was one of the symptoms of Propofol she had mentioned to MJ. Lee says on July 2009 when she talked to the police, she didn’t know what medication MJ was taking.
In July 09, when she talked to the police, she didn't know what medication MJ was taking.
Walgren cross
Walgren goes over medical records of Lee. She kept detailed reports.
January 29 Lee saw the kids for colds.
February 1st she came back to give nutritional supplements. She did a medical checkup. MJ said he had vitiligo and lupus. Lee says Redbull cans were obvious. MJ went to sleep with light , music and movies on. MJ said when performing he would sweat a lot and people would have to mop the floors. Walgren shows the part that she has written MJ’s vital signs. MJ wanted to start a nutritional program so she planned to do lab work. She drew blood and MJ had small veins. She told MJ to stop drinking Red Bull.
February 2nd and 3rd she saw MJ. She kept documenting progress notes, her impressions, her recommendations and complaints if any.
February 16th Lee looked to MJ’s vitals and discussed lab results with MJ. The plan was MJ needed to discontinue Red Bull drinks. She took blood again to see the effects of the treatment. Lee says MJ had greatly improved and his results were normal.
March 9 Lee went over the lab results with MJ and again kept documented all of her findings, impressions, recommendations and complaints.
March 13 Lee was again documenting her findings.
March 16 MJ had no complaints and felt good. Plan was to continue with vitamins, Myers cocktails and nutritional supplements.
March 20th, March 24th, March 26th, March 31st Lee continues to see Michael and document everything.
April 12th MJ’s main complaint is that he needs products to sleep and he’s willing to try natural products.
April 19th MJ’s energy is good but he’s unable to sleep and the natural products don’t help him to sleep.
April 19 morning MJ requested Lee to observe him to sleep. MJ said he needed something that would “knock him out”. MJ asked for Diprivan. Lee never heard of Propofol before. She searched and made a phone call and found out it was used in hospitals for surgery. Lee told MJ that it was not safe to use at home. MJ assured her that it was safe and he “only needed a doctor to monitor him while he sleeps”. Lee brought back PDR from her office and showed it to MJ and explained him the side effects. PDR has several side effects. Some of them are dizziness, agitation, chills, trembling and memory loss.
Lee asked MJ “what if you forget your lines?”. MJ said “I would never forget my lines”. MJ again told her that doctors said it would be safe. Lee asked “I understand you want a good night’s sleep. You want to be “knocked out” but what if you don't wake up?”. MJ said “I'll be okay I only need someone to monitor me with the equipment while I sleep”.
Lee gets emotional and starts crying.
April 19 night MJ fell asleep at 12:15 AM and woke up around 3:15AM. He said he needed Dirpivan IV. Lee said it would be dangerous and MJ repeated he would be okay if a doctor monitored him. Lee says she was not willing to give MJ IV Propofol. She says it wasn’t used at home and it was not a sleep medication.
She never saw MJ again.
July 2009 Lee was interviewed by police. She said she told MJ “no one who cared or had your best interest at heart is going to give you this”.
Chenoff redirect
Chernoff asks if she gave interviews to the media before talking to the police. She says yes. Lee explains that one of her patients is a PR and arranged the interviews.
Chernoff asks about the June 21st call. She doesn’t’ remember the time she received the phone call. She was in hospital herself.
Amir Dan Rubin Testimony
Chernoff Direct
On June 25th he was chief operating executive at UCLA medical center. Rubin starts by explaining the layout of UCLA. On June 25th he got a call saying that there was a “person of interest” at the hospital, he didn’t initially knew it was MJ.
Rubin was outside the ER room and tried to secure the area for privacy and security. Rubin organized 3 conference rooms: one for the family, one for the police and one for other people. The third conference room was used for a meeting about a press release. There were people from AEG and UCLA. Jermaine Jackson was in the room as well. Rubin came and went from the room. Rubin saw CM in the conference room reading the press release and commenting that the cause of death was not known. CM looked distressed. Press release was given in the auditorium in the basement by Jermaine Jackson.
Walgren Cross
Walgren mentions Katherine Jackson was notified about the death of MJ by Richelle Cooper. Rubin told the police that he heard the “anguish of a mom hearing about losing her child and from a personal perspective it was not a good thing to hear”.
Randy Philips Testimony
Chernoff Direct
Phillips is the president and CEO of AEG Live. Prior to working with AEG he ran a record company. Phillips has been in the entertainment business for 30 years. He explains what AEG and AEG Live does, the venues they operate etc.
Phillips first met MJ in the mid 1990s. Phillips had brought LA Gear endorsement deal to John Branca and MJ.
Next time he saw MJ was in 2007. At the time he was CEO of AEG and Peter Lopez, MJ’s attorney, had contacted AEG for a tour. A meeting in Las Vegas had been arranged with MJ, Lopez and MJ’s manager.
Lunch Break
Morning Session
Cherilyn Lee Testimony continued
Direct by Chernoff
Lee has reviewed her charts last evening. Lee says she’s not feeling well. Judge Pastor takes a break so that she can rest.
Lee has a PhD in nutrition and she’s a certified nutritionist and believes in holistic medicines.
Chernoff goes over her records. April 12 Michael wanted products for sleep but did not tell her what he wanted. April 19 she went to MJ’s house in the morning to prepare a smoothie and gave MJ B12. MJ said he had trouble sleeping and asked her to watch him sleep. He told Lee that he had a pattern of 2 to 3 hours sleep. MJ also asked about Diprivan (Propofol), Lee didn’t know what it is. MJ told her it’s the only medication that gets him to sleep right away. Lee says she doesn’t know if MJ had received Propofol in the past, he seemed to have familiarity with it. Lee talks about natural ways to sleep and sleep hygiene with MJ.
Before coming back that evening Lee searched Diprivan and called a doctor. Doctor told Lee what Diprivan is and it’s never used at home. Lee tells this to MJ. MJ says doctors had told him it was safe and he thought he would be safe he if he had someone at home to monitor him. Lee goes to her office and gets her PDR and shows the adverse effects to MJ. MJ tells her he had Diprivan for surgery and he had fallen asleep so easily. MJ says he needed rest to work.
Lee checks her records and corrects that MJ actually slept 3 hours (not 5 hours) according to her records. When MJ woke only sleeping 3 hours on April 19th he wasn’t happy. He said only thing that would help him sleep was Diprivan and asked Lee to help him find someone that would give it to him.
Lee didn’t see MJ after that.
June 21st she received a call from FM. FM called to say that MJ wanted to see her. Lee heard MJ in the background saying “tell her what's wrong with me, one half of my body is hot, one half is cold”. Lee told FM that someone needed to take MJ to hospital. Lee was in Florida when she got the call.
Lee mentioned the June 21st phone call to the police and said that it could be a central nervous system problem. Lee says this was one of the symptoms of Propofol she had mentioned to MJ. Lee says on July 2009 when she talked to the police, she didn’t know what medication MJ was taking.
In July 09, when she talked to the police, she didn't know what medication MJ was taking.
Walgren cross
Walgren goes over medical records of Lee. She kept detailed reports.
January 29 Lee saw the kids for colds.
February 1st she came back to give nutritional supplements. She did a medical checkup. MJ said he had vitiligo and lupus. Lee says Redbull cans were obvious. MJ went to sleep with light , music and movies on. MJ said when performing he would sweat a lot and people would have to mop the floors. Walgren shows the part that she has written MJ’s vital signs. MJ wanted to start a nutritional program so she planned to do lab work. She drew blood and MJ had small veins. She told MJ to stop drinking Red Bull.
February 2nd and 3rd she saw MJ. She kept documenting progress notes, her impressions, her recommendations and complaints if any.
February 16th Lee looked to MJ’s vitals and discussed lab results with MJ. The plan was MJ needed to discontinue Red Bull drinks. She took blood again to see the effects of the treatment. Lee says MJ had greatly improved and his results were normal.
March 9 Lee went over the lab results with MJ and again kept documented all of her findings, impressions, recommendations and complaints.
March 13 Lee was again documenting her findings.
March 16 MJ had no complaints and felt good. Plan was to continue with vitamins, Myers cocktails and nutritional supplements.
March 20th, March 24th, March 26th, March 31st Lee continues to see Michael and document everything.
April 12th MJ’s main complaint is that he needs products to sleep and he’s willing to try natural products.
April 19th MJ’s energy is good but he’s unable to sleep and the natural products don’t help him to sleep.
April 19 morning MJ requested Lee to observe him to sleep. MJ said he needed something that would “knock him out”. MJ asked for Diprivan. Lee never heard of Propofol before. She searched and made a phone call and found out it was used in hospitals for surgery. Lee told MJ that it was not safe to use at home. MJ assured her that it was safe and he “only needed a doctor to monitor him while he sleeps”. Lee brought back PDR from her office and showed it to MJ and explained him the side effects. PDR has several side effects. Some of them are dizziness, agitation, chills, trembling and memory loss.
Lee asked MJ “what if you forget your lines?”. MJ said “I would never forget my lines”. MJ again told her that doctors said it would be safe. Lee asked “I understand you want a good night’s sleep. You want to be “knocked out” but what if you don't wake up?”. MJ said “I'll be okay I only need someone to monitor me with the equipment while I sleep”.
Lee gets emotional and starts crying.
April 19 night MJ fell asleep at 12:15 AM and woke up around 3:15AM. He said he needed Dirpivan IV. Lee said it would be dangerous and MJ repeated he would be okay if a doctor monitored him. Lee says she was not willing to give MJ IV Propofol. She says it wasn’t used at home and it was not a sleep medication.
She never saw MJ again.
July 2009 Lee was interviewed by police. She said she told MJ “no one who cared or had your best interest at heart is going to give you this”.
Chenoff redirect
Chernoff asks if she gave interviews to the media before talking to the police. She says yes. Lee explains that one of her patients is a PR and arranged the interviews.
Chernoff asks about the June 21st call. She doesn’t’ remember the time she received the phone call. She was in hospital herself.
Amir Dan Rubin Testimony
Chernoff Direct
On June 25th he was chief operating executive at UCLA medical center. Rubin starts by explaining the layout of UCLA. On June 25th he got a call saying that there was a “person of interest” at the hospital, he didn’t initially knew it was MJ.
Rubin was outside the ER room and tried to secure the area for privacy and security. Rubin organized 3 conference rooms: one for the family, one for the police and one for other people. The third conference room was used for a meeting about a press release. There were people from AEG and UCLA. Jermaine Jackson was in the room as well. Rubin came and went from the room. Rubin saw CM in the conference room reading the press release and commenting that the cause of death was not known. CM looked distressed. Press release was given in the auditorium in the basement by Jermaine Jackson.
Walgren Cross
Walgren mentions Katherine Jackson was notified about the death of MJ by Richelle Cooper. Rubin told the police that he heard the “anguish of a mom hearing about losing her child and from a personal perspective it was not a good thing to hear”.
Randy Philips Testimony
Chernoff Direct
Phillips is the president and CEO of AEG Live. Prior to working with AEG he ran a record company. Phillips has been in the entertainment business for 30 years. He explains what AEG and AEG Live does, the venues they operate etc.
Phillips first met MJ in the mid 1990s. Phillips had brought LA Gear endorsement deal to John Branca and MJ.
Next time he saw MJ was in 2007. At the time he was CEO of AEG and Peter Lopez, MJ’s attorney, had contacted AEG for a tour. A meeting in Las Vegas had been arranged with MJ, Lopez and MJ’s manager.
Lunch Break
Murray Trial Day 17 October 25, 2011
Afternoon session
Randy Phillips testimony continued
Chernoff direct continued
AEG was contacted by Peter Lopez about MJ potentially going back on stage in 2007. RP was this would have been monumental achievement for AEG as MJ was the greatest star.
The meeting happened in Las Vegas with Lopez, another lawyer named Cross, Raymone Bain and her assistant. The meeting lasted 90 minutes. At that time MJ wasn’t ready to back to stage so Phillips didn’t pursue it any further.
August 2008 AEG got contacted by Tom Barrack fro Colony Capital who bought the note on Neverland. They met and talked about concerts. Phillips met with Tohme same week. Tohme said MJ wanted to restart his career, first do live shows and then put out new music.
Phillips met with MJ at September 2008. The plan was to do a residency show at the O2. Phillips calls only special artists can do that and it’s like “bringing the mountain to Muhammad”. MJ seemed motivated and receptive to the idea. Phillips had other meeting with MJ to talk about creative stuff.
Phillips met with MJ on Halloween (October 31st). MJ mentioned Phillips how he wanted to restart his career and how he was living like a vagabond. The meeting got emotional and both RP and MJ cried.
AEG contract was for 31 shows. MJ came up with that number as he wanted to do 10 more shows then prince. The contract was signed at MJ’s house on January 2009.
Chernoff tries to ask many questions about the contract but it’s sustained. Judge didn’t allow that line of questioning.
Press conference was on March and AEG advertised initially 10 shows. Chernoff tries to ask MJ being late to press conference etc but the judge doesn’t allow it.
After the announcement they did a presale and the demand was unbelieveable. Gongaware told Phillips to ask if MJ would do more shows. Phillips talked to Tohme and got a phone call from MJ after 20 minutes. MJ said he would do 50 shows maximum and had 2 conditions. He wanted a house outside London with 16 acres, horses, pastoral for his kids and he wanted Guinness book of world records to be present at the 50th show.
In March MJ told he wanted Ortega to be the director of the concerts. Ortega was hired and then auditions were done and additional personnel were hired in April. Rehearsals started in May.
MJ talked about a personal doctor in May. RP was away and heard it from Dileo, Gongaware and Whooley. They asked if Phillips can talk MJ out of hiring his own doctor. Phillips told MJ it would be expensive to bring a US doctor to London and asked if MJ would hire a doctor that’s based in London. MJ was firm and said he wanted his own physician. Gongaware negotiated with Murray.
There was a meeting at the first week of June. Dileo was worried about MJ not eating enough. CM said he’ll make sure that MJ ate properly and he’ll give MJ supplemental protein drinks. CM told them MJ’s health was good. Phillips say it is obvious to him that MJ trusted CM and they had close relationship. This was the first time Phillips met CM.
There was a concern raised by Ortega at the second week of June. Ortega felt like MJ wasn’t as engaged as he needed to be. The main concern was MJ’s focus and attending rehearsals.
Phillips says he wasn’t sure what Ortega meant by tough love and pulling the plug. Phillips say no one was contemplating pulling the plug and there was no concern that the show would be cancelled, they would have been postponed. After Ortega’s email Dileo called and asked Phillips to arrange a meeting. Phillips called CM to arrange the meeting.
During one conversation Phillips mentioned CM that MJ was seeing Klein. Phillips mentioned this because at one production meeting MJ wasn’t as focused as he usually was (Phillips say MJ was generally laser focused). Phillips asked MAW if MJ was okay and MAW had told him he just came back from Klein.
June 20th meeting. MJ, CM, Phillips and Ortega were present. Ortega started by saying MJ needed to focus and show more engagement. MJ told Ortega that he was ready and “you build the house and I’ll put the door and paint”.
Phillips went to rehearsals on June 23rd and 24th.
June 25th Phillips got a call from Dileo around 10:30 – 11:00AM. Dileo told him MJ was having difficulty breathing and told him to go to Carolwood. It took Phillips 15 minutes to arrive to Carolwood. When he arrived paramedics were leaving the house so Phillips followed them to the hospital. Dileo joined him at hospital. Phillips saw CM at the hospital. CM was in severe distress and Phillips doesn’t remember what CM said.
mid afternoon break
(will finish the rest of tomorrow)
Afternoon session
Randy Phillips testimony continued
Chernoff direct continued
AEG was contacted by Peter Lopez about MJ potentially going back on stage in 2007. RP was this would have been monumental achievement for AEG as MJ was the greatest star.
The meeting happened in Las Vegas with Lopez, another lawyer named Cross, Raymone Bain and her assistant. The meeting lasted 90 minutes. At that time MJ wasn’t ready to back to stage so Phillips didn’t pursue it any further.
August 2008 AEG got contacted by Tom Barrack fro Colony Capital who bought the note on Neverland. They met and talked about concerts. Phillips met with Tohme same week. Tohme said MJ wanted to restart his career, first do live shows and then put out new music.
Phillips met with MJ at September 2008. The plan was to do a residency show at the O2. Phillips calls only special artists can do that and it’s like “bringing the mountain to Muhammad”. MJ seemed motivated and receptive to the idea. Phillips had other meeting with MJ to talk about creative stuff.
Phillips met with MJ on Halloween (October 31st). MJ mentioned Phillips how he wanted to restart his career and how he was living like a vagabond. The meeting got emotional and both RP and MJ cried.
AEG contract was for 31 shows. MJ came up with that number as he wanted to do 10 more shows then prince. The contract was signed at MJ’s house on January 2009.
Chernoff tries to ask many questions about the contract but it’s sustained. Judge didn’t allow that line of questioning.
Press conference was on March and AEG advertised initially 10 shows. Chernoff tries to ask MJ being late to press conference etc but the judge doesn’t allow it.
After the announcement they did a presale and the demand was unbelieveable. Gongaware told Phillips to ask if MJ would do more shows. Phillips talked to Tohme and got a phone call from MJ after 20 minutes. MJ said he would do 50 shows maximum and had 2 conditions. He wanted a house outside London with 16 acres, horses, pastoral for his kids and he wanted Guinness book of world records to be present at the 50th show.
In March MJ told he wanted Ortega to be the director of the concerts. Ortega was hired and then auditions were done and additional personnel were hired in April. Rehearsals started in May.
MJ talked about a personal doctor in May. RP was away and heard it from Dileo, Gongaware and Whooley. They asked if Phillips can talk MJ out of hiring his own doctor. Phillips told MJ it would be expensive to bring a US doctor to London and asked if MJ would hire a doctor that’s based in London. MJ was firm and said he wanted his own physician. Gongaware negotiated with Murray.
There was a meeting at the first week of June. Dileo was worried about MJ not eating enough. CM said he’ll make sure that MJ ate properly and he’ll give MJ supplemental protein drinks. CM told them MJ’s health was good. Phillips say it is obvious to him that MJ trusted CM and they had close relationship. This was the first time Phillips met CM.
There was a concern raised by Ortega at the second week of June. Ortega felt like MJ wasn’t as engaged as he needed to be. The main concern was MJ’s focus and attending rehearsals.
Phillips says he wasn’t sure what Ortega meant by tough love and pulling the plug. Phillips say no one was contemplating pulling the plug and there was no concern that the show would be cancelled, they would have been postponed. After Ortega’s email Dileo called and asked Phillips to arrange a meeting. Phillips called CM to arrange the meeting.
During one conversation Phillips mentioned CM that MJ was seeing Klein. Phillips mentioned this because at one production meeting MJ wasn’t as focused as he usually was (Phillips say MJ was generally laser focused). Phillips asked MAW if MJ was okay and MAW had told him he just came back from Klein.
June 20th meeting. MJ, CM, Phillips and Ortega were present. Ortega started by saying MJ needed to focus and show more engagement. MJ told Ortega that he was ready and “you build the house and I’ll put the door and paint”.
Phillips went to rehearsals on June 23rd and 24th.
June 25th Phillips got a call from Dileo around 10:30 – 11:00AM. Dileo told him MJ was having difficulty breathing and told him to go to Carolwood. It took Phillips 15 minutes to arrive to Carolwood. When he arrived paramedics were leaving the house so Phillips followed them to the hospital. Dileo joined him at hospital. Phillips saw CM at the hospital. CM was in severe distress and Phillips doesn’t remember what CM said.
mid afternoon break
(will finish the rest of tomorrow)
Walgren cross
Phillips says he learned in May 2009 that MJ had a personal doctor. Phillips say he had no knowledge of what CM was doing as treatment to MJ.
Phillips says it never got to the point that they considered to pull the plug on TII concerts.
Phillips says he mentioned that MJ was seeing Klein in the meeting at the first week of June. Phillips says CM either knew or said that he would check into it.
Phillips again asked about TII concerts. Phillips says MJ was motivated and that he’s a genius. Phillips again tells how the concerts were increased to 50 shows. After the presales demand Gongaware asked him to talk to Michael. Phillips called Tohme and MJ called him within 20 minutes. MJ said he’ll do 50 shows but wanted Guinness Book of World records to document it and he wanted an estate for his kids. Phillips says that MJ was a phenomenal father.
Walgren goes over the meetings. The meeting in first week of June was about MJ not eating enough and CM said he’ll take care of it. MJ had great trust in CM. 19th June meeting was about missing rehearsals. CM was very reassuring and told Ortega to take care of the show and CM was the doctor and he would take care of MJ’s health.
After being told what time paramedics was leaving the house, Phillips says he might be mistaken about the time he got the phone call about MJ on June 25th.
Phillips says he attended rehearsals on June 23rd and June 24th. Last time he saw MJ was on June 24th. Phillips says he had Goosebumps while watching MJ. MJ walked to his car with Phillips. "He put his hands on my shoulders as we were walking out and he said to me, 'You got me here, now I'm ready. I can take it from here.' And that's the last I saw him," said Phillips.
Chernoff redirect
Phillips said he never felt that MJ was not able to do the shows. Phillips says the reason the initial shows were pushed back had nothing to do with MJ’s health. Phillips says during the meeting they were always reassured by CM.
Chernoff talks about cancellation of the shows. Phillips says AEG had a contractual obligation to MJ and they (MJ and AEG) would have to mutually agree on cancelling the tour. Chernoff asks if contractually MJ was responsible for the production cost, Phillips says yes. Chernoff tries to ask more about the contract such as insurance but they are sustained.
Chernoff asks what Ortega meant by tough love, pulling the plug. Phillips says he doesn’t know and that he’s not in Kenny’s mind.
Chernoff asks why he mentioned Klein to CM. Phillips say at one meeting MJ was distracted and when he asked MAW if MJ was okay, MAW said he just came from Klein. Another time it was mentioned MJ couldn’t; come to a meeting because he had been at Klein.
Micahel Hansen Testimony
Flanagan Direct
Hansen works at Pacific Toxicology. They got samples from the coroner’s office and did tests for total Lorazepam (the drug and metabolite) for the defense.
Flanagan tries to ask questions but they can’t be answered because it’s beyond knowledge of Hansen. There are a lot of objections. Flanagan has no further questions
Walgren Cross
Walgren asks how long Hansen knew Flanagan. Hansen says since 2009 and his firm worked with Flanagan’s firm for decades.
Walgren asks about the stomach contents test. They looked for total Lorazepam (free drug and the metabolite) because it’s their standard procedure. They found it was 634ng/ml. In their analysis they did not differentiate between the drug and the metabolite. It was later sent to another lab in Pennsylvania to determine the free Lorazepam. The results were 84 ng/ml. It equals to 0.006 mg which is 1/333 of a 2mg tablet.
Walgren asks if Dr. Shafer contacted the lab asking about their methodology for the drug testing. They didn’t respond and notified Flanagan. Ms Brazil called the lab to get the procedures and said if they don’t respond she would have to get the court involved. Only after this they provided their procedures to the prosecution.
Walgren says they got a corrected version of toxicology results and defense’s copy didn’t have correction. Walgren asks why but Hansen doesn’t know the reason.
Flanagan redirect
Flanagan says the quantity found by the coroner is 0.008 mg but their lab found 0.006mg and asks the reasons. Hansen says it could be due to the timing of the testing and degradation or it could be due to methods used.
Phillips says he learned in May 2009 that MJ had a personal doctor. Phillips say he had no knowledge of what CM was doing as treatment to MJ.
Phillips says it never got to the point that they considered to pull the plug on TII concerts.
Phillips says he mentioned that MJ was seeing Klein in the meeting at the first week of June. Phillips says CM either knew or said that he would check into it.
Phillips again asked about TII concerts. Phillips says MJ was motivated and that he’s a genius. Phillips again tells how the concerts were increased to 50 shows. After the presales demand Gongaware asked him to talk to Michael. Phillips called Tohme and MJ called him within 20 minutes. MJ said he’ll do 50 shows but wanted Guinness Book of World records to document it and he wanted an estate for his kids. Phillips says that MJ was a phenomenal father.
Walgren goes over the meetings. The meeting in first week of June was about MJ not eating enough and CM said he’ll take care of it. MJ had great trust in CM. 19th June meeting was about missing rehearsals. CM was very reassuring and told Ortega to take care of the show and CM was the doctor and he would take care of MJ’s health.
After being told what time paramedics was leaving the house, Phillips says he might be mistaken about the time he got the phone call about MJ on June 25th.
Phillips says he attended rehearsals on June 23rd and June 24th. Last time he saw MJ was on June 24th. Phillips says he had Goosebumps while watching MJ. MJ walked to his car with Phillips. "He put his hands on my shoulders as we were walking out and he said to me, 'You got me here, now I'm ready. I can take it from here.' And that's the last I saw him," said Phillips.
Chernoff redirect
Phillips said he never felt that MJ was not able to do the shows. Phillips says the reason the initial shows were pushed back had nothing to do with MJ’s health. Phillips says during the meeting they were always reassured by CM.
Chernoff talks about cancellation of the shows. Phillips says AEG had a contractual obligation to MJ and they (MJ and AEG) would have to mutually agree on cancelling the tour. Chernoff asks if contractually MJ was responsible for the production cost, Phillips says yes. Chernoff tries to ask more about the contract such as insurance but they are sustained.
Chernoff asks what Ortega meant by tough love, pulling the plug. Phillips says he doesn’t know and that he’s not in Kenny’s mind.
Chernoff asks why he mentioned Klein to CM. Phillips say at one meeting MJ was distracted and when he asked MAW if MJ was okay, MAW said he just came from Klein. Another time it was mentioned MJ couldn’t; come to a meeting because he had been at Klein.
Micahel Hansen Testimony
Flanagan Direct
Hansen works at Pacific Toxicology. They got samples from the coroner’s office and did tests for total Lorazepam (the drug and metabolite) for the defense.
Flanagan tries to ask questions but they can’t be answered because it’s beyond knowledge of Hansen. There are a lot of objections. Flanagan has no further questions
Walgren Cross
Walgren asks how long Hansen knew Flanagan. Hansen says since 2009 and his firm worked with Flanagan’s firm for decades.
Walgren asks about the stomach contents test. They looked for total Lorazepam (free drug and the metabolite) because it’s their standard procedure. They found it was 634ng/ml. In their analysis they did not differentiate between the drug and the metabolite. It was later sent to another lab in Pennsylvania to determine the free Lorazepam. The results were 84 ng/ml. It equals to 0.006 mg which is 1/333 of a 2mg tablet.
Walgren asks if Dr. Shafer contacted the lab asking about their methodology for the drug testing. They didn’t respond and notified Flanagan. Ms Brazil called the lab to get the procedures and said if they don’t respond she would have to get the court involved. Only after this they provided their procedures to the prosecution.
Walgren says they got a corrected version of toxicology results and defense’s copy didn’t have correction. Walgren asks why but Hansen doesn’t know the reason.
Flanagan redirect
Flanagan says the quantity found by the coroner is 0.008 mg but their lab found 0.006mg and asks the reasons. Hansen says it could be due to the timing of the testing and degradation or it could be due to methods used.
Murray Trial Day 18 October 26, 2011
Gerry Causey Testimony
Causey met CM 11 years ago in Las Vegas when he had a heart attack. He was 57 years old and had high blood pressure but didn’t expect to have a heart attack. CM talked to him for a few minutes about the procedure, made sure he understood and made him sign papers. He didn’t want to be sedated for the procedure.
Causey says that he received one stent and kept seeing CM for controls after the procedure and they became friends. Causey says that CM explains everything in simple terms and doesn’t rush the patients. Once Causey spent 4 and half hours in CM’s office.
Causey says CM isn’t greedy because he didn’t charge his deductible. CM told him he would be back and gave him his phone number.
Walgren cross
Causey had given 2 media interviews about CM.
CM had informed him he was leaving his practice around April.
After Walgren’s questioning Causey says he was treated for a heart condition and not for a sleep disorder or drug dependency.
Walgren asks where the procedure happened. Causey says it was in a hospital, he signed papers, and there were monitor and 3 additional people in the room.
Causey got put additional stents all again in a hospital with additional personnel present.
Chernoff redirect
Causey says he was not paid for media interview and gave them to help his friend CM. Causey says he helped CM because of love, compassion and he doesn’t think he did what he’s accused of.
Walgren recross
Walgren asks even if CM acted with gross negligence would he still be here to support CM. Causey says yes.
Andrew Guest Testimony
Guest met CM in 2002. He was 39 years old and had pain in his chest, arm and had a headache. CM put stents to him and solved his chest pain.
Guest says that CM is the best doctor and explains everything and makes sure that you are okay.
Walgren cross
Causey did media interviews as well.
Walgren asks what kind of treatments he got. It was for a heart condition and CM had a team to help him and necessary medical equipment was available.
Walgren asks if CM gave him Propofol in his bedroom. Guest says no.
Walgren asks if every patient deserves the level of care he had. Guest says yes and wants to add something but Walgren doesn’t let him.
Chernoff redirect
Guest wanted to add CM provides great care in his office too. Guest also says that he wasn’t paid by the media and he talked to the media because he believes CM needs support.
Walgren recross
Guest says that nothing would change his mind about CM.
Lunette Sampson Testimony
Sampson had 3 heart attacks. In 2008 she had a heart attack while CM was out of town. Another doctor told her that she’s okay. CM didn’t agree with the doctor and wanted her to have a test done. She didn’t have the test and had another heart attack.
Sampson says that CM is very caring and takes his time with the patients (he doesn’t rush).
Sampson says CM is not greedy and he takes care of people pro bono and pays for medication when patients can’t pay.
Walgren cross
Walgren asks who asked her to testify. Sampson was contacted by CM’s PR people.
CM never mentioned he was going to work for MJ. He just said that he was going to London for a year and referred her to another doctor. Sampson says she was distresses because she doesn’t trust other doctor because of what happened to her.
Walgren mentions a discipline letter CM got from Sunrise Hospital. On December 24th CM was called at 11:00AM and at 11:05AM. CM called the hospital back around 12:00PM and asked the staff to call another doctor. CM got to the hospital at 01:56PM. This was 3 hours after he was first called and there was a serious risk of blood clotting for the patient. Sampson was not aware of this letter.
Walgren asks what kind of treatment Sampson received. She says heart condition. Walgren asks if CM knew what the other doctor did to her is because the other doctor kept records.
Chernoff redirect
Due to hospital procedures doctors are supposed to call in within 1 hour and 20 minutes.
Dennis Hix Testimony
Hix lives at a house next door to CM’s children in Las Vegas and met CM around 1999. He had heart problem. His previous doctor told that it can’t be fixed but CM fixed his problem. CM put 6 stents in a hospital.
Hix says CM is the best doctor and helped his brother for free when he didn’t have the money to go to ER.
Walgren cross
Hix received a letter from CM in 2009. CM didn’t say what he was going to do and never mentioned MJ.
Walgren asks what Hix was treated for. It was for heart condition and several other things but it was not for sleep disorder or drug dependency. Hix says he doesn’t know if CM kept records for his medical treatment.
Ruby Mosley Testimony
Mosley lives in Houston in Acres home community. Acres home is a senior citizen low income area. Mosley says she knew CM’s father. In 2006 CM opened a clinic in honor of his father.
Mosley says CM is not greedy and if he was greedy he wouldn’t open a clinic in a low income area. Mosley says CM didn’t do much money in Houston and opened the clinic because CM’s father had a clinic there and CM made a commitment to continue the medical care after his father.
Mosley says she and her husband is treated by CM. CM put her stents.
Walgren cross
Walgrens asks if Mosley met Sade Anding. Mosley says she saw CM at the clinic and does not know what he did in his personal life.
Mosley says CM is very knowledgeable and can recite details as it related to medical care plans.
Chernoff redirect
Mosley says that CM took his time with the patients and explained everything to her. Appointments could go on for an hour. Mosley says he saw patients no matter how long it took.
Mosley says she misses CM.
Court ends early due to scheduling issues
Gerry Causey Testimony
Causey met CM 11 years ago in Las Vegas when he had a heart attack. He was 57 years old and had high blood pressure but didn’t expect to have a heart attack. CM talked to him for a few minutes about the procedure, made sure he understood and made him sign papers. He didn’t want to be sedated for the procedure.
Causey says that he received one stent and kept seeing CM for controls after the procedure and they became friends. Causey says that CM explains everything in simple terms and doesn’t rush the patients. Once Causey spent 4 and half hours in CM’s office.
Causey says CM isn’t greedy because he didn’t charge his deductible. CM told him he would be back and gave him his phone number.
Walgren cross
Causey had given 2 media interviews about CM.
CM had informed him he was leaving his practice around April.
After Walgren’s questioning Causey says he was treated for a heart condition and not for a sleep disorder or drug dependency.
Walgren asks where the procedure happened. Causey says it was in a hospital, he signed papers, and there were monitor and 3 additional people in the room.
Causey got put additional stents all again in a hospital with additional personnel present.
Chernoff redirect
Causey says he was not paid for media interview and gave them to help his friend CM. Causey says he helped CM because of love, compassion and he doesn’t think he did what he’s accused of.
Walgren recross
Walgren asks even if CM acted with gross negligence would he still be here to support CM. Causey says yes.
Andrew Guest Testimony
Guest met CM in 2002. He was 39 years old and had pain in his chest, arm and had a headache. CM put stents to him and solved his chest pain.
Guest says that CM is the best doctor and explains everything and makes sure that you are okay.
Walgren cross
Causey did media interviews as well.
Walgren asks what kind of treatments he got. It was for a heart condition and CM had a team to help him and necessary medical equipment was available.
Walgren asks if CM gave him Propofol in his bedroom. Guest says no.
Walgren asks if every patient deserves the level of care he had. Guest says yes and wants to add something but Walgren doesn’t let him.
Chernoff redirect
Guest wanted to add CM provides great care in his office too. Guest also says that he wasn’t paid by the media and he talked to the media because he believes CM needs support.
Walgren recross
Guest says that nothing would change his mind about CM.
Lunette Sampson Testimony
Sampson had 3 heart attacks. In 2008 she had a heart attack while CM was out of town. Another doctor told her that she’s okay. CM didn’t agree with the doctor and wanted her to have a test done. She didn’t have the test and had another heart attack.
Sampson says that CM is very caring and takes his time with the patients (he doesn’t rush).
Sampson says CM is not greedy and he takes care of people pro bono and pays for medication when patients can’t pay.
Walgren cross
Walgren asks who asked her to testify. Sampson was contacted by CM’s PR people.
CM never mentioned he was going to work for MJ. He just said that he was going to London for a year and referred her to another doctor. Sampson says she was distresses because she doesn’t trust other doctor because of what happened to her.
Walgren mentions a discipline letter CM got from Sunrise Hospital. On December 24th CM was called at 11:00AM and at 11:05AM. CM called the hospital back around 12:00PM and asked the staff to call another doctor. CM got to the hospital at 01:56PM. This was 3 hours after he was first called and there was a serious risk of blood clotting for the patient. Sampson was not aware of this letter.
Walgren asks what kind of treatment Sampson received. She says heart condition. Walgren asks if CM knew what the other doctor did to her is because the other doctor kept records.
Chernoff redirect
Due to hospital procedures doctors are supposed to call in within 1 hour and 20 minutes.
Dennis Hix Testimony
Hix lives at a house next door to CM’s children in Las Vegas and met CM around 1999. He had heart problem. His previous doctor told that it can’t be fixed but CM fixed his problem. CM put 6 stents in a hospital.
Hix says CM is the best doctor and helped his brother for free when he didn’t have the money to go to ER.
Walgren cross
Hix received a letter from CM in 2009. CM didn’t say what he was going to do and never mentioned MJ.
Walgren asks what Hix was treated for. It was for heart condition and several other things but it was not for sleep disorder or drug dependency. Hix says he doesn’t know if CM kept records for his medical treatment.
Ruby Mosley Testimony
Mosley lives in Houston in Acres home community. Acres home is a senior citizen low income area. Mosley says she knew CM’s father. In 2006 CM opened a clinic in honor of his father.
Mosley says CM is not greedy and if he was greedy he wouldn’t open a clinic in a low income area. Mosley says CM didn’t do much money in Houston and opened the clinic because CM’s father had a clinic there and CM made a commitment to continue the medical care after his father.
Mosley says she and her husband is treated by CM. CM put her stents.
Walgren cross
Walgrens asks if Mosley met Sade Anding. Mosley says she saw CM at the clinic and does not know what he did in his personal life.
Mosley says CM is very knowledgeable and can recite details as it related to medical care plans.
Chernoff redirect
Mosley says that CM took his time with the patients and explained everything to her. Appointments could go on for an hour. Mosley says he saw patients no matter how long it took.
Mosley says she misses CM.
Court ends early due to scheduling issues
(morning session will be posted later)
Murray Trial Day 19 October 27, 2011
Afternoon session
Dr Paul White Testimony
Flanagan Direct
White is an anesthesiologist that’s currently retired. He’s still consulting and involved in research projects. White lists his education, his board certification, his articles, books, his awards and research.
White says he was introduced to propofol by a European doctor and at that time emulsion of Propofol created allergies. White suggested a fatty emulsion to avoid allergies.
Flanagan asks about Shafer and the research they did together.
Flanagan called White in January 2011. White heard about CM and didn’t want to be a part of this case about the death of an icon and he says he doesn’t like the public attention. After his wife’s encouragement White agrees to review the docs.
Flanagan asks and White agrees that he cannot justify the elephant in the room that CM infused propofol to MJ and abandoned him.
White says his initial report was based on CM’s police interview and autopsy report with 13 expert opinions. White was surprised and says if CM did what he says in his interview MJ wouldn’t have died. White asked to meet with CM. Flanagan tries to ask if he met CM but sustained. White flies to LA to meet with Flanagan and Chernoff and was given the transcripts of the preliminary hearing.
White wrote a letter that had his conclusions but he currently doesn’t think the same way. In his letter he wrote oral consumption as a speculation based on other expert’s testimony and says that he was not aware of the studies about oral bioavailability. White says he learned about them from Dr. Shafer’s report.
Flanagan asks about the Chilean study. White says he felt bad that Dr. Shafer himself drank Propofol. White mentions his concerns with that study there was no blind test and one subject had similar levels to MJ. He had done a study on beagles and agrees that there was no absorption by the stomach. White and Shafer think that one subject might have absorption through the mouth esophagus and they thought of doing a Propofol lollipop to sedate patients non-invasively.
White mentions the variations in blood levels from the same dose and he says its 5 fold. For example from the same dose of propofol , you could get a blood level from 1mg/ ml to 5 mg/ml.
They show some examples from articles that show patients with different blood levels.
Mid afternoon break
White says most centrally active drugs have the same variability in the blood levels such as lorazepam. Again example articles and graphs are shown to demonstrate variability in the levels.
White mentions Propofol as sedative hypnotic. Low doses cause sleepiness, reduces anxiety. Medium dose means deeper sedation and higher dose means that patient is not responsive to pain and anesthesia. Benzos have the same variability.
Flanagan asks about off label use. Sleep in a ICU is on label and sleep at home is off label.
Flanagan asks about the Chinese study about Propofol and insomnia. White says that he found the study interesting and the authors should be given a chance. He says he understands Shafer’s concerns but those could be corrected with a review.
Flanagan asks if White has read the toxicology report for MJ. White says he has.
Flanagan asks about polypharmacy. White explains that it’s combining drugs. It’s reducing the side effects by combining lower doses of drugs. White gives the example of pain management and mixing opiates and non opiates to reduce opiates side effects. White says that it’s common in their area and that midazolam + propofol is a standard technique.
Flanagan shows a graph done by Dr Shafer that shows 2 doses of 2 mg Lorazepam given at 2AM and 5AM. The graph has 2 lines of responsive and non responsive to pain levels. White says Lorazepam is not an analgesic, doesn't understand these line.
Flanagan tries to find the graph for midazolam but he can’t. Court ends 15-20 minutes early.
Murray Trial Day 19 October 27, 2011
Afternoon session
Dr Paul White Testimony
Flanagan Direct
White is an anesthesiologist that’s currently retired. He’s still consulting and involved in research projects. White lists his education, his board certification, his articles, books, his awards and research.
White says he was introduced to propofol by a European doctor and at that time emulsion of Propofol created allergies. White suggested a fatty emulsion to avoid allergies.
Flanagan asks about Shafer and the research they did together.
Flanagan called White in January 2011. White heard about CM and didn’t want to be a part of this case about the death of an icon and he says he doesn’t like the public attention. After his wife’s encouragement White agrees to review the docs.
Flanagan asks and White agrees that he cannot justify the elephant in the room that CM infused propofol to MJ and abandoned him.
White says his initial report was based on CM’s police interview and autopsy report with 13 expert opinions. White was surprised and says if CM did what he says in his interview MJ wouldn’t have died. White asked to meet with CM. Flanagan tries to ask if he met CM but sustained. White flies to LA to meet with Flanagan and Chernoff and was given the transcripts of the preliminary hearing.
White wrote a letter that had his conclusions but he currently doesn’t think the same way. In his letter he wrote oral consumption as a speculation based on other expert’s testimony and says that he was not aware of the studies about oral bioavailability. White says he learned about them from Dr. Shafer’s report.
Flanagan asks about the Chilean study. White says he felt bad that Dr. Shafer himself drank Propofol. White mentions his concerns with that study there was no blind test and one subject had similar levels to MJ. He had done a study on beagles and agrees that there was no absorption by the stomach. White and Shafer think that one subject might have absorption through the mouth esophagus and they thought of doing a Propofol lollipop to sedate patients non-invasively.
White mentions the variations in blood levels from the same dose and he says its 5 fold. For example from the same dose of propofol , you could get a blood level from 1mg/ ml to 5 mg/ml.
They show some examples from articles that show patients with different blood levels.
Mid afternoon break
White says most centrally active drugs have the same variability in the blood levels such as lorazepam. Again example articles and graphs are shown to demonstrate variability in the levels.
White mentions Propofol as sedative hypnotic. Low doses cause sleepiness, reduces anxiety. Medium dose means deeper sedation and higher dose means that patient is not responsive to pain and anesthesia. Benzos have the same variability.
Flanagan asks about off label use. Sleep in a ICU is on label and sleep at home is off label.
Flanagan asks about the Chinese study about Propofol and insomnia. White says that he found the study interesting and the authors should be given a chance. He says he understands Shafer’s concerns but those could be corrected with a review.
Flanagan asks if White has read the toxicology report for MJ. White says he has.
Flanagan asks about polypharmacy. White explains that it’s combining drugs. It’s reducing the side effects by combining lower doses of drugs. White gives the example of pain management and mixing opiates and non opiates to reduce opiates side effects. White says that it’s common in their area and that midazolam + propofol is a standard technique.
Flanagan shows a graph done by Dr Shafer that shows 2 doses of 2 mg Lorazepam given at 2AM and 5AM. The graph has 2 lines of responsive and non responsive to pain levels. White says Lorazepam is not an analgesic, doesn't understand these line.
Flanagan tries to find the graph for midazolam but he can’t. Court ends 15-20 minutes early.
Murray Trial Day 19 October 27, 2011
Morning Session
Dr. Robert Waldman Addiction Specialist
Chernoff Direct
RW states that addiction specialists help patients to stop using alcohol and/or drugs. RW states that if a person came to him looking for help, he would first do an interview and a complete history; repetitive use, age of onset, history of all substances of abuse, history of adverse consequences of use such as legal, social consequences. RW states that a complete medical history but also to focus on the consequences.
RW states that there are different types of treatment programs depending on the substance that a person is addicted to. RW states he asks the person if the addiction has caused legal issues, problems in their marriage, etc. RW states that he has treated professional athletes and celebrities with addictions to prescription pain pills. RW states that the signs of withdrawal can be performance changes, behavior changes, use beyond the regular use can come from a dependence.
RW states that demerol is an older drug, and since then, there have been newer drugs that have surfaced. RW states that opioids are prescribed for pain. RW states that people who stop using prescription pills they have been abusing, the situation is not safe, nor is it comfortable. RW states that people in denial of their addiction, telling everyone surrounding them that they don't have a problem. RW states that interventions are necessary at times, because addicted people don't want to give up their daily lives, or live by the rehab's rules. RW states that addicted people hide the use, and do everything in their power to maintain their privacy and discretion, including patients who hide their addictions from a variety of doctors and pharmacies (referred to as doctor shopping) RW states that to keep their addiction from family or friends, addicts use drugs away from them.
RW states that there are two ways to help a opioid addict, one is a opioid substitution drug such as methadone, but one has to enter withdrawal first before they can use the opioid substitution drug. The second method is given through lots of benzodiazepines for sedation through the withdrawal process. Symptoms of opioid withdrawal consist of sweating, tachycardia, muscular aches, bone pain, abdominal cramps, vomiting, severe anxiety, hot and cold chills, diarrhea. RW states that an addict's greatest fear is that they are going to be uncomfortable going through withdrawal. RW states that both lorazepam and ativan can be used for opioid withdrawal. RW states that withdrawal time is variable, and often the addict will say they do not need the rehabilitative drugs anymore because they are now comfortable.
RW states that anesthesia can be used to withdraw from opioid addiction, and while under anesthesia, other drugs can be given to alleviate drug withdrawal symptoms.
RW states that he reviewed the medical records of Michael Jackson from Dr. Arnold Klein, statements/testimony from witnesses. RW states that MJ's medical records begin in January and end on June 22, 2009. RW states that on March 12, a page from the medical records shows that a patient named Omar Arnold (MJ alias) was treated with Restylne/Botox and received Demerol injections for those treatments. RW states that Restylne and Botox are fillers for wrinkles, but he is not familiar with the drugs. RW states that he asked his colleagues whether the REstylne or Botox would be painful enough to call for demerol, and his colleagues said no. RW states MJ also received Midazolam on this day, and that the doses of demerol were above average, meaning it was a large dose.
RW states that he reviewed MJ's medical records for March 17, and that the treatment was similar to March 12, but no botox, and similar demerol injections. RW states that the recommended top limit for demerol is 600 mgs in 24 hours; MJ received 100 mg at 10:45 am and another 100 mg injection of demerol at 11:45 am.
RW states that on April 6, MJ's medical records reveal that at 8 pm, demerol was given at 200 mg and 1 mg midazolam, in one shot. On April 9, MJ received at 3:30 pm an injection of demerol at 200 mg, and midazolam 1 mg. On April 13, MJ received 200 mg of demerol and 1 mg of Midazolam at 11:15 along with Restylne for both the 13th and the 9th. April 5th MJ received 200 mg demerol and midazolam 1 mg injection. April 17th MJ received Botox in the armpit for perspiration, 200 mg demerol 1 mg midazolam, then another demerol 100 mg injection 1 mg midazolam for a total of 300 mg demerol. April 21, MJ received Botox to groin, demerol 200 mg midazolam 1 mg, an hour later demerol 100 mg. RW states that the progression from 200 mg of demerol to 300 mg demerol is significant in that he believes MJ was developing a tolerance of demerol. April 22 11:30 am 200 mg demerol 1 midazolam an hour later, 100 mg of demerol, an hour later 75 mg demerol for total of 375 mg demerol along with Botox. RW states he has never given 375 mg of demerol to a patient. April 23, MJ received 100 mg demerol, 1 mg midazolam, so the total for the 3 days (April 21,22,23) demerol injection was 775 mg.
RW states that April 27, MJ received 11:30 200 mg demerol 1 mg Midazolam an hour later 100 mg demerol and 1 mg midazolam. On April 30, MJ received 200 mg demerol 1 mg midazolam, two hours later 100 mg demerol 2 mg Midazolam. May 4, MJ received 200 mg demerol, 1 mg midazolam, an hour later 100 mg demerol 1 mg midazolam. RW states that he believes MJ was dependent on demerol and possibly/probably addicted to opioids. RW states that six weeks of very high opioid use would provoke a dependence for anyone.
RW states May 5, 200 mg demerol, 1 mg midazolam, then 100 mg demerol 1 mg midazolam. May 6, total 300 mg demerol in two separate doses, 2 mg midazolam in two separate doses. RW states that there are not any notes in the medical records from Dr. Klein, because there are no signatures or initials from Klein. RW states that total demerol given to MJ in three days (May 4,5,6) is 900 mg.
RW states that between May 6 and May 19, there was no interaction between MJ and Dr. Klein. RW states that on May 19, MJ received 200 mg demerol and 1 mg midazolam (versed generic name). RW states that on May 20, MJ received 200 mg demerol and 1 mg versed. May 21, MJ received 100 mg demerol, 1 mg midazolam. RW states that on June 1, MJ received 200 mg demerol, 1 mg of midazolam, june 3 200 mg demerol, 2 mgs of midazolam, June 9 200 mg demerol, 2 mg midazolam, June 16 100 mg demerol 1 mg of midazolam, June 22 100 mg demerol 1 mg midazolam.
RW states that opioid withdrawal entails anxiety, restlessness, insomnia. RW states insomnia is very common, nearly universal with opioid withdrawal. RW states that the simplest way to end withdrawal from demerol would be to provide benzodiazepines.
Walgren Cross
RW states that it is possible to be addicted to benzodiazepines, including lorazepam. RW states that he did not review Conrad Murray's statement as to what happened the night before and the morning of MJ's death. RW states that he was unaware that Murray was shipping lorazepam and midazolam to his girlfriend's apartment, but he was aware that Murray was giving them to MJ. RW states that the shipping of benzodiazepines was not pertinent.
RW states that opioid and benzodiazpine withdrawal do not have the same symptoms. RW states that he based his opinion that MJ was physically dependent on demerol on the medical record from Klein, but would be highly suspicious of diagnosing MJ as an addict based on the same record.
RW states that he is not board certified in drug addiction. RW states that he is involved in dialysis professionally. RW states that this involves a process by which a machine provides kidney function for those patients whose kidneys do not function properly. RW states that he requests a urinalysis for patients who he feels have been lying to him, but not for every patient.
RW states that he works in his office and a number of facilities that are confidential. RW states that he works at Visions Treatment Facility, Clearview Treatment Facility, Authentic Recovery Center, Cliffside Malibu and his office. RW states that he is a consultant and he sees patients at all the above facilities, and also does dialysis but cannot pinpoint how many hours he works a week.
RW states he has determined that some of his patients have not received adequate care prior to treating those patients. RW states that the easy part of his job is getting patients off the drugs, the hard part is keeping them off the drugs.
RW states that the Botox/Restylne injections from Dr. Klein were given in the cheekbones, chin and facial tissue.
RW states he has not used demerol in his practice for two decades, as there are much better and safer drugs to use.
RW states that with demerol, withdrawal symptoms would appear within a day. RW states that there are significant lapses of demerol shots in June, 2009.
RW states that most common withdrawal symptoms of benzodiazepine: anxiety, insomnia, crawly skin. RW states that he would agree with the CA State Medical Board's requirement that controlled substances should be in a locked cabinet, to prevent theft. RW also agree with CA State Medical Board's requirement that medical records are kept by all physicians. RW states that doctors and patients decide what kind of medical care that is best for the patient.
Chernoff Redirect
RW states that he read the testimony of both Faheem Muhammad and Michael Amir Williams.
RW states that although there are blocks of time that MJ did not receive demerol, it was concerning.
Walgren Recross
RW states that a chart he created was made only for his own use representing MJ's doctor visits with Dr. Klein. Walgren and RW go back and forth over what each area represents. RW admits that he has made mistakes in the chart, including April 20, 2009. On April 20, MJ was not seen by Klein, but RW entered data into his chart that reflect that date. RW states that the chart does not reflect a June 4 entry, in which MJ did receive injections from Klein.
RW states that he was not personally aware that Conrad Murray was MJ's personal doctor during April, May and June of 2009. RW states that he was aware that CM was MJ's personal doctor through the media when MJ died.
Chernoff Re-redirect
RW states that he reviewed a summary from Chernoff of MJ's medical records and the medical records themselves of Dr. Klein's. RW states that the medical records were very difficult to read and therefore, there were charts made for RW's personal use.
Morning Session
Dr. Robert Waldman Addiction Specialist
Chernoff Direct
RW states that addiction specialists help patients to stop using alcohol and/or drugs. RW states that if a person came to him looking for help, he would first do an interview and a complete history; repetitive use, age of onset, history of all substances of abuse, history of adverse consequences of use such as legal, social consequences. RW states that a complete medical history but also to focus on the consequences.
RW states that there are different types of treatment programs depending on the substance that a person is addicted to. RW states he asks the person if the addiction has caused legal issues, problems in their marriage, etc. RW states that he has treated professional athletes and celebrities with addictions to prescription pain pills. RW states that the signs of withdrawal can be performance changes, behavior changes, use beyond the regular use can come from a dependence.
RW states that demerol is an older drug, and since then, there have been newer drugs that have surfaced. RW states that opioids are prescribed for pain. RW states that people who stop using prescription pills they have been abusing, the situation is not safe, nor is it comfortable. RW states that people in denial of their addiction, telling everyone surrounding them that they don't have a problem. RW states that interventions are necessary at times, because addicted people don't want to give up their daily lives, or live by the rehab's rules. RW states that addicted people hide the use, and do everything in their power to maintain their privacy and discretion, including patients who hide their addictions from a variety of doctors and pharmacies (referred to as doctor shopping) RW states that to keep their addiction from family or friends, addicts use drugs away from them.
RW states that there are two ways to help a opioid addict, one is a opioid substitution drug such as methadone, but one has to enter withdrawal first before they can use the opioid substitution drug. The second method is given through lots of benzodiazepines for sedation through the withdrawal process. Symptoms of opioid withdrawal consist of sweating, tachycardia, muscular aches, bone pain, abdominal cramps, vomiting, severe anxiety, hot and cold chills, diarrhea. RW states that an addict's greatest fear is that they are going to be uncomfortable going through withdrawal. RW states that both lorazepam and ativan can be used for opioid withdrawal. RW states that withdrawal time is variable, and often the addict will say they do not need the rehabilitative drugs anymore because they are now comfortable.
RW states that anesthesia can be used to withdraw from opioid addiction, and while under anesthesia, other drugs can be given to alleviate drug withdrawal symptoms.
RW states that he reviewed the medical records of Michael Jackson from Dr. Arnold Klein, statements/testimony from witnesses. RW states that MJ's medical records begin in January and end on June 22, 2009. RW states that on March 12, a page from the medical records shows that a patient named Omar Arnold (MJ alias) was treated with Restylne/Botox and received Demerol injections for those treatments. RW states that Restylne and Botox are fillers for wrinkles, but he is not familiar with the drugs. RW states that he asked his colleagues whether the REstylne or Botox would be painful enough to call for demerol, and his colleagues said no. RW states MJ also received Midazolam on this day, and that the doses of demerol were above average, meaning it was a large dose.
RW states that he reviewed MJ's medical records for March 17, and that the treatment was similar to March 12, but no botox, and similar demerol injections. RW states that the recommended top limit for demerol is 600 mgs in 24 hours; MJ received 100 mg at 10:45 am and another 100 mg injection of demerol at 11:45 am.
RW states that on April 6, MJ's medical records reveal that at 8 pm, demerol was given at 200 mg and 1 mg midazolam, in one shot. On April 9, MJ received at 3:30 pm an injection of demerol at 200 mg, and midazolam 1 mg. On April 13, MJ received 200 mg of demerol and 1 mg of Midazolam at 11:15 along with Restylne for both the 13th and the 9th. April 5th MJ received 200 mg demerol and midazolam 1 mg injection. April 17th MJ received Botox in the armpit for perspiration, 200 mg demerol 1 mg midazolam, then another demerol 100 mg injection 1 mg midazolam for a total of 300 mg demerol. April 21, MJ received Botox to groin, demerol 200 mg midazolam 1 mg, an hour later demerol 100 mg. RW states that the progression from 200 mg of demerol to 300 mg demerol is significant in that he believes MJ was developing a tolerance of demerol. April 22 11:30 am 200 mg demerol 1 midazolam an hour later, 100 mg of demerol, an hour later 75 mg demerol for total of 375 mg demerol along with Botox. RW states he has never given 375 mg of demerol to a patient. April 23, MJ received 100 mg demerol, 1 mg midazolam, so the total for the 3 days (April 21,22,23) demerol injection was 775 mg.
RW states that April 27, MJ received 11:30 200 mg demerol 1 mg Midazolam an hour later 100 mg demerol and 1 mg midazolam. On April 30, MJ received 200 mg demerol 1 mg midazolam, two hours later 100 mg demerol 2 mg Midazolam. May 4, MJ received 200 mg demerol, 1 mg midazolam, an hour later 100 mg demerol 1 mg midazolam. RW states that he believes MJ was dependent on demerol and possibly/probably addicted to opioids. RW states that six weeks of very high opioid use would provoke a dependence for anyone.
RW states May 5, 200 mg demerol, 1 mg midazolam, then 100 mg demerol 1 mg midazolam. May 6, total 300 mg demerol in two separate doses, 2 mg midazolam in two separate doses. RW states that there are not any notes in the medical records from Dr. Klein, because there are no signatures or initials from Klein. RW states that total demerol given to MJ in three days (May 4,5,6) is 900 mg.
RW states that between May 6 and May 19, there was no interaction between MJ and Dr. Klein. RW states that on May 19, MJ received 200 mg demerol and 1 mg midazolam (versed generic name). RW states that on May 20, MJ received 200 mg demerol and 1 mg versed. May 21, MJ received 100 mg demerol, 1 mg midazolam. RW states that on June 1, MJ received 200 mg demerol, 1 mg of midazolam, june 3 200 mg demerol, 2 mgs of midazolam, June 9 200 mg demerol, 2 mg midazolam, June 16 100 mg demerol 1 mg of midazolam, June 22 100 mg demerol 1 mg midazolam.
RW states that opioid withdrawal entails anxiety, restlessness, insomnia. RW states insomnia is very common, nearly universal with opioid withdrawal. RW states that the simplest way to end withdrawal from demerol would be to provide benzodiazepines.
Walgren Cross
RW states that it is possible to be addicted to benzodiazepines, including lorazepam. RW states that he did not review Conrad Murray's statement as to what happened the night before and the morning of MJ's death. RW states that he was unaware that Murray was shipping lorazepam and midazolam to his girlfriend's apartment, but he was aware that Murray was giving them to MJ. RW states that the shipping of benzodiazepines was not pertinent.
RW states that opioid and benzodiazpine withdrawal do not have the same symptoms. RW states that he based his opinion that MJ was physically dependent on demerol on the medical record from Klein, but would be highly suspicious of diagnosing MJ as an addict based on the same record.
RW states that he is not board certified in drug addiction. RW states that he is involved in dialysis professionally. RW states that this involves a process by which a machine provides kidney function for those patients whose kidneys do not function properly. RW states that he requests a urinalysis for patients who he feels have been lying to him, but not for every patient.
RW states that he works in his office and a number of facilities that are confidential. RW states that he works at Visions Treatment Facility, Clearview Treatment Facility, Authentic Recovery Center, Cliffside Malibu and his office. RW states that he is a consultant and he sees patients at all the above facilities, and also does dialysis but cannot pinpoint how many hours he works a week.
RW states he has determined that some of his patients have not received adequate care prior to treating those patients. RW states that the easy part of his job is getting patients off the drugs, the hard part is keeping them off the drugs.
RW states that the Botox/Restylne injections from Dr. Klein were given in the cheekbones, chin and facial tissue.
RW states he has not used demerol in his practice for two decades, as there are much better and safer drugs to use.
RW states that with demerol, withdrawal symptoms would appear within a day. RW states that there are significant lapses of demerol shots in June, 2009.
RW states that most common withdrawal symptoms of benzodiazepine: anxiety, insomnia, crawly skin. RW states that he would agree with the CA State Medical Board's requirement that controlled substances should be in a locked cabinet, to prevent theft. RW also agree with CA State Medical Board's requirement that medical records are kept by all physicians. RW states that doctors and patients decide what kind of medical care that is best for the patient.
Chernoff Redirect
RW states that he read the testimony of both Faheem Muhammad and Michael Amir Williams.
RW states that although there are blocks of time that MJ did not receive demerol, it was concerning.
Walgren Recross
RW states that a chart he created was made only for his own use representing MJ's doctor visits with Dr. Klein. Walgren and RW go back and forth over what each area represents. RW admits that he has made mistakes in the chart, including April 20, 2009. On April 20, MJ was not seen by Klein, but RW entered data into his chart that reflect that date. RW states that the chart does not reflect a June 4 entry, in which MJ did receive injections from Klein.
RW states that he was not personally aware that Conrad Murray was MJ's personal doctor during April, May and June of 2009. RW states that he was aware that CM was MJ's personal doctor through the media when MJ died.
Chernoff Re-redirect
RW states that he reviewed a summary from Chernoff of MJ's medical records and the medical records themselves of Dr. Klein's. RW states that the medical records were very difficult to read and therefore, there were charts made for RW's personal use.
Murray Trial Day 20 October 28, 2011
Morning Session
Dr White Testimony
Flanagan Direct
They still discuss the variability between people. Propofol’s effect site is the brain and the amounts in the brain are not measurable in living humans so they use alternative measures such as EEG.
Flanagan shows several papers and graphs that show that levels and effects in patients vary a lot. White explain why models are not representing each and every patient and models are just an average.
Flanagan switches to Dr. Shafer’s graph for Lorazepam (2 doses of 2 mg). White says this is accurate for an average patient but not for MJ. White says if MJ was taking oral Lorazepam, you would expect to see residual levels of Lorazepam from previous days. Walgren objects to the use of word “oral”.
White says as CM said he treated MJ with Midazolam and Lorazepam, he would expect to find residual levels but White doesn’t know how much MJ was given to make this determination.
Flanagan shows Shafer’s graph for Midazolam (2 doses of 2 mg given at 3AM and 7:30AM). Actual blood concentration for midazolam in autopsy report was close to Shafer’s model.
Flanagan shows graphs done by Shafer that combines Midazolam and Lorazepam, another graph that shows 25mg Propofol given over 3 to 5 minutes and another graph combining all (25mg Propofol, 2 doses of 2 mg Lorazepam and 2 doses of 2 mg Midazolam).This combination doesn’t show a dangerous situation.
Flanagan and White goes over a study and based on that White says that 25mg of Propofol would provide minimal sedation and help with anxiety relief and bring a little sleepiness. White says that CM gave minimal sedation.
Flanagan asks what is moderate / mac/ conscious/ procedural sedation. White says there’s verbal response, airway is unaffected and cardiovascular functions will be okay.
White says hospitals require doctors that use conscious sedation be trained so that if they mistakenly sedate the patient in a deep sedation they can rescue the patient.
Flanagan shows that CM has a certification from Sunrise Hospital in Las Vegas for moderate sedation. That allows CM to evaluate the patient, administer sedation, manage a compromised airway, provide adequate ventilation in case of apnea, rescue a patient from deeper sedation, and monitor the patient to evaluate sedation.
Flanagan shows Shafer’s graph for 40mg Lorazepam. Initially the doses started around 12:00AM but later Shafer corrected the time. White says the average patient would be dead at the very least comatose for several hours, receiving 40mg over 5 hours. Shafer did that simulation because of the 10ml vial found at the house. For Shafer’s modified simulation ( 9 doses of 4 mg each starting at 1:30AM), White says it doesn’t fit with the vial found in the house. Also last doses would have been given when he was still asleep.
Flanagan shows the graph with 40 mg Lorazepam with 2 doses of midazolam and Lorazepam. White says that it doesn’t make sense when MJ was highly sedated with Lorazepam, Midazolam would be given to him.
Flanagan shows a computer simulation: 2 doses of 2 mg Lorazepam (2AM and 5AM) and an oral dose of 20 mg (10 pills taken at the same time) at 7AM. This graph assumes there was no residual Lorazepam from previous days.
Flanagan shows another graph. It’s the same but assumes a residual level for 10mg for last 5 days. It would achieve the same result with 16 mg oral Lorazepam (8 pills) taken at 7AM.
Flanagan says the amount of Lorazepam in MJ’s stomach was very low. White says the pill will dissolve in 15 minutes and the absorption halftime is 22 minutes. White says that it’s normal that there was a little Lorazepam found in his stomach.
White says that his Lorazepam simulations are more reasonable and that 40 mg simulation of Shafer is irrational. White says the simulation with residual level is more realistic.
White says that maybe MJ didn’t take 8 pills at once. Maybe he took a few at one time and then later took some more such as at 6 AM and 8 AM. White says it’s a speculation but it’s more reasonable than 4mg boluses every 30 minutes.
White explains the small amount of Lorazepam in the stomach by absorption half-life.
Flanagan mentions another article and asks finding equivalent of 1/300th of a pill in stomach is consistent with White’s simulation. White says you would not expect to find free Lorazepam in the stomach if it was given via IV.
Mid morning break.
White says that as there was free Lorazepam in the stomach it has to be oral consumption.
White goes over Dr. Shafer’s simulations. White says Shafer’s simulations have Propofol injections in 30 seconds to 60 seconds and say that it’s inconsistent with CM’s interview. White says Shafer’s simulation of 100mg bolus is inconsistent with lidocaine. White says such injection would burn tremendously in small veins.
White says multiple injections of 50mg is inconsistent with lidocaine levels found at autopsy. White says it would be difficult for MJ to draw Propofol himself 6 times and the defense never claimed that.
White says 25mg scenario is less absurd as its minimal sedation. Flanagan asks if a person could be awake to do a 25mg injection over 30 seconds and White answers yes. White adds that the blood concentration depends on how fast the injection is done. Slow injection would have less effect on the heart and respiratory system.
Flanagan shows a graph with Lorazepam and Midazolam and a rapif 25mg bolus Propofol. White says if a fast bolus was put on the Lorazepam levels , the combination could be lethal.
White says Shafer’s 100ml infusion (IV) was inconsistent with CM’s interview. White says that an IV system was needed and the handle of Propofol was not used. White says bottle in the bag would be too low and it would be dangerous. Also White says if the patient moves or someone touches the tube the bottle could fall. White says he can’t think of a reason to not use the handle and go to the hassle of cutting the bag with a knife.
White says before the infusion pumps the practice was to empty the propofol bottle into the saline bag. If you do that when the bag is empty you would see the Propofol residue on the bag and the chamber. There was no propofol in the bag or in the long tube.
White says there’s no evidence that there was an IV and says that he think there was no infusion.
White again mentions Shafer’s simulation of 100ml IV. He says it’s an incredible coincidence that the patient dies when the bottle runs out.
White also says that Propofol in the urine doesn’t support the 100ml IV over 3 hours. White says according to urine levels the most consistent scenario is a self injection of 25mg Propofol between 11:30AM and 12:00PM.
White says that Shafer’s scenarios don’t reconcile with CM's statement, evidence at the scene, urine concentration. White says his scenario with self injection fits fit everything.
Court ends early. Media reports that Prosecutor Walgren asked for time to get ready for cross.
Morning Session
Dr White Testimony
Flanagan Direct
They still discuss the variability between people. Propofol’s effect site is the brain and the amounts in the brain are not measurable in living humans so they use alternative measures such as EEG.
Flanagan shows several papers and graphs that show that levels and effects in patients vary a lot. White explain why models are not representing each and every patient and models are just an average.
Flanagan switches to Dr. Shafer’s graph for Lorazepam (2 doses of 2 mg). White says this is accurate for an average patient but not for MJ. White says if MJ was taking oral Lorazepam, you would expect to see residual levels of Lorazepam from previous days. Walgren objects to the use of word “oral”.
White says as CM said he treated MJ with Midazolam and Lorazepam, he would expect to find residual levels but White doesn’t know how much MJ was given to make this determination.
Flanagan shows Shafer’s graph for Midazolam (2 doses of 2 mg given at 3AM and 7:30AM). Actual blood concentration for midazolam in autopsy report was close to Shafer’s model.
Flanagan shows graphs done by Shafer that combines Midazolam and Lorazepam, another graph that shows 25mg Propofol given over 3 to 5 minutes and another graph combining all (25mg Propofol, 2 doses of 2 mg Lorazepam and 2 doses of 2 mg Midazolam).This combination doesn’t show a dangerous situation.
Flanagan and White goes over a study and based on that White says that 25mg of Propofol would provide minimal sedation and help with anxiety relief and bring a little sleepiness. White says that CM gave minimal sedation.
Flanagan asks what is moderate / mac/ conscious/ procedural sedation. White says there’s verbal response, airway is unaffected and cardiovascular functions will be okay.
White says hospitals require doctors that use conscious sedation be trained so that if they mistakenly sedate the patient in a deep sedation they can rescue the patient.
Flanagan shows that CM has a certification from Sunrise Hospital in Las Vegas for moderate sedation. That allows CM to evaluate the patient, administer sedation, manage a compromised airway, provide adequate ventilation in case of apnea, rescue a patient from deeper sedation, and monitor the patient to evaluate sedation.
Flanagan shows Shafer’s graph for 40mg Lorazepam. Initially the doses started around 12:00AM but later Shafer corrected the time. White says the average patient would be dead at the very least comatose for several hours, receiving 40mg over 5 hours. Shafer did that simulation because of the 10ml vial found at the house. For Shafer’s modified simulation ( 9 doses of 4 mg each starting at 1:30AM), White says it doesn’t fit with the vial found in the house. Also last doses would have been given when he was still asleep.
Flanagan shows the graph with 40 mg Lorazepam with 2 doses of midazolam and Lorazepam. White says that it doesn’t make sense when MJ was highly sedated with Lorazepam, Midazolam would be given to him.
Flanagan shows a computer simulation: 2 doses of 2 mg Lorazepam (2AM and 5AM) and an oral dose of 20 mg (10 pills taken at the same time) at 7AM. This graph assumes there was no residual Lorazepam from previous days.
Flanagan shows another graph. It’s the same but assumes a residual level for 10mg for last 5 days. It would achieve the same result with 16 mg oral Lorazepam (8 pills) taken at 7AM.
Flanagan says the amount of Lorazepam in MJ’s stomach was very low. White says the pill will dissolve in 15 minutes and the absorption halftime is 22 minutes. White says that it’s normal that there was a little Lorazepam found in his stomach.
White says that his Lorazepam simulations are more reasonable and that 40 mg simulation of Shafer is irrational. White says the simulation with residual level is more realistic.
White says that maybe MJ didn’t take 8 pills at once. Maybe he took a few at one time and then later took some more such as at 6 AM and 8 AM. White says it’s a speculation but it’s more reasonable than 4mg boluses every 30 minutes.
White explains the small amount of Lorazepam in the stomach by absorption half-life.
Flanagan mentions another article and asks finding equivalent of 1/300th of a pill in stomach is consistent with White’s simulation. White says you would not expect to find free Lorazepam in the stomach if it was given via IV.
Mid morning break.
White says that as there was free Lorazepam in the stomach it has to be oral consumption.
White goes over Dr. Shafer’s simulations. White says Shafer’s simulations have Propofol injections in 30 seconds to 60 seconds and say that it’s inconsistent with CM’s interview. White says Shafer’s simulation of 100mg bolus is inconsistent with lidocaine. White says such injection would burn tremendously in small veins.
White says multiple injections of 50mg is inconsistent with lidocaine levels found at autopsy. White says it would be difficult for MJ to draw Propofol himself 6 times and the defense never claimed that.
White says 25mg scenario is less absurd as its minimal sedation. Flanagan asks if a person could be awake to do a 25mg injection over 30 seconds and White answers yes. White adds that the blood concentration depends on how fast the injection is done. Slow injection would have less effect on the heart and respiratory system.
Flanagan shows a graph with Lorazepam and Midazolam and a rapif 25mg bolus Propofol. White says if a fast bolus was put on the Lorazepam levels , the combination could be lethal.
White says Shafer’s 100ml infusion (IV) was inconsistent with CM’s interview. White says that an IV system was needed and the handle of Propofol was not used. White says bottle in the bag would be too low and it would be dangerous. Also White says if the patient moves or someone touches the tube the bottle could fall. White says he can’t think of a reason to not use the handle and go to the hassle of cutting the bag with a knife.
White says before the infusion pumps the practice was to empty the propofol bottle into the saline bag. If you do that when the bag is empty you would see the Propofol residue on the bag and the chamber. There was no propofol in the bag or in the long tube.
White says there’s no evidence that there was an IV and says that he think there was no infusion.
White again mentions Shafer’s simulation of 100ml IV. He says it’s an incredible coincidence that the patient dies when the bottle runs out.
White also says that Propofol in the urine doesn’t support the 100ml IV over 3 hours. White says according to urine levels the most consistent scenario is a self injection of 25mg Propofol between 11:30AM and 12:00PM.
White says that Shafer’s scenarios don’t reconcile with CM's statement, evidence at the scene, urine concentration. White says his scenario with self injection fits fit everything.
Court ends early. Media reports that Prosecutor Walgren asked for time to get ready for cross.
Murray Trial day 21 October 31, 2011
Morning Session
Dr White Testimony
Walgren cross
Dr White is retired after 30 years of clinical care, teaching and research. White says he’s an expert in the use of Propofol, not expert in pharmacokinetics and dynamics modeling. He asks other people to do that such as Dr Shafer.
Walgren asks if there were instances Dr Murray deviated from standards of care on June 25th and the preceding 2 months. Dr White agrees.
Walgren asks what did Dr. White understood from CM’s police interview. White says he understood CM gave 25mg to 50 mg Propofol with 5 CC of lidocaine. Based on interview, could not say how CM administered the drip. White says there could be a number of possibilities about the drip and multiple IV tubes as described by Dr. Shafer is one of the possibilities.
White agrees and says that giving Propofol without proper monitoring could be dangerous and could result in cardio-respiratory depression. White says at the minimum he would want to have an ambu bag.
Walgren asks White if he has given Propofol in a bedroom. White says he has never heard of it. White says that he knows Propofol being given in medical offices and clinics.
Walgren asks about the suctioning equipment. White says it’s desirable to have it but vomiting is fairly rare. White says pulse oximeter is essential and blood pressure cuff is important. White says for an infusion you measure blood pressure every 5 minutes and for minimal sedation you measure it every 5 minutes. Capnography is not utilized everywhere, White finds it useful but not very precise.
Walgren asks if failing to maintain medical records is egregious deviation from standard of care. White says charts are needed but in this case it didn’t contribute to death. White also classifies it as minor to moderate deviation from standard of cares.
Walgren asks about pre procedural assessment. It’s when the patients overall condition is evaluated to see if there are any factors that can increase cardio respiratory depression. Respiratory depression from Propofol is mentioned to be rare and generally happens when narcotics are present.
Walgren asks how much Dr. White has been paid by the defense. White says that he was paid $11,000 so far. White says he also charges $3,500 a day for court appearances but he didn’t ask that because defense doesn’t have the resources.
Walgren asks if White ever had a patient that stopped breathing after Propofol. White says he did (after general anesthesia) and he assited them with an ambu bag and mask or other ventilation techniques such as endotracheal intubation or laryngeal mask.
Walgren mentions doctor’s oath of “do no harm” and asks if CM violated this by giving Propofol. White says CM did not harm.
Walgren asks who makes the final decision – the doctor or the patient. White says both share the responsibility but the doctor have the option to walk away. White says he would never administer something he considers inappropriate, he would walk away.
Walgren asks if it is easy to go from a level of sedation to the other. White agrees that the monitoring is required but 25 mg dose is a very minimal dose that would wear off after 15 minutes. He says monitoring a patient for that dose for around 15-30 minutes would be enough and then it’s okay to leave the patient.
Walgren asks about pulse oximeter without an alarm. White says it has no value when you are out of the room. White also states that 25 mg propofol wouldn’t have effects after 25-30 minutes. Walgren asks if benzodiazepines would have an effect, White says if they have been given hours before they would have little effect.
White tries to justify CM’s treatment saying that this was an unusual case with the goal being sleep and what CM leaving MJ was acceptable.
Walgren asks what if the patient liked to push Propofol. White says he would not left the room.
White asks about failure to call 911. White says he cannot justify it but also adds the situation was different, CM didn’t know the address and the house was not easily accessible. Walgren pushes White. White says CM should have called 911 sooner but it wouldn’t have made a difference in this case. White says he would have started resuscitation and call 911 within 3 to 5 minutes.
White say he doesn’t think everything CM said to the police is true. White says in emergency situations it’s hard to remember the details and CM could have overlooked to mention Propofol and didn’t do it in a devious way. Walgren suggests that the other alternative is that CM lied. White reluctantly agrees.
Walgren does over the letter White gave to the defense. In the letter it’s written that sedatives, analgesic and benzos may increase the risk of Propofol. White says high concentration of lorazepam and 25mg propofol given too fast causes arrhythmia, and a rapid demise.
White mentions although CM bought Propofol MJ had his own stocks of Propofol. Walgren asks where he saw this information. White says CM told that to Dr. White.
Walgren shows the IV tubing found in the scene and asks if it is easily concealable and fits in the hand or in the pocket. Dr White admits to that.
Walgren mentions how White speculated that MJ drank propofol and now White rejects that's the cause of death. White says Dr Shafer explained why there could be propofol in the stomach and why it would not cause death.
White says he did his 3 page letter in a very short time as Flanagan needed something from him. White says he did not write any other report. In the letter White wrote MJ self administered either by injecting or orally. Flanagan had mentioned oral Propofol before he wrote the letter and White say he did a search but did not find anything about it.
Walgren asks if according to White the only option was to blame the victim. White says if CM only given what he said he did, there was to be something else. Walgren asks if White now blames MJ for Lorazepam as well. White says yes. Walgren asks if White took everything CM said to be the truth. White says yes. White says what CM said in regards to drug administration is consistent with the autopsy report.
Walgren goes over the report and point outs that White now says MJ died of a rapid bolus but he never wrote that in his report / letter. Walgren asks if he came up with any other theory that does not attribute the drug taking to MJ. White says no.
Walgren asks who Dr. Gabriella Ornelas is. White says she’s a PhD in biomedical engineering. White met her for the first time last week and asked is she could calculate the amount of free propofol you would expect to see in the urine after a 3 hour 100mk infusion.
Mid morning break
.... will post the rest of the morning session momentarily.
Morning Session
Dr White Testimony
Walgren cross
Dr White is retired after 30 years of clinical care, teaching and research. White says he’s an expert in the use of Propofol, not expert in pharmacokinetics and dynamics modeling. He asks other people to do that such as Dr Shafer.
Walgren asks if there were instances Dr Murray deviated from standards of care on June 25th and the preceding 2 months. Dr White agrees.
Walgren asks what did Dr. White understood from CM’s police interview. White says he understood CM gave 25mg to 50 mg Propofol with 5 CC of lidocaine. Based on interview, could not say how CM administered the drip. White says there could be a number of possibilities about the drip and multiple IV tubes as described by Dr. Shafer is one of the possibilities.
White agrees and says that giving Propofol without proper monitoring could be dangerous and could result in cardio-respiratory depression. White says at the minimum he would want to have an ambu bag.
Walgren asks White if he has given Propofol in a bedroom. White says he has never heard of it. White says that he knows Propofol being given in medical offices and clinics.
Walgren asks about the suctioning equipment. White says it’s desirable to have it but vomiting is fairly rare. White says pulse oximeter is essential and blood pressure cuff is important. White says for an infusion you measure blood pressure every 5 minutes and for minimal sedation you measure it every 5 minutes. Capnography is not utilized everywhere, White finds it useful but not very precise.
Walgren asks if failing to maintain medical records is egregious deviation from standard of care. White says charts are needed but in this case it didn’t contribute to death. White also classifies it as minor to moderate deviation from standard of cares.
Walgren asks about pre procedural assessment. It’s when the patients overall condition is evaluated to see if there are any factors that can increase cardio respiratory depression. Respiratory depression from Propofol is mentioned to be rare and generally happens when narcotics are present.
Walgren asks how much Dr. White has been paid by the defense. White says that he was paid $11,000 so far. White says he also charges $3,500 a day for court appearances but he didn’t ask that because defense doesn’t have the resources.
Walgren asks if White ever had a patient that stopped breathing after Propofol. White says he did (after general anesthesia) and he assited them with an ambu bag and mask or other ventilation techniques such as endotracheal intubation or laryngeal mask.
Walgren mentions doctor’s oath of “do no harm” and asks if CM violated this by giving Propofol. White says CM did not harm.
Walgren asks who makes the final decision – the doctor or the patient. White says both share the responsibility but the doctor have the option to walk away. White says he would never administer something he considers inappropriate, he would walk away.
Walgren asks if it is easy to go from a level of sedation to the other. White agrees that the monitoring is required but 25 mg dose is a very minimal dose that would wear off after 15 minutes. He says monitoring a patient for that dose for around 15-30 minutes would be enough and then it’s okay to leave the patient.
Walgren asks about pulse oximeter without an alarm. White says it has no value when you are out of the room. White also states that 25 mg propofol wouldn’t have effects after 25-30 minutes. Walgren asks if benzodiazepines would have an effect, White says if they have been given hours before they would have little effect.
White tries to justify CM’s treatment saying that this was an unusual case with the goal being sleep and what CM leaving MJ was acceptable.
Walgren asks what if the patient liked to push Propofol. White says he would not left the room.
White asks about failure to call 911. White says he cannot justify it but also adds the situation was different, CM didn’t know the address and the house was not easily accessible. Walgren pushes White. White says CM should have called 911 sooner but it wouldn’t have made a difference in this case. White says he would have started resuscitation and call 911 within 3 to 5 minutes.
White say he doesn’t think everything CM said to the police is true. White says in emergency situations it’s hard to remember the details and CM could have overlooked to mention Propofol and didn’t do it in a devious way. Walgren suggests that the other alternative is that CM lied. White reluctantly agrees.
Walgren does over the letter White gave to the defense. In the letter it’s written that sedatives, analgesic and benzos may increase the risk of Propofol. White says high concentration of lorazepam and 25mg propofol given too fast causes arrhythmia, and a rapid demise.
White mentions although CM bought Propofol MJ had his own stocks of Propofol. Walgren asks where he saw this information. White says CM told that to Dr. White.
Walgren shows the IV tubing found in the scene and asks if it is easily concealable and fits in the hand or in the pocket. Dr White admits to that.
Walgren mentions how White speculated that MJ drank propofol and now White rejects that's the cause of death. White says Dr Shafer explained why there could be propofol in the stomach and why it would not cause death.
White says he did his 3 page letter in a very short time as Flanagan needed something from him. White says he did not write any other report. In the letter White wrote MJ self administered either by injecting or orally. Flanagan had mentioned oral Propofol before he wrote the letter and White say he did a search but did not find anything about it.
Walgren asks if according to White the only option was to blame the victim. White says if CM only given what he said he did, there was to be something else. Walgren asks if White now blames MJ for Lorazepam as well. White says yes. Walgren asks if White took everything CM said to be the truth. White says yes. White says what CM said in regards to drug administration is consistent with the autopsy report.
Walgren goes over the report and point outs that White now says MJ died of a rapid bolus but he never wrote that in his report / letter. Walgren asks if he came up with any other theory that does not attribute the drug taking to MJ. White says no.
Walgren asks who Dr. Gabriella Ornelas is. White says she’s a PhD in biomedical engineering. White met her for the first time last week and asked is she could calculate the amount of free propofol you would expect to see in the urine after a 3 hour 100mk infusion.
Mid morning break
.... will post the rest of the morning session momentarily.
Walgren mentions that Dr. Shafer provided software for the models to the defense and White only provided computer codes on paper.
Walgren goes over the 10 AM Lorazepam theory. As the peak effect will be in 2 hours it first nicely with 12 AM. Last week when Dr. Shafer testified that Lorazepam had to be taken at least 4 hour prior to death that’s when White met with Ornelas. She created several scenarios. White says he was not aware of the 10 AM Lorazepam theory.
Walgren asks if MJ came and asked him to work for him to give Propofol , if he would accepted the job. White says absolutely not. He says no amount of money could convince him to do it because of time required, the responsibility and off label use of propofol.
Walgren asks if White’s 11:40AM self administration theory is based on a lot of assumptions for the lack of medical records. White agrees.
Walgren asks if for his theory he used CM leaving the room for 2 minutes. White says no.
Walgren asks about the beagle Propofol study. White says that Flanagan knew a veterinarian that could do the study and he had no part in it. White says he only got a report from Flanagan that oral propofol had no effect on beagles.
Walgren asks when White assumes that MJ took Lorazepam was CM out of the room as well. White says MJ was walking around. Walgren objects as White is telling what CM told him. White says he understood that CM was in the another part of the room (adjacent bedroom etc) or not watching. White says CM wasn’t aware that MJ took Lorazepam.
Walgren asks White if he’s aware that CM left the room only once. White says yes. He also says that he believes CM was away around 7 AM. Dr. White says when CM was on the phone he was presumably away from MJ because he was sleeping.
White’s theory is that CM drew 50 mg Propofol and lidocaine and gave half of it to MJ and left the half full syringe. White then says CM was in the corridor, Walgren objects as he is once again telling what CM told White. White thinks after CM gave MJ the half the syringe and observed him left him to talk on the phone and went to the bathroom. White thinks MJ could have injected in that 40 minutes.
Walgren asks if MJ injected through the IV port and the syringe was originally on the chair. Walgren asks if wouldn’t it raise an alarm when CM found the syringe in the injection port. Walgren also asks if according to his theory MJ fell back to bed in the same position.
Walgren asks if it’s White’s understanding that MJ moved around the house wheeling an IV stand with a condom catheter on him and a urine bag attached to his leg.
Walgren asks if isn’t it a possibility that CM injected the additional Propofol. White answers yes if he wanted to harm MJ.
Walgren asks if putting MJ to sleep was mild/ minimal sedation which means response to verbal stimuli. Walgren asks if it makes sense to him. White says providing sleep doesn’t need a higher level of sedation.
White says he believes that MJ didn’t receive Propofol on the 23rd and 24th based on the urine levels.
White says during the 6 weeks prior CM gave MJ 1 or 2 boluses of Propofol (25 to 50 mg) and followed it with an infusion with the Propofol bottle. Walgren again objects as White is once again telling what CM told him. White speculates that it was minimal to moderate sedation.
Walgren cites several articles written by Dr White. One article says that MAC (moderate sedation) requires the same level of standard of care as general anesthesia.
Guidelines for Office based anesthesia (written by Dr White) :
1-appropriately trained personnel
2-anesthesia equipment
3-complete documentation of care provided
4-monitoring equipment
5-recovery area with appropriate staff
6-availability of emergency equipment
7-plan for emergency transport of patients to a site that provides more comprehensive care, should a complication occur
8-documention on a quality assurance program
9-continuous training of physician
10- safety standards that can't be jeopardized for patients' comfort or cost
Walgren asks if these standards should apply if Propofol is administered in a bedroom ? White says that he wouldn’t give it in a bedroom and White eventually agrees that giving Propofol in a home requires the minimum requirements of office based anesthesia
Lunch break
Walgren goes over the 10 AM Lorazepam theory. As the peak effect will be in 2 hours it first nicely with 12 AM. Last week when Dr. Shafer testified that Lorazepam had to be taken at least 4 hour prior to death that’s when White met with Ornelas. She created several scenarios. White says he was not aware of the 10 AM Lorazepam theory.
Walgren asks if MJ came and asked him to work for him to give Propofol , if he would accepted the job. White says absolutely not. He says no amount of money could convince him to do it because of time required, the responsibility and off label use of propofol.
Walgren asks if White’s 11:40AM self administration theory is based on a lot of assumptions for the lack of medical records. White agrees.
Walgren asks if for his theory he used CM leaving the room for 2 minutes. White says no.
Walgren asks about the beagle Propofol study. White says that Flanagan knew a veterinarian that could do the study and he had no part in it. White says he only got a report from Flanagan that oral propofol had no effect on beagles.
Walgren asks when White assumes that MJ took Lorazepam was CM out of the room as well. White says MJ was walking around. Walgren objects as White is telling what CM told him. White says he understood that CM was in the another part of the room (adjacent bedroom etc) or not watching. White says CM wasn’t aware that MJ took Lorazepam.
Walgren asks White if he’s aware that CM left the room only once. White says yes. He also says that he believes CM was away around 7 AM. Dr. White says when CM was on the phone he was presumably away from MJ because he was sleeping.
White’s theory is that CM drew 50 mg Propofol and lidocaine and gave half of it to MJ and left the half full syringe. White then says CM was in the corridor, Walgren objects as he is once again telling what CM told White. White thinks after CM gave MJ the half the syringe and observed him left him to talk on the phone and went to the bathroom. White thinks MJ could have injected in that 40 minutes.
Walgren asks if MJ injected through the IV port and the syringe was originally on the chair. Walgren asks if wouldn’t it raise an alarm when CM found the syringe in the injection port. Walgren also asks if according to his theory MJ fell back to bed in the same position.
Walgren asks if it’s White’s understanding that MJ moved around the house wheeling an IV stand with a condom catheter on him and a urine bag attached to his leg.
Walgren asks if isn’t it a possibility that CM injected the additional Propofol. White answers yes if he wanted to harm MJ.
Walgren asks if putting MJ to sleep was mild/ minimal sedation which means response to verbal stimuli. Walgren asks if it makes sense to him. White says providing sleep doesn’t need a higher level of sedation.
White says he believes that MJ didn’t receive Propofol on the 23rd and 24th based on the urine levels.
White says during the 6 weeks prior CM gave MJ 1 or 2 boluses of Propofol (25 to 50 mg) and followed it with an infusion with the Propofol bottle. Walgren again objects as White is once again telling what CM told him. White speculates that it was minimal to moderate sedation.
Walgren cites several articles written by Dr White. One article says that MAC (moderate sedation) requires the same level of standard of care as general anesthesia.
Guidelines for Office based anesthesia (written by Dr White) :
1-appropriately trained personnel
2-anesthesia equipment
3-complete documentation of care provided
4-monitoring equipment
5-recovery area with appropriate staff
6-availability of emergency equipment
7-plan for emergency transport of patients to a site that provides more comprehensive care, should a complication occur
8-documention on a quality assurance program
9-continuous training of physician
10- safety standards that can't be jeopardized for patients' comfort or cost
Walgren asks if these standards should apply if Propofol is administered in a bedroom ? White says that he wouldn’t give it in a bedroom and White eventually agrees that giving Propofol in a home requires the minimum requirements of office based anesthesia
Lunch break
Murray Trial Day 21 October 31, 2011
Afternoon Session
Dr White Testimony
Walgren cross
Walgren continues with quotes from Dr. White's books/articles: "because of the profound risk of cardio respiratory depression, propofol should always be administered by anesthesiologists, not by gastroenterologists, etc (other doctors)". White states that the book was published in 1996, things have evolved since then. White states that he would agree that propofol has profound a risk of cardio respiratory depression, but it can be administered by trained doctors other than anesthesiologists, in a proper setting.
White states that the guidelines for sedation, for non anesthesiologists are: "even if moderate sedation is intended, the same standard of care should be applied as for deep sedation" and that "because it's not always possible to predict how a patient will react, the caregiver needs to prepared to rescue a patient from deep sedation."
Dr White agrees that for moderate sedation (when an infusion is used), the patient should receive the same care as for deep sedation.
For mild sedation, Dr. White states that the doctor should be prepared in the event that the patient goes into moderate sedation, not deep sedation.
Dr. White states that he wouldn't administer propofol in a home, but thinks that these guidelines should be followed with an infusion. White states that he doesn't know if a second person is necessary, assuming the doctor is monitoring the patient, while the propofol is being administered.
Walgren asks what about administering benzodiazepines and a propofol bolus? Dr. White states that in an ideal situation, it would be great to follow the guidelines.
Walgren shows Ornelas model with 25mg propofol infused over 3 to 5 minutes versus a 25mg fast injection and the differences in blood concentration and free propofol in urine levels. Her model is based on a 1998 article.
Dr White has not read the article in detail. Dr White had a conversation with Ornelas at the Flanagan’s house for a few hours at the end of last week. The models Dr White testified to, were not done by him, he is not an expert in models.
Walgren again shows the model with Murray infusing 25mg at 10:40 am versus MJ self injecting at 11:40 am. Before the self injection, blood level was near 0.
Walgren shows a zoom of the same graph, zooming on the self injection. Dr White believes that self injection occurred later than 11:40.
Dr White thinks this scenario is the most likely as it’s consistent with Murray's interview with LAPD, not recovering the tubing, matches the concentration of free propofol in the urine, matches blood concentration.
Walgren shows another zoom of the same graph, over 10 minutes, showing only blood concentration. The circulation stops almost immediately. Dr White says it could have been arrhythmia, the cause is unclear.
Walgren brings up the autopsy report: MJ had no heart problems. Dr White says that doesn't preclude an arrhythmia.
Murray told LAPD that when he returned to the room, MJ's heart rate was 122. Dr White said it's unclear what 122 was and it could have been the saturation. Walgren reads the police interview; Murray also reported that he felt a thready pulse. Dr White says that Murray might have felt his own pulse, he was under stress. He might not have felt a perfusing pulse. Walgren: "This fits with you new theory that MJ died instantly"
Dr White states he doesn't see any evidence of respiratory arrest, or cardiac arrest, or both combined.
Walgren goes back to March 8th letter White sent to the defense. First cause of death Dr. White thought of is respiratory depression. Dr White corrects "cardio pulmonary depression" among other things. Walgren mentions the oral consumption is one of the other things.
Walgren shows models of lorazeapm (multiple 4 mg injection, 2 X 2 mg IV +16mg oral).
The graph shows 0.0013 mg in the stomach, Dr White doesn't know where this number comes from, but it is smaller than the 0.006mg.
White states that the fact that there is free lorazepam in the stomach suggests oral ingestion.
White states that residual lorazepam is an assumption of 10mg for the past 5 nights.
Walgren shows the graph where Murray would have injected 25mg of propofol, and where MJ would have self injected. When MJ self injected, the lorazepam was a little lower.
Walgren again goes back to Ornelas model with 25mg propofol over 3 to 5 minutes, 25mg fast injection blood concentration and free propofol in urine levels. Walgren asks why it doesn’t show the effect site (brain). White says it’s because she was only asked about the free propofol in the urine.
Graph by Dr Shafer added effect site concentration to Ornelas graph: the levels at effect site are the same in both Murray's injection, or the supposed MJ's self injection. Dr White says these numbers are meaningless, because of variability. Dr White would be more interested in the heart concentration.
Afternoon break
Walgren asks White if he did any research to make sure that the 0.3% used by Ornelas (0.3% of the propofol is excreted unchanged) was accurate. White says it’s his feeling that it was the most conservative number.
Walgren shows an article used by Dr Ornelas as a basis for her analysis. It was published in 1988. It indicated that less than 0.3% of propofol is excreted unchanged, but the model uses 0.3%. Dr White recalls a paper that said 1% .
Walgren asks based on this paper (less than 0.3%), could it be 0? Dr White doesn't agree.
Walgren says that the article says that 0.3 could be an overestimate. Dr White says that the difference with a 3 hour infusion would still be huge.
Walgren shows a 1991 article about animals (dogs, rat). There was no unchanged propofol at all whether it was bolus or infusion. Dr White says he doesn't rely on articles about animals, he would prefer to rely on articles about humans.
Walgren shows a 1999 article: they found no free propofol in the urine. Dr White indicates he did not search the subject
Walgren shows a 2002 article in which the levels found were much smaller. Objection, sustained. The judge asks Walgren to change the subject.
Flanagan redirect
Flanagan talks about 911 not being called for 20 minutes. Flanagan says mentions that it was a large house, fenced, gate closed that can only be opened by security, guards were just outside the kitchen, incident happens upstairs , there are no landlines. Flanagan asks would it be unreasonable to ask a person in the kitchen for help.
White says he would resuscitate the patient and ask the person in the kitchen, it sounds more reasonable than going to security.White says that CPR should be given within 1 to 2 minutes, and sustained for at least 3 minutes, before leaving the patient.
Flanagan asks what kind of CPR should be given. White says mouth to mouth and adds that an ambu bag would be better but mouth to mouth is a possibility.
Flanagan asks Dr. White what would be his assessment if the patient was not breathing and his eyes and mouth were open. White says he would assess the patient to see if they are alive as they are often a sign of death.
Flanagan asks if the patient was dead at 12:00PM, could anything be done. White says if the patient was dead, not keeping a chart would not have changed anything.
Flanagan asks White if he would suspect Propofol to have anything with the death. White says if the propofol was given at 10:40 and the patient was dead at 12:00 he wouldn’t suspect propofol.
Flanagan asks after the EMT’s received the authorization to declare the patient dead if the further attempts was realistic and had a chance of saving the patient. White says no.
White says even if the ER doctors had known about propofol, it would not change the outcome.
Flanagan and White talk about 25 mg Propofol bolus over 3 to 5 minutes. White says if it had any negative effects it would be apparent by the end of the bolus and there would have been no reason to suspect anything at a later time.
Flanagan asks about concelling the IV tube and White says it’s easier to conceal an IV tube than an IV bag but if the IV tube was in a pocket there would be liquid in the pocket.
Flanagan mentions that at preliminary hearing 2 witnesses indicated the possibility of oral consumption of propofol.
Flanagan asks if Walgren has contacted Dr. White. White says Walgren called him and they talked. White said that he was contacted by the defense. Walgren asked him if he was paid and White said he was. White says this is his only source of income.
Afternoon Session
Dr White Testimony
Walgren cross
Walgren continues with quotes from Dr. White's books/articles: "because of the profound risk of cardio respiratory depression, propofol should always be administered by anesthesiologists, not by gastroenterologists, etc (other doctors)". White states that the book was published in 1996, things have evolved since then. White states that he would agree that propofol has profound a risk of cardio respiratory depression, but it can be administered by trained doctors other than anesthesiologists, in a proper setting.
White states that the guidelines for sedation, for non anesthesiologists are: "even if moderate sedation is intended, the same standard of care should be applied as for deep sedation" and that "because it's not always possible to predict how a patient will react, the caregiver needs to prepared to rescue a patient from deep sedation."
Dr White agrees that for moderate sedation (when an infusion is used), the patient should receive the same care as for deep sedation.
For mild sedation, Dr. White states that the doctor should be prepared in the event that the patient goes into moderate sedation, not deep sedation.
Dr. White states that he wouldn't administer propofol in a home, but thinks that these guidelines should be followed with an infusion. White states that he doesn't know if a second person is necessary, assuming the doctor is monitoring the patient, while the propofol is being administered.
Walgren asks what about administering benzodiazepines and a propofol bolus? Dr. White states that in an ideal situation, it would be great to follow the guidelines.
Walgren shows Ornelas model with 25mg propofol infused over 3 to 5 minutes versus a 25mg fast injection and the differences in blood concentration and free propofol in urine levels. Her model is based on a 1998 article.
Dr White has not read the article in detail. Dr White had a conversation with Ornelas at the Flanagan’s house for a few hours at the end of last week. The models Dr White testified to, were not done by him, he is not an expert in models.
Walgren again shows the model with Murray infusing 25mg at 10:40 am versus MJ self injecting at 11:40 am. Before the self injection, blood level was near 0.
Walgren shows a zoom of the same graph, zooming on the self injection. Dr White believes that self injection occurred later than 11:40.
Dr White thinks this scenario is the most likely as it’s consistent with Murray's interview with LAPD, not recovering the tubing, matches the concentration of free propofol in the urine, matches blood concentration.
Walgren shows another zoom of the same graph, over 10 minutes, showing only blood concentration. The circulation stops almost immediately. Dr White says it could have been arrhythmia, the cause is unclear.
Walgren brings up the autopsy report: MJ had no heart problems. Dr White says that doesn't preclude an arrhythmia.
Murray told LAPD that when he returned to the room, MJ's heart rate was 122. Dr White said it's unclear what 122 was and it could have been the saturation. Walgren reads the police interview; Murray also reported that he felt a thready pulse. Dr White says that Murray might have felt his own pulse, he was under stress. He might not have felt a perfusing pulse. Walgren: "This fits with you new theory that MJ died instantly"
Dr White states he doesn't see any evidence of respiratory arrest, or cardiac arrest, or both combined.
Walgren goes back to March 8th letter White sent to the defense. First cause of death Dr. White thought of is respiratory depression. Dr White corrects "cardio pulmonary depression" among other things. Walgren mentions the oral consumption is one of the other things.
Walgren shows models of lorazeapm (multiple 4 mg injection, 2 X 2 mg IV +16mg oral).
The graph shows 0.0013 mg in the stomach, Dr White doesn't know where this number comes from, but it is smaller than the 0.006mg.
White states that the fact that there is free lorazepam in the stomach suggests oral ingestion.
White states that residual lorazepam is an assumption of 10mg for the past 5 nights.
Walgren shows the graph where Murray would have injected 25mg of propofol, and where MJ would have self injected. When MJ self injected, the lorazepam was a little lower.
Walgren again goes back to Ornelas model with 25mg propofol over 3 to 5 minutes, 25mg fast injection blood concentration and free propofol in urine levels. Walgren asks why it doesn’t show the effect site (brain). White says it’s because she was only asked about the free propofol in the urine.
Graph by Dr Shafer added effect site concentration to Ornelas graph: the levels at effect site are the same in both Murray's injection, or the supposed MJ's self injection. Dr White says these numbers are meaningless, because of variability. Dr White would be more interested in the heart concentration.
Afternoon break
Walgren asks White if he did any research to make sure that the 0.3% used by Ornelas (0.3% of the propofol is excreted unchanged) was accurate. White says it’s his feeling that it was the most conservative number.
Walgren shows an article used by Dr Ornelas as a basis for her analysis. It was published in 1988. It indicated that less than 0.3% of propofol is excreted unchanged, but the model uses 0.3%. Dr White recalls a paper that said 1% .
Walgren asks based on this paper (less than 0.3%), could it be 0? Dr White doesn't agree.
Walgren says that the article says that 0.3 could be an overestimate. Dr White says that the difference with a 3 hour infusion would still be huge.
Walgren shows a 1991 article about animals (dogs, rat). There was no unchanged propofol at all whether it was bolus or infusion. Dr White says he doesn't rely on articles about animals, he would prefer to rely on articles about humans.
Walgren shows a 1999 article: they found no free propofol in the urine. Dr White indicates he did not search the subject
Walgren shows a 2002 article in which the levels found were much smaller. Objection, sustained. The judge asks Walgren to change the subject.
Flanagan redirect
Flanagan talks about 911 not being called for 20 minutes. Flanagan says mentions that it was a large house, fenced, gate closed that can only be opened by security, guards were just outside the kitchen, incident happens upstairs , there are no landlines. Flanagan asks would it be unreasonable to ask a person in the kitchen for help.
White says he would resuscitate the patient and ask the person in the kitchen, it sounds more reasonable than going to security.White says that CPR should be given within 1 to 2 minutes, and sustained for at least 3 minutes, before leaving the patient.
Flanagan asks what kind of CPR should be given. White says mouth to mouth and adds that an ambu bag would be better but mouth to mouth is a possibility.
Flanagan asks Dr. White what would be his assessment if the patient was not breathing and his eyes and mouth were open. White says he would assess the patient to see if they are alive as they are often a sign of death.
Flanagan asks if the patient was dead at 12:00PM, could anything be done. White says if the patient was dead, not keeping a chart would not have changed anything.
Flanagan asks White if he would suspect Propofol to have anything with the death. White says if the propofol was given at 10:40 and the patient was dead at 12:00 he wouldn’t suspect propofol.
Flanagan asks after the EMT’s received the authorization to declare the patient dead if the further attempts was realistic and had a chance of saving the patient. White says no.
White says even if the ER doctors had known about propofol, it would not change the outcome.
Flanagan and White talk about 25 mg Propofol bolus over 3 to 5 minutes. White says if it had any negative effects it would be apparent by the end of the bolus and there would have been no reason to suspect anything at a later time.
Flanagan asks about concelling the IV tube and White says it’s easier to conceal an IV tube than an IV bag but if the IV tube was in a pocket there would be liquid in the pocket.
Flanagan mentions that at preliminary hearing 2 witnesses indicated the possibility of oral consumption of propofol.
Flanagan asks if Walgren has contacted Dr. White. White says Walgren called him and they talked. White said that he was contacted by the defense. Walgren asked him if he was paid and White said he was. White says this is his only source of income.
Murray Trial Day 22 November 1, 2011
Dr White Testimony
Flanagan redirect
Flanagan again mentions the variability in the models.
Flanagan shows the Lorazepam model that includes 16 mg oral consumption which is based on 0.0013 mg in the stomach content. If you move the oral intake to 8 AM, the amount of free Lorazepam in the stomach would equal to the 0.008mg found in the autopsy and the concentrations find in blood.
Flanagan goes over the 0.3 free Propofol in the urine. In a model about 100 ml Propofol infusion over 3 hours the level of propofol would range from 1 to 3 mg in urine. 1 mg is the 10 times the amount found at autopsy.
Flanagan mentions the burn feeling of propofol will be increased by small veins, the concentration of the drug and the speed of the injection. Lidocaine is given before the infusion, or at the beginning. White says given the half life of lidocaine and with a 3 hours infusion there shouldn't be lidocaine found at autopsy, and there was 0.84 mg/ml at autopsy.
White says if there were 2 injections, Lidocaine would have been given twice and White would expect the lidocaine to be around the levels found at autopsy.
Flanagan mentions standard of care versus standard of practice. White says standard of care is the ideal that they would seek for every patient but it's not always possible.
Flanagan goes over minimal sedation. There would be normal response to verbal simulation. Flanagan asks if he took an ambient if White would be able to wake up by talking to him. They discuss 25 mg Propofol. White sys it would reduce anxiety and generally would not produce sleep. White says it could create a restful state if the patient is very tired. White also says that any noise in the room would wake the patient up. White says with minimal sedation airway, breathing and cardiovascular functions will not be affected.
Flanagan’s redirect of Dr. White is over. Walgren does not recross.
Off camera judge asks Dr. Murray if he will testify. Murray says that he won’t testify.
Judge gives a 30 minute break so that the prosecution can decide whether they would do a rebuttal.
After the break Walgren calls Dr. Shafer for rebuttal.
Dr. Shafer Rebuttal Testimony
Walgren direct
Walgren asks if Lorazepam is given IV would some of it go to the stomach. Shafer says yes and it has nothing to do with post mortem distribution.
Walgren asks and Shafer agrees that there’s no way to differentiate between MJ taking oral Lorazepam and CM giving MJ oral Lorazepam.
Walgren brings up Shafer’s 100 ml Propofol infusion over 3 hours. Shafer says it doesn’t show when MJ died and it was not necessarily at 12:00PM. Shafer says it was basically to show that MJ died with infusion running.
Walgren asks about the IV setup. Shafer says controlling the rate with the clamps are commonly done with some medication that you don’t need to precisely set the rate but a pump is required for Propofol.
Shafer says the Lidocaine levels found at autopsy is not inconsistent with 100 ml infusion over 3 hour simulation. Shafer says Lidocaine could have been mixed into the Propofol bottle.
Walgren asks about the main risk of Propofol and Shafer says its failure to breath and the lack of oxygen in the heart kills the heart.
Walgren brings up the article the defense used in their simulation about the unchanged Propofol in the urine. Shafer says he researched the literature. 1988 article that the defense used says they found very little (0 to 0.3) unchanged propofol in the urine but they didn’t know if it was free propofol or its metabolite.
Shafer says there are newer articles on the subject. The most detailed one is a 2002 article. 2002 article measured the actual unchanged propofol and the level was between 0.002% to 0.004%.
Autopsy urine propofol was 0.15 mg/ml . 500 ml of the urine = 82.50 micrograms of propofol .
Walgren shows a table from the 2002 article. The average Propofol found is 70.71 micrograms of propofol in the urine; it corresponds to a dose of 2000 mg.
Shafer says this absolutely rules out Dr White's theory and it actually suggests that MJ received more propofol that what even Dr Shafer thought.
Walgren asks about standard of care such as for an anesthesiologist providing care in a remote location (ex: radiology suite, etc..), . Shafer says you have less tolerance for error, because you have no back up. You should not take short cuts. Shafer says if there was such a thing as bedroom based anesthesia, if you have an error, you have mortality. So the standards of care would actually be higher.
Flanagan cross
Flanagan argues with Shafer about what he wrote in his report about lidocaine. Shafer thinks Flanagan misunderstood what he wrote. Flanagan asks Dr Shafer to read a paragraph from his report.
Flanagan goes over the 2002 article and if the 25 mg propofol dose was a sub anesthetic dose. Shafer says in most patients it's a sub anesthetic dose and it depends on what other medication is on board. Flanagan is trying to say that the article didn't mention sub anesthetic doses.
Walgren redirect
Walgren tries to clear the issue about the article and the use of sub anesthetic dose, Shafer says the use of a larger doses makes the result more precise, that's all.
Both sides work on a stipulation. Stipulation 52a says that Peoples 52 reflects the accurate phone numbers.
Both prosecution and the defense rest their cases. Judge informs the jurors that both sides asked for a day to prepare for their closing statements. Judge excuses the jurors. In a not televised afternoon session judge and the both sides work on jury instructions.
There will be no court on Wednesday November the 2nd. Closing statements and jury instructions are set for Thursday November 3rd. Court would start at 9 AM.
Dr White Testimony
Flanagan redirect
Flanagan again mentions the variability in the models.
Flanagan shows the Lorazepam model that includes 16 mg oral consumption which is based on 0.0013 mg in the stomach content. If you move the oral intake to 8 AM, the amount of free Lorazepam in the stomach would equal to the 0.008mg found in the autopsy and the concentrations find in blood.
Flanagan goes over the 0.3 free Propofol in the urine. In a model about 100 ml Propofol infusion over 3 hours the level of propofol would range from 1 to 3 mg in urine. 1 mg is the 10 times the amount found at autopsy.
Flanagan mentions the burn feeling of propofol will be increased by small veins, the concentration of the drug and the speed of the injection. Lidocaine is given before the infusion, or at the beginning. White says given the half life of lidocaine and with a 3 hours infusion there shouldn't be lidocaine found at autopsy, and there was 0.84 mg/ml at autopsy.
White says if there were 2 injections, Lidocaine would have been given twice and White would expect the lidocaine to be around the levels found at autopsy.
Flanagan mentions standard of care versus standard of practice. White says standard of care is the ideal that they would seek for every patient but it's not always possible.
Flanagan goes over minimal sedation. There would be normal response to verbal simulation. Flanagan asks if he took an ambient if White would be able to wake up by talking to him. They discuss 25 mg Propofol. White sys it would reduce anxiety and generally would not produce sleep. White says it could create a restful state if the patient is very tired. White also says that any noise in the room would wake the patient up. White says with minimal sedation airway, breathing and cardiovascular functions will not be affected.
Flanagan’s redirect of Dr. White is over. Walgren does not recross.
Off camera judge asks Dr. Murray if he will testify. Murray says that he won’t testify.
Judge gives a 30 minute break so that the prosecution can decide whether they would do a rebuttal.
After the break Walgren calls Dr. Shafer for rebuttal.
Dr. Shafer Rebuttal Testimony
Walgren direct
Walgren asks if Lorazepam is given IV would some of it go to the stomach. Shafer says yes and it has nothing to do with post mortem distribution.
Walgren asks and Shafer agrees that there’s no way to differentiate between MJ taking oral Lorazepam and CM giving MJ oral Lorazepam.
Walgren brings up Shafer’s 100 ml Propofol infusion over 3 hours. Shafer says it doesn’t show when MJ died and it was not necessarily at 12:00PM. Shafer says it was basically to show that MJ died with infusion running.
Walgren asks about the IV setup. Shafer says controlling the rate with the clamps are commonly done with some medication that you don’t need to precisely set the rate but a pump is required for Propofol.
Shafer says the Lidocaine levels found at autopsy is not inconsistent with 100 ml infusion over 3 hour simulation. Shafer says Lidocaine could have been mixed into the Propofol bottle.
Walgren asks about the main risk of Propofol and Shafer says its failure to breath and the lack of oxygen in the heart kills the heart.
Walgren brings up the article the defense used in their simulation about the unchanged Propofol in the urine. Shafer says he researched the literature. 1988 article that the defense used says they found very little (0 to 0.3) unchanged propofol in the urine but they didn’t know if it was free propofol or its metabolite.
Shafer says there are newer articles on the subject. The most detailed one is a 2002 article. 2002 article measured the actual unchanged propofol and the level was between 0.002% to 0.004%.
Autopsy urine propofol was 0.15 mg/ml . 500 ml of the urine = 82.50 micrograms of propofol .
Walgren shows a table from the 2002 article. The average Propofol found is 70.71 micrograms of propofol in the urine; it corresponds to a dose of 2000 mg.
Shafer says this absolutely rules out Dr White's theory and it actually suggests that MJ received more propofol that what even Dr Shafer thought.
Walgren asks about standard of care such as for an anesthesiologist providing care in a remote location (ex: radiology suite, etc..), . Shafer says you have less tolerance for error, because you have no back up. You should not take short cuts. Shafer says if there was such a thing as bedroom based anesthesia, if you have an error, you have mortality. So the standards of care would actually be higher.
Flanagan cross
Flanagan argues with Shafer about what he wrote in his report about lidocaine. Shafer thinks Flanagan misunderstood what he wrote. Flanagan asks Dr Shafer to read a paragraph from his report.
Flanagan goes over the 2002 article and if the 25 mg propofol dose was a sub anesthetic dose. Shafer says in most patients it's a sub anesthetic dose and it depends on what other medication is on board. Flanagan is trying to say that the article didn't mention sub anesthetic doses.
Walgren redirect
Walgren tries to clear the issue about the article and the use of sub anesthetic dose, Shafer says the use of a larger doses makes the result more precise, that's all.
Both sides work on a stipulation. Stipulation 52a says that Peoples 52 reflects the accurate phone numbers.
Both prosecution and the defense rest their cases. Judge informs the jurors that both sides asked for a day to prepare for their closing statements. Judge excuses the jurors. In a not televised afternoon session judge and the both sides work on jury instructions.
There will be no court on Wednesday November the 2nd. Closing statements and jury instructions are set for Thursday November 3rd. Court would start at 9 AM.
Murray Trial Day 23, November 3, 2011
Morning Session
Court starts with Judge Pastor reading the jury instructions.
Judge tells the jurors the evidence that contain medical items will not be in the jury room but it will be brought to them by a bailiff if they ask.
Important points from jury instructions
- Pastor tells the jurors they must follow his instructions about the law even though they might not agree with it.
- Pastor says People need to prove guilt beyond reasonable doubt. He explains that it doesn’t need to eliminate all possible doubt.
- Pastor says what the attorneys say and ask aren’t evidence.
- Pastor says things can be proved by direct or circumstantial evidence. He says they are equal.
- Pastor says if they can come to 2 reasonable conclusions – one showing innocence and the other one showing guilt- they must find the defendant not guilty.
- Pastor says they can find the witness testimony truthful or not – in full or in partial.
- Pastor says people can forget or make mistakes and 2 people can witness the same thing but remember it differently.
- Pastor says in regards to expert witnesses their education, qualifications, the information they relied on while forming their opinion and why they made a certain statement should be considered.
- Pastor says character witness testimony can be considered and can create a reasonable doubt.
- Pastor tells the jurors not to be influenced by the fact that Murray didn’t testify.
- Pastor explains involuntary manslaughter. People claim that Murray did 1) committed a lawful act with criminal negligence and 2) failed to provide a legal duty with criminal negligence.
- Pastor tells that there could be more than one cause of death and it’s required that the actions of Murray must be a substantial factor in causing the death. It doesn’t need to be the only factor.
- Pastor says Michael could have failed to use reasonable care and may have contributed to death. However if Murray’s actions were substantial he’s still responsible for the death.
David Walgren Closing Statement
Walgren starts by thanking the jurors to their services.
Walgren mentions that CM does not need to be the sole cause of MJ’s death; he only needs to be a substantial factor.
Walgren says that CM caused MJ’s death and left Prince, Paris and Blanket without a father. “For Prince, Paris and Blanket this trial will not end today for them it will go on forever”.
Walgren mentions trust and the relationship between a doctor and patient and “do no harm”. Doctor decides what the proper care is for the patient. All the doctors testified said they would never do such thing. Walgren expresses that CM violated that trust between doctor and patient "each and every day."
CM was an employee for money. “MJ trusted CM. He trusted him with his life. He trusted CM with his individual life and the future lives of his children. CM would care for him as he slept so in the morning he could share a meal with his children”. “MJ paid with his life”.
On June 24, 2009 MJ performed at the Staples Center and gave a great performance. He was optimistic and looking for future. 12 short hours later he was laying dead in his bed palms up, had tilted to the side – dead - in his home.
MJ was a 50 year old man anxious about the upcoming tour. MJ wanted to satisfy his fans that have been loyal to him for so long, his family, and his children. MJ was a creative genius who was striving for perfection. He was looking to the future. He was making long term plans for both himself and his children to whom he was so dedicated.
MJ wanted to share his message with the world. He wanted to satisfy his fans. He wanted his children to see him perform.
For MJ his children were paramount. He wanted a house for his children so they wouldn’t be cooped up in a hotel. MJ wanted to do a movie based on Thriller and wanted to direct movies. MJ wanted to open a children's hospital. He wanted to give this to the world. He had plans and hopes and dreams.
The tour would have expanded around the world. He was excited his kids would get to see their dad perform in London. But none of this came to be because on June 25, 2009, MJ just 50 years old was pronounced dead. Paris had to see her dead in that situation and scream “daddy”, Prince was shocked. That’s what CM did to MJ and his kids.
Walgren mentions that CM is charged with IVM and Walgren goes over the law. Walgren says there could still be questions unanswered and they only need to answer 3 questions.
The law recognizes the special relationship between doctor and patient. Doctors have a legal duty of care to their patients and the failure to act on that duty would be IVM. Walgren goes over criminal negligence and causation.
Walgren mentions that the defense’s theory is MJ injected himself with Propofol and caused his death. Walgren says CM is criminally negligent if he could have foreseen what happened. By his own admission, Conrad Murray knew MJ liked to push his own Propofol. He should have never left him alone in a room full of drugs. Walgren says even if true, it was foreseeable.
Walgren says misleading statements can show guilt. Dr. Murray made misleading statements when he failed to tell paramedics and doctors he administered Propofol. That is consciousness of guilt. “That is putting CM first”. Walgren says CM was intentionally giving false statements.
Walgren goes over the background of the case. CM had signed a contract. He was going to get $150,000 a month and housing. CM sent letters to his patients saying he was taking a sabbatical and ceasing practicing medicine “indefinitely”.
Walgren goes over the shipments of medicine and he told jurors that CM ordered more than four gallons of Propofol and had it shipped to his girlfriend's apartment in LA.
Walgren mentions May 10 recording. CM says he realized there was a problem in June but the recording was 1.5 months ago. Murray couldn't bother to keep records ... but had no problem recording a drugged up MJ and then for some reason keeping it.
Even in vulnerable state MJ talks about the future and his desires. He’s talking about a children’s hospital. He has no reason to believe that anyone will hear him; he’s talking about his true feelings and his true desires.
2 days after that recording, CM orders the largest shipment of drugs. Walgren says that they couldn’t find the other propofol bottles with search warrants.
At a meeting in early June, Murray assures everyone MJ is doing just fine. On June 19, 2009, director Kenny Ortega is so concerned about MJ's health and sent him home. Ortega sends an urgent email to Randy Phillips saying MJ is in a bad state. Ortega tried to reach CM but couldn’t. June 20th meeting CM was upset that MJ was sent home. CM insists MJ is doing fine ... lashing out at Ortega for sending MJ home from rehearsal. Murray sternly told Ortega to mind his own business. “Unfortunately, that's what happened”.
On June 21, 2009, MJ was complaining he was half hot and half cold. FM called a nurse who told them MJ needed to go to the hospital.
On June 23 MJ performed at the Staples Center. By all accounts it was a great performance. There was light at the end of the tunnel. MJ's last rehearsal on June 24 was, again, a success. Everyone was excited that the tour was going to finally happen. MJ was particularly excited about the "illusion" that was to be performed the next day. Walgren goes over MJ’s final goodbyes with Ortega and Phillips.
CM’s version of events changed. June 25th he said he witnessed the arrest. After MJ's death an arrangement was made to meet with CM at Marina del Rey. CM was there with his lawyers. At this point, investigators knew very little. The cause of the death had not yet been determined. Detectives were working in the dark. They sat down to listen to Conrad Murray to listen to what he had to say. Detectives did not have medical knowledge. CM told detectives he was giving MJ Propofol. When detectives ask how frequently did this happen? Murray tells them every day. CM admitted he gave MJ 50 mg Propofol injections followed by a drip almost every night for two months.
During his interview, CM told cops he was worried about giving MJ Propofol at 10:00 am because MJ had to be up at noon -- 2 hours later. CM says he agreed to give Propofol when MJ said he didn’t need to get up at noon. This suggests that CM intended to give MJ a drip, because a 25 mg injection would only put someone to sleep for 5 minutes. CM intended to knock him out.
Walgren says CM didn’t call 911 and it’s bizarre and he aimed to protect himself. CM never called 911 because, as he claimed, speaking to an operator would be negligent ... so what does he do instead? He calls Michael Amir Williams and leaves him a message. Setting aside all the other bizarre behavior, all he needed to say was, "Call 911..." but he didn't. CM knew what he did and his actions killed MJ. Walgren says CM intentionally didn’t call 911.
Walgren goes over CM’s phone records and emails. Walgren asks jurors if they believe MJ was paying him $150,000 and awake and complaining and CM was away on the phone. Walgren suggests that CM was able to spend all that time on the phone because MJ was asleep on a drip.
Walgren asks why CM called his female friend Sade Anding at that time. What was so pressing to call her? Sade Anding heard voices in the background at the exact time Murray drops the phone. “Was Conrad Murray in another room? How long was MJ in that condition? Was MJ calling for help? Did he gasp? Did he choke? We don't know ... and we'll never know.”
Alberto Alvarez comes to the home. CM grabs vials of medicine and instructs him to put them in a bag. Only then does CM asks him to call 911. It took 20 + minutes to call 911. FM finds the children crying. Paramedics responded in 4 minutes. They were a mile and a half away. Walgren says CM put himself first and put MJ last. Blount was able to get ventilation quickly but it was too late.
As paramedics transport MJ to the ambulance, Senneff finds Murray is picking stuff off the floor and putting it in a trash bag. Walgren asks the jurors to why? They were trying to get MJ to the hospital but CM was in the room alone picking up stuff. Walgren mentions CM’s cargo pants pockets.
In the hospital doctors ask CM what drugs administered ... again CM never mentioned Propofol. After MJ was pronounced dead, CM is concerned about retrieving a "cream" which he claimed MJ didn't want people to know about. Walgren says CM knows that his bags, drugs, syringes were at the house. CM was not concerned about a cream... he was worried about himself.
Walgren mentions that detectives found the bags because CM told them where they were. Walgren says CM went into this interview assuming the police had found his bags. He came forward for the self preservation of CM. CM thought his bags were discovered. He knew the toxicology report was about to be completed. He came forward to get ahead of the story. Unfortunately his story doesn't match up with the evidence.
Walgren switches to standard of care. “Every single doctor has told you they would never have done what Murray did.”
Propofol should be used in a highly monitored setting. No one had ever heard of anyone using Propofol in a bedroom EVER until CM. There’s no backup. It's an egregious violation of medical care. It's gross criminal negligence. Walgren says the setting is direct cause for MJ’s death.
Propofol is not used for insomnia. The article the defense used is written after MJ’s death.
Walgren mentions the equipment needed and being able to use them. None of the required equipments was there. Again this was criminal negligence.
Walgren goes over the abandonment and the patient should not be left alone because things can happen very quickly. Murray's preoccupation with emails, texts and calls constitute abandonment.
Walgren says benzos contributed. Walgren mentions what White said about variability and that’s why all the precautions was needed because you cannot know how a patient would react.
CM kept record in the previous years but he didn’t do for his last 2 months treatment. CM chose not to keep any medical records because he didn't want his bizarre treatment to be documented.
CM deceived the paramedics and the doctors at UCLA Medical Center.
Walgren says there had been some speculation with scenarios as they had no medical records. Dr. Steven Shafer said the most likely scenario is that Murray gave Jackson a drip. It's based on the evidence such as the propofol shipments, a cut saline bag, Propofol bottle with CM’s finger prints on it and a spike tear. It’s not unusual Murray admitted he did that every night, a 50 mg injection followed by a drip.
Walgren says it was perhaps MJ’s idea to put the bottle in the saline bag to hide it.
Walgren says drip theory explains the blood levels and phone evidence. Walgren says CM was an employee and it’s unrealistic to think that MJ was lying there complaining and CM was ignoring him and being on the phone. MJ wasn't complaining he couldn't fall asleep because he was asleep because CM put him on a drip.
White’s theories of self injection and lorazepam pills happened during not in 2 minutes but during other times of abandonment.
CM's former patients say he was a good doctor. They were all treated in a hospital for heart conditions CM was trained to do. Walgren mentions we didn’t hear from CM’s current patients and how they felt about receiving the letter and feeling abandoned.
Walgren plays defense's own witness Dr. Allan Metzger’s statement that he said there no amount of money would get him to agree to give Propofol in a bedroom. Lee’s statement is played in which she says MJ told him he would be safe as long as he’s monitored by a doctor.
Walgren says there’s no evidence to suggest that MJ seek propofol without a doctor present. MJ was not reckless. He had a life ahead of him. He had 3 children he loved dearly. He wanted Propofol to sleep but he also wanted a doctor monitoring him at all time to be safe.
Walgren mentions that Lorazepam is a controlled substance and it should be kept under lock and key and their usage has to be recorded.
Defense expert Dr. Paul White presented was junk science. It was garbage. It was sad for science and for truth seeking. White has been consistent to blame MJ. When he’s debunked by Dr.Shafer, he goes and picks another theory.
Walgren goes over what White said about the Beagle study under direct and cross. During direct by Flanagan White says it was his idea. During Walgren’s cross he says he had nothing to do anything with it and didn’t study it.
White during testimony said he would not administer Propofol in a home setting, a pulse oximeter without an alarm has no value, he wouldn’t leave a patient that liked to push to Propofol alone and he would have called 911 earlier.
Walgren says White didn’t do the models, didn’t provide any information for the models, he didn’t read the article and he’s not an expert in this area. Walgren says he didn’t research or studied. Walgren says the theories constantly changed.
Walgren mentions the IV tubing is very compact and concealable. Walgren later plays the video of Flanagan asking White if he has another IV line and White pulling one out of his pocket. Walgren says the IV line was concealable.
Walgren mentions the 1988 article was old and the 2002 article confirms Shafer’s theory of IV drip and debunks the defense’s self administration theory.
MJ trusted CM. He trusted him with his life. He paid with his life. CM lied, deceived, obscured but more importantly. CM acted with negligence and he looked out for himself. That's not what a doctor does. CM action directly caused MJ's death. But the People do not need to prove that because all it needs to be proven is that CM is a substantial factor in death. Even if you accept defense's facts CM should still be held responsible.
Walgren ask the jury to find Murray guilty of manslaughter because he abandoned his patient. "Justice demands a guilty verdict," he concluded.
lunch break
Morning Session
Court starts with Judge Pastor reading the jury instructions.
Judge tells the jurors the evidence that contain medical items will not be in the jury room but it will be brought to them by a bailiff if they ask.
Important points from jury instructions
- Pastor tells the jurors they must follow his instructions about the law even though they might not agree with it.
- Pastor says People need to prove guilt beyond reasonable doubt. He explains that it doesn’t need to eliminate all possible doubt.
- Pastor says what the attorneys say and ask aren’t evidence.
- Pastor says things can be proved by direct or circumstantial evidence. He says they are equal.
- Pastor says if they can come to 2 reasonable conclusions – one showing innocence and the other one showing guilt- they must find the defendant not guilty.
- Pastor says they can find the witness testimony truthful or not – in full or in partial.
- Pastor says people can forget or make mistakes and 2 people can witness the same thing but remember it differently.
- Pastor says in regards to expert witnesses their education, qualifications, the information they relied on while forming their opinion and why they made a certain statement should be considered.
- Pastor says character witness testimony can be considered and can create a reasonable doubt.
- Pastor tells the jurors not to be influenced by the fact that Murray didn’t testify.
- Pastor explains involuntary manslaughter. People claim that Murray did 1) committed a lawful act with criminal negligence and 2) failed to provide a legal duty with criminal negligence.
- Pastor tells that there could be more than one cause of death and it’s required that the actions of Murray must be a substantial factor in causing the death. It doesn’t need to be the only factor.
- Pastor says Michael could have failed to use reasonable care and may have contributed to death. However if Murray’s actions were substantial he’s still responsible for the death.
David Walgren Closing Statement
Walgren starts by thanking the jurors to their services.
Walgren mentions that CM does not need to be the sole cause of MJ’s death; he only needs to be a substantial factor.
Walgren says that CM caused MJ’s death and left Prince, Paris and Blanket without a father. “For Prince, Paris and Blanket this trial will not end today for them it will go on forever”.
Walgren mentions trust and the relationship between a doctor and patient and “do no harm”. Doctor decides what the proper care is for the patient. All the doctors testified said they would never do such thing. Walgren expresses that CM violated that trust between doctor and patient "each and every day."
CM was an employee for money. “MJ trusted CM. He trusted him with his life. He trusted CM with his individual life and the future lives of his children. CM would care for him as he slept so in the morning he could share a meal with his children”. “MJ paid with his life”.
On June 24, 2009 MJ performed at the Staples Center and gave a great performance. He was optimistic and looking for future. 12 short hours later he was laying dead in his bed palms up, had tilted to the side – dead - in his home.
MJ was a 50 year old man anxious about the upcoming tour. MJ wanted to satisfy his fans that have been loyal to him for so long, his family, and his children. MJ was a creative genius who was striving for perfection. He was looking to the future. He was making long term plans for both himself and his children to whom he was so dedicated.
MJ wanted to share his message with the world. He wanted to satisfy his fans. He wanted his children to see him perform.
For MJ his children were paramount. He wanted a house for his children so they wouldn’t be cooped up in a hotel. MJ wanted to do a movie based on Thriller and wanted to direct movies. MJ wanted to open a children's hospital. He wanted to give this to the world. He had plans and hopes and dreams.
The tour would have expanded around the world. He was excited his kids would get to see their dad perform in London. But none of this came to be because on June 25, 2009, MJ just 50 years old was pronounced dead. Paris had to see her dead in that situation and scream “daddy”, Prince was shocked. That’s what CM did to MJ and his kids.
Walgren mentions that CM is charged with IVM and Walgren goes over the law. Walgren says there could still be questions unanswered and they only need to answer 3 questions.
The law recognizes the special relationship between doctor and patient. Doctors have a legal duty of care to their patients and the failure to act on that duty would be IVM. Walgren goes over criminal negligence and causation.
Walgren mentions that the defense’s theory is MJ injected himself with Propofol and caused his death. Walgren says CM is criminally negligent if he could have foreseen what happened. By his own admission, Conrad Murray knew MJ liked to push his own Propofol. He should have never left him alone in a room full of drugs. Walgren says even if true, it was foreseeable.
Walgren says misleading statements can show guilt. Dr. Murray made misleading statements when he failed to tell paramedics and doctors he administered Propofol. That is consciousness of guilt. “That is putting CM first”. Walgren says CM was intentionally giving false statements.
Walgren goes over the background of the case. CM had signed a contract. He was going to get $150,000 a month and housing. CM sent letters to his patients saying he was taking a sabbatical and ceasing practicing medicine “indefinitely”.
Walgren goes over the shipments of medicine and he told jurors that CM ordered more than four gallons of Propofol and had it shipped to his girlfriend's apartment in LA.
Walgren mentions May 10 recording. CM says he realized there was a problem in June but the recording was 1.5 months ago. Murray couldn't bother to keep records ... but had no problem recording a drugged up MJ and then for some reason keeping it.
Even in vulnerable state MJ talks about the future and his desires. He’s talking about a children’s hospital. He has no reason to believe that anyone will hear him; he’s talking about his true feelings and his true desires.
2 days after that recording, CM orders the largest shipment of drugs. Walgren says that they couldn’t find the other propofol bottles with search warrants.
At a meeting in early June, Murray assures everyone MJ is doing just fine. On June 19, 2009, director Kenny Ortega is so concerned about MJ's health and sent him home. Ortega sends an urgent email to Randy Phillips saying MJ is in a bad state. Ortega tried to reach CM but couldn’t. June 20th meeting CM was upset that MJ was sent home. CM insists MJ is doing fine ... lashing out at Ortega for sending MJ home from rehearsal. Murray sternly told Ortega to mind his own business. “Unfortunately, that's what happened”.
On June 21, 2009, MJ was complaining he was half hot and half cold. FM called a nurse who told them MJ needed to go to the hospital.
On June 23 MJ performed at the Staples Center. By all accounts it was a great performance. There was light at the end of the tunnel. MJ's last rehearsal on June 24 was, again, a success. Everyone was excited that the tour was going to finally happen. MJ was particularly excited about the "illusion" that was to be performed the next day. Walgren goes over MJ’s final goodbyes with Ortega and Phillips.
CM’s version of events changed. June 25th he said he witnessed the arrest. After MJ's death an arrangement was made to meet with CM at Marina del Rey. CM was there with his lawyers. At this point, investigators knew very little. The cause of the death had not yet been determined. Detectives were working in the dark. They sat down to listen to Conrad Murray to listen to what he had to say. Detectives did not have medical knowledge. CM told detectives he was giving MJ Propofol. When detectives ask how frequently did this happen? Murray tells them every day. CM admitted he gave MJ 50 mg Propofol injections followed by a drip almost every night for two months.
During his interview, CM told cops he was worried about giving MJ Propofol at 10:00 am because MJ had to be up at noon -- 2 hours later. CM says he agreed to give Propofol when MJ said he didn’t need to get up at noon. This suggests that CM intended to give MJ a drip, because a 25 mg injection would only put someone to sleep for 5 minutes. CM intended to knock him out.
Walgren says CM didn’t call 911 and it’s bizarre and he aimed to protect himself. CM never called 911 because, as he claimed, speaking to an operator would be negligent ... so what does he do instead? He calls Michael Amir Williams and leaves him a message. Setting aside all the other bizarre behavior, all he needed to say was, "Call 911..." but he didn't. CM knew what he did and his actions killed MJ. Walgren says CM intentionally didn’t call 911.
Walgren goes over CM’s phone records and emails. Walgren asks jurors if they believe MJ was paying him $150,000 and awake and complaining and CM was away on the phone. Walgren suggests that CM was able to spend all that time on the phone because MJ was asleep on a drip.
Walgren asks why CM called his female friend Sade Anding at that time. What was so pressing to call her? Sade Anding heard voices in the background at the exact time Murray drops the phone. “Was Conrad Murray in another room? How long was MJ in that condition? Was MJ calling for help? Did he gasp? Did he choke? We don't know ... and we'll never know.”
Alberto Alvarez comes to the home. CM grabs vials of medicine and instructs him to put them in a bag. Only then does CM asks him to call 911. It took 20 + minutes to call 911. FM finds the children crying. Paramedics responded in 4 minutes. They were a mile and a half away. Walgren says CM put himself first and put MJ last. Blount was able to get ventilation quickly but it was too late.
As paramedics transport MJ to the ambulance, Senneff finds Murray is picking stuff off the floor and putting it in a trash bag. Walgren asks the jurors to why? They were trying to get MJ to the hospital but CM was in the room alone picking up stuff. Walgren mentions CM’s cargo pants pockets.
In the hospital doctors ask CM what drugs administered ... again CM never mentioned Propofol. After MJ was pronounced dead, CM is concerned about retrieving a "cream" which he claimed MJ didn't want people to know about. Walgren says CM knows that his bags, drugs, syringes were at the house. CM was not concerned about a cream... he was worried about himself.
Walgren mentions that detectives found the bags because CM told them where they were. Walgren says CM went into this interview assuming the police had found his bags. He came forward for the self preservation of CM. CM thought his bags were discovered. He knew the toxicology report was about to be completed. He came forward to get ahead of the story. Unfortunately his story doesn't match up with the evidence.
Walgren switches to standard of care. “Every single doctor has told you they would never have done what Murray did.”
Propofol should be used in a highly monitored setting. No one had ever heard of anyone using Propofol in a bedroom EVER until CM. There’s no backup. It's an egregious violation of medical care. It's gross criminal negligence. Walgren says the setting is direct cause for MJ’s death.
Propofol is not used for insomnia. The article the defense used is written after MJ’s death.
Walgren mentions the equipment needed and being able to use them. None of the required equipments was there. Again this was criminal negligence.
Walgren goes over the abandonment and the patient should not be left alone because things can happen very quickly. Murray's preoccupation with emails, texts and calls constitute abandonment.
Walgren says benzos contributed. Walgren mentions what White said about variability and that’s why all the precautions was needed because you cannot know how a patient would react.
CM kept record in the previous years but he didn’t do for his last 2 months treatment. CM chose not to keep any medical records because he didn't want his bizarre treatment to be documented.
CM deceived the paramedics and the doctors at UCLA Medical Center.
Walgren says there had been some speculation with scenarios as they had no medical records. Dr. Steven Shafer said the most likely scenario is that Murray gave Jackson a drip. It's based on the evidence such as the propofol shipments, a cut saline bag, Propofol bottle with CM’s finger prints on it and a spike tear. It’s not unusual Murray admitted he did that every night, a 50 mg injection followed by a drip.
Walgren says it was perhaps MJ’s idea to put the bottle in the saline bag to hide it.
Walgren says drip theory explains the blood levels and phone evidence. Walgren says CM was an employee and it’s unrealistic to think that MJ was lying there complaining and CM was ignoring him and being on the phone. MJ wasn't complaining he couldn't fall asleep because he was asleep because CM put him on a drip.
White’s theories of self injection and lorazepam pills happened during not in 2 minutes but during other times of abandonment.
CM's former patients say he was a good doctor. They were all treated in a hospital for heart conditions CM was trained to do. Walgren mentions we didn’t hear from CM’s current patients and how they felt about receiving the letter and feeling abandoned.
Walgren plays defense's own witness Dr. Allan Metzger’s statement that he said there no amount of money would get him to agree to give Propofol in a bedroom. Lee’s statement is played in which she says MJ told him he would be safe as long as he’s monitored by a doctor.
Walgren says there’s no evidence to suggest that MJ seek propofol without a doctor present. MJ was not reckless. He had a life ahead of him. He had 3 children he loved dearly. He wanted Propofol to sleep but he also wanted a doctor monitoring him at all time to be safe.
Walgren mentions that Lorazepam is a controlled substance and it should be kept under lock and key and their usage has to be recorded.
Defense expert Dr. Paul White presented was junk science. It was garbage. It was sad for science and for truth seeking. White has been consistent to blame MJ. When he’s debunked by Dr.Shafer, he goes and picks another theory.
Walgren goes over what White said about the Beagle study under direct and cross. During direct by Flanagan White says it was his idea. During Walgren’s cross he says he had nothing to do anything with it and didn’t study it.
White during testimony said he would not administer Propofol in a home setting, a pulse oximeter without an alarm has no value, he wouldn’t leave a patient that liked to push to Propofol alone and he would have called 911 earlier.
Walgren says White didn’t do the models, didn’t provide any information for the models, he didn’t read the article and he’s not an expert in this area. Walgren says he didn’t research or studied. Walgren says the theories constantly changed.
Walgren mentions the IV tubing is very compact and concealable. Walgren later plays the video of Flanagan asking White if he has another IV line and White pulling one out of his pocket. Walgren says the IV line was concealable.
Walgren mentions the 1988 article was old and the 2002 article confirms Shafer’s theory of IV drip and debunks the defense’s self administration theory.
MJ trusted CM. He trusted him with his life. He paid with his life. CM lied, deceived, obscured but more importantly. CM acted with negligence and he looked out for himself. That's not what a doctor does. CM action directly caused MJ's death. But the People do not need to prove that because all it needs to be proven is that CM is a substantial factor in death. Even if you accept defense's facts CM should still be held responsible.
Walgren ask the jury to find Murray guilty of manslaughter because he abandoned his patient. "Justice demands a guilty verdict," he concluded.
lunch break
Murray Trial Day 23 , November 3 2011
Afternoon Session
Ed Chernoff Closing arguments
- Walgren's argument is exactly why we have a jury trial in America.
- Walgren gave bits and pieces of statements from witnesses regarding propofol, rather than the whole context.
- Defense team has never stated that Conrad Murray did not make mistakes. But this case is not a medical board hearing or a civil lawsuit. For a crime to be proven, the prosecution has to show that Conrad Murray actually killed MJ. Prosecution must show criminal negligence, but also the specific act was the cause of death, otherwise this is not a crime.
- What defense believes is that Murray found MJ in distress, at 12 pm. The very first thing Murray did was try to revive MJ. At 11:51 Sade Anding received a phone call from Murray. From Anding's testimony defense believes she listened for about 2 minutes before hanging up. From 11:18 am until 12 noon, Murray was on the phone. If Murray had found MJ anywhere between 11:18 am and noon, the same thing would have happened that Sade Anding reported when she was on the phone with him (Murray would have dropped the phone and tried to revive MJ). Defense states that from 11:18 am to 12 noon, Murray never found MJ not breathing.
- The nature of propofol, is a 10 minute drug. The only way to keep propofol actually working after that is through an IV drip or IV injection. The prosecution spent 6 weeks trying to prove a drip theory, because the evidence proves that Murray injected propofol into MJ's IV prior to him leaving the room. The prosecution wants the jury to convict Conrad Murray for Michael Jackson's actions.
-Alberto Alvarez stated that he has had a hard time finding steady employment since MJ died, and that he was offered $500,000 for his story. Alvarez stated when he first talked to police, all he claimed he did was call 911. But when Alvarez spoke to police in August 2009, he then stated he comforted the children, he hid evidence for Murray and he comforted the children. The story became monumentally more compelling and valuable. Chernoff asks the jury if they honestly believe that Alberto Alvarez, after this trial is over, is not going to cash in on MJ's death story?
-Alvarez stated that he grabbed MJ's legs, Murray got MJ's shoulders and they took him and placed him on the floor. Alvarez stated that Murray asked him to take the IV bag off the stand and that there was a milky substance in the bag, but when tested there was nothing in the bag. Chernoff reminds the jury that the EMT's stated that they found MJ on the floor not the bed.
-The problem with prosecution theory starts with Alvarez inconsistencies, but moves on to Elyssa Fleak, and that she never mentioned a bottle in a bag originally. In the notes that she didn't destroy, there is no mention of a propofol bottle inside a cut IV bag, and there are no photos of it either. Fleak only mentions it 18 months later in testimony.
-Detective Smith, who Chernoff claims is a methodical, consummate professional, took notes of a smaller bottle of Lorazepam with an IV bag inside a bag fromt eh room where MJ died but did not remember seeing a vial of propofol inside a cut IV bag. Chernoff says that the reason Smith never saw it is because it never existed.
-April, 2011: Alvarez is interviewed by LAPD, and draws a picture of the IV bag. Chernoff states that the tubing, the IV bag, insinuating that LAPD coached Alvarez into drawing a bag that was similar to the bags the LAPD had at the interview. Chernoff states that the prosecution's theory was solidified then.
-Chernoff questions Dr. Shafer's testimony: stating that the IV tubing was hung to prove the prosecution's theory that Murray used an IV drip. Chernoff states that the short tubing used for testimony is used for an IV drip, the short tubing that Murray claims he used would be for IV injection. Chernoff states that Shafer testified he was wrong the next day, even though Murray's life is on the line. Chernoff states that the short tubing is proven to be used by Murray from medical records that show Murray ordered the short tubing only, and no long tubing, therefore showing that Murray did in fact, use an injection IV rather than a drip IV.
-Chernoff states that Dr. Shafer is a pharmacokineticist first and an anesthesiologist second. Chernoff stated that the prosecution turned Shafer into a cop, and that Shafer stated what he believed he happened as if it were true, but it's merely opinion.
-Chernoff on Dr. White: White is completely honest and said when needed, I don't have those qualifications to comment on certain testimony, but Shafer never said that. Chernoff states that White knows more about propofol than Shafer will ever, ever know. White just tried to tell the jury the truth, for $11,000. Chernoff states that Shafer gave simulations, one right after another, and none of them have anything to do with the case except for one, and that one is because the defense asked him to do it. Shafer showed a rapid bolus demonstration, when nobody from the defense ever asked him to do that. Shafer worked backwards on his theory (from concentration to dose), and when someone does that, there are a million different outcomes.
-MJ could not have died from what Murray admitted he did (25 mg injection to IV) and Shafer admitted that. Chernoff questions whether Shafer is a scientist or a prosecution advocate.
-Chernoff states that prosecution cannot prove a crime. When Chernoff asked Shafer about oral Lorazepam ingestion, Shafer stated that MJ's stomach held 1/300th of a tablet. Chernoff states that defense knows MJ orally ingested Lorazepam, and that's Shafer's exhibits are nothing representative of any proof, it represents nothing.
-Chernoff states that there are two reasonable scenarios about Lorazepam. First is MJ went into his bathroom and swallowed Lorazepam and Murray didn't know. Chernoff states that if this case were about anyone else, Murray wouldn't be on trial.
-Chernoff states that Murray's patients were willing to come to court and testify in front of cameras for him. People that know Murray believe that he could never have a disregard for human life as prosecution has claimed.
-Chernoff states that if Murray is such a liar, why did he tell LAPD he had been giving MJ propofol for 60 days straight?
-Definition of criminal negligence: prosecution has shown negligence, in many different respects. Three aspects of criminal negligence (as stated on jury instructions) #1 With the act (of propofol in a home), is it the direct cause of MJ's death, and #3, is it the natural probable consequence of the act (the death).
-Chernoff states that it's easy in hindsight to say that Murray is a lousy doctor, but the prosecution witness doctors have never walked in Murray's shoes. It's easy to judge when people have a miniscule amount of compassion, but do not question his motives. Murray's biggest personality defect is his also his greatest strength; he thought he could help MJ, he thought he could help him sleep. But Murray was wrong, he was a little fish in a big dirty pond.
-Chernoff states that Murray had no idea why when he came back in the room, MJ looked like he was dead. Chernoff states that Murray should not have been expected to call 911 first, but to try to revive the patient (MJ) first. Chernoff states that Dr. Steinberg stated that maybe two minutes for revival, after that, it's a felony not to call 911.
-Chernoff states that Murray injected MJ with Flumanezil, runs down and gets Kai Chase, and then says that Chase got Prince I (MJ's oldest son), not Murray.
-Chernoff states that Steinberg stated that Murray performed substandard CPR, but it's based on testimony that the compressions were done on the bed. Chernoff states that compressions with Murray's hand behind MJ's back, and one hand compressing MJ's chest is not a violation of standard of care. Chernoff states that the prosecution stated Murray deviated from care from the standard of care because he did not provide sufficient for MJ, but Chernoff states that an ambubag was on the floor. Chernoff states that every single thing Murray did, the prosecution claimed that it was a deviation from the standard of care.
-Chernoff states that the prosecution brought in MJ's kids to gain sympathy. He states that the prosecution brought in Nicole Alvarez for no reason. He states that the prosecution wants to paint a perfect villain and a perfect victim, but there are neither. Chernoff states that the only reason that the fact that Murray helped with the press release at the time of MJ's death was because the defense brought it into testimony.
-Chernoff states that it is believable that Murray wanted to back to MJ's house from the hospital the day MJ died because his car was there, and it was believable that he wanted to go eat. What is not believable is that Murray wanted to go back to the house to get some cream, that Amir Williams was so disturbed by that, that he locked the house down, but never mentioned it to the police.
-Chernoff plays the voicemail from Frank Dileo to Conrad Murray again (6/19/09 stating that MJ had an episode, he was sick and Murray should get a blood test on MJ)
-Chernoff states that MJ was under tremendous, abnormal, impossible pressure from AEG. Chernoff concedes that giving propofol in the home was not an appropriate thing to do. But Murray gave an uncontrolled substance, not Demerol, to MJ. Chernoff states that when Murray went home, the other life of MJ took over.
-Chernoff repeats Steinberg's testimony that Murray giving propofol to MJ was "like a baby on a countertop". Chernoff states that this was insulting MJ, as if MJ was a baby, couldn't make contracts for himself, couldn't raise his children for himself, because he was just a baby. Chernoff asks if Murray was supposed to watch MJ all the time to save him from himself?
-Chernoff states to take this case away from MJ, in a psych unit, and some patient kills himself, overdoses. If jury is going to hold Murray responsible, don't do it because it's MJ. This is not a reality show, it's reality, and it's how it affects a real person and the people who love him.
David Walgren Rebuttal Closing
-Walgren states that they are not on trial because the victim is MJ.
-Criminal gross negligence, giving propofol, which is known for respiratory depression, as a one man operation, no safety measures, nothing. Bizarre, unethical, unconscionable behavior that has never been seen before, and that is why Murray is on trial.
- Murray's patients who were witnesses had the benefit of a hospital, a team, monitors and were being treated for heart conditions, MJ did not have any of those benefits. MJ was being treated for insomnia that Murray knew nothing about.
-Walgren questions why the witnesses that were called who were Murray's patients were patients from over a decade ago. Walgren questions why none of Murray's current patients were called to testify.
Walgren: "Poor Conrad Murray. Everyone is just working against him." Defense blamed Elyssa Fleak, Alberto Alvarez, Shafer, AEG, Randy Phillips, Michael Amir Williams, Kai Chase. "Poor Conrad Murray." Walgren states that witness Mr. Ruben states that Murray was grieving, Walgren states that is because it's about Murray and nobody else.
Walgren states defense contends that Alvarez and Fleak are lying, Shafer is a cop, Kai Chase failed to get security, and "if allowed more time I'm sure they would find a way to blame Michael's son, Prince." Everyone is to blame except for Conrad Murray, according to defense. If Alvarez wanted to lie, he could have done a lot better than a bizarre story with an IV bag and propofol inside of it. Walgren states defense is claiming it's a conspiracy between LAPD, bodyguards, and others to pin this on Murray. Poor Conrad Murray. Everything Conrad Murray did in his treatment was bizarre. Waited 20 minutes to call 911, bizarre. Gave propofol in home setting for 60 days, bizarre. Lied to EMT's and UCLA doctors about giving propofol, bizarre. Is it surprising that Murray had some usual setup for the saline bag? Walgren states nobody knows, but that MJ was sensitive to getting all of the medical stuff cleaned up each day so the children did not see it. Everything Murray did was bizarre, and none of it was consistent with a trained competent medical doctor, who was putting his patient first.
Walgren states defense blames MJ, that Murray left him alone. MJ sought out propofol to sleep, but only one doctor said yes to administering it. Poor Conrad Murray. MJ is dead. Poor Conrad Murray. Nobody knows what it's like to walk in his shoes. Walgren: "You got that right. Because I haven't seen a doctor in this case that said they would ever do what Conrad Murray did. Ever. Including the defense experts."
Walgren states that defense closing arguments said nothing about Dr. White's testimony because it was junk science. Shafer on the other hand, did this pro bono, and showed true science to show how MJ died.
Walgren states that Murray had a legal duty to provide the standard of care for his patient, MJ. If Murray hadn't have left the room, this wouldn't have happened. If Murray had attached a monitoring system to MJ, this wouldn't have happened. If Murray knew how to effectively revive a patient, this wouldn't have happened. The law says that causation only be a natural and probable consequence. If you administer propofol in a bedroom, a natural and probable consequence is that there could be death. It's a respiratory depressant, it has unpredictable effects as both Shafer and White says, it's dependent on your fasting, how much food you ate, other drugs in the system, how dehydrated you are. It is entirely foreseeable and predicatable that death would occur. White, defense witness stated that if he had a patient that liked to push propofol, he would not leave him alone.
Walgren states that Alvarez could have easily made up easier lies. There's no evidence that Alvarez had any animosity toward Murray, thought he was a good doctor until MJ died. Alvarez nor Fleak have any position in this case, no reason to lie.
Walgren states that Shafer provided all graphs and data to the defense at their request. Shafer told the truth.
Walgren states MJ's fingerprints were not on the syringe. Alvarez fingerprints aren't on the saline bag. Conrad Murray's fingerprint is on the propofol bottle found in the saline bag.
Walgren asks the jury to evaluate the lies Murray told: Murray lied to Ortega, Gongaware, Phillips, Jorrie that MJ was in great health. Murray emailed Bob Taylor in London and lied about MJ's health. MJ lied to EMT's , to UCLA Dr. Cooper and Dr. Nguyen. Murray lied to Tim Lopez, about the propofol being shipped to his clinic rather than Nicole Alvarez apartment. Murray lied when he said he insisted on an autopsy, when he played no role in that whatsoever. Murray lied when he said he got a social group together for the family at UCLA, when it is UCLA protocol. Murray lied when he said he pulled Katherine Jackson aside and asked if there was anything he could do, she asked what happened, and he said he didn't know. Poor Conrad Murray.
Walgren states law is clear about causation. Defense theory does not fit causation. Murray said he knew MJ was dependent on propofol, Murray said MJ liked to push the drug, and Murray was the one who gave MJ the valium, midazolam, lorazepam and the propofol and abandoned Michael Jackson.
Walgren concedes that the People cannot prove exactly what happened behind the doors. But jury knows what happened every night, propofol being shipped, and that MJ died. It was a foreseeable and predictable consequence, and what is unusual is that MJ lived as long as he did receiving propofol in this setting.
Walgren states that if Murray was so concerned, why did he record Michael in his bedroom? This was supposed to be a relationship based on trust, and MJ clearly trusted Murray. Murray brought propofol into the house, administered, abandoned MJ, failed monitoring, failed to call 911, Murray is responsible. Murray is criminally negligent not because this is MJ, but because he behaved in a criminally negligent way. Murray was a substantial factor in MJ's death.
Walgren asks to jury to consider all evidence, and that he trusts that the jury will find that Murray was criminally negligent, because this was a pharmaceutical experiment in a bedroom. Walgren asks the jury to come back with the only right and true verdict in this case, and the only just verdict in this case. Walgren asks that the jury come back with a guilty verdict for the solitary count of involuntary manslaughter based on Murray's actions and his actions alone.
Afternoon Session
Ed Chernoff Closing arguments
- Walgren's argument is exactly why we have a jury trial in America.
- Walgren gave bits and pieces of statements from witnesses regarding propofol, rather than the whole context.
- Defense team has never stated that Conrad Murray did not make mistakes. But this case is not a medical board hearing or a civil lawsuit. For a crime to be proven, the prosecution has to show that Conrad Murray actually killed MJ. Prosecution must show criminal negligence, but also the specific act was the cause of death, otherwise this is not a crime.
- What defense believes is that Murray found MJ in distress, at 12 pm. The very first thing Murray did was try to revive MJ. At 11:51 Sade Anding received a phone call from Murray. From Anding's testimony defense believes she listened for about 2 minutes before hanging up. From 11:18 am until 12 noon, Murray was on the phone. If Murray had found MJ anywhere between 11:18 am and noon, the same thing would have happened that Sade Anding reported when she was on the phone with him (Murray would have dropped the phone and tried to revive MJ). Defense states that from 11:18 am to 12 noon, Murray never found MJ not breathing.
- The nature of propofol, is a 10 minute drug. The only way to keep propofol actually working after that is through an IV drip or IV injection. The prosecution spent 6 weeks trying to prove a drip theory, because the evidence proves that Murray injected propofol into MJ's IV prior to him leaving the room. The prosecution wants the jury to convict Conrad Murray for Michael Jackson's actions.
-Alberto Alvarez stated that he has had a hard time finding steady employment since MJ died, and that he was offered $500,000 for his story. Alvarez stated when he first talked to police, all he claimed he did was call 911. But when Alvarez spoke to police in August 2009, he then stated he comforted the children, he hid evidence for Murray and he comforted the children. The story became monumentally more compelling and valuable. Chernoff asks the jury if they honestly believe that Alberto Alvarez, after this trial is over, is not going to cash in on MJ's death story?
-Alvarez stated that he grabbed MJ's legs, Murray got MJ's shoulders and they took him and placed him on the floor. Alvarez stated that Murray asked him to take the IV bag off the stand and that there was a milky substance in the bag, but when tested there was nothing in the bag. Chernoff reminds the jury that the EMT's stated that they found MJ on the floor not the bed.
-The problem with prosecution theory starts with Alvarez inconsistencies, but moves on to Elyssa Fleak, and that she never mentioned a bottle in a bag originally. In the notes that she didn't destroy, there is no mention of a propofol bottle inside a cut IV bag, and there are no photos of it either. Fleak only mentions it 18 months later in testimony.
-Detective Smith, who Chernoff claims is a methodical, consummate professional, took notes of a smaller bottle of Lorazepam with an IV bag inside a bag fromt eh room where MJ died but did not remember seeing a vial of propofol inside a cut IV bag. Chernoff says that the reason Smith never saw it is because it never existed.
-April, 2011: Alvarez is interviewed by LAPD, and draws a picture of the IV bag. Chernoff states that the tubing, the IV bag, insinuating that LAPD coached Alvarez into drawing a bag that was similar to the bags the LAPD had at the interview. Chernoff states that the prosecution's theory was solidified then.
-Chernoff questions Dr. Shafer's testimony: stating that the IV tubing was hung to prove the prosecution's theory that Murray used an IV drip. Chernoff states that the short tubing used for testimony is used for an IV drip, the short tubing that Murray claims he used would be for IV injection. Chernoff states that Shafer testified he was wrong the next day, even though Murray's life is on the line. Chernoff states that the short tubing is proven to be used by Murray from medical records that show Murray ordered the short tubing only, and no long tubing, therefore showing that Murray did in fact, use an injection IV rather than a drip IV.
-Chernoff states that Dr. Shafer is a pharmacokineticist first and an anesthesiologist second. Chernoff stated that the prosecution turned Shafer into a cop, and that Shafer stated what he believed he happened as if it were true, but it's merely opinion.
-Chernoff on Dr. White: White is completely honest and said when needed, I don't have those qualifications to comment on certain testimony, but Shafer never said that. Chernoff states that White knows more about propofol than Shafer will ever, ever know. White just tried to tell the jury the truth, for $11,000. Chernoff states that Shafer gave simulations, one right after another, and none of them have anything to do with the case except for one, and that one is because the defense asked him to do it. Shafer showed a rapid bolus demonstration, when nobody from the defense ever asked him to do that. Shafer worked backwards on his theory (from concentration to dose), and when someone does that, there are a million different outcomes.
-MJ could not have died from what Murray admitted he did (25 mg injection to IV) and Shafer admitted that. Chernoff questions whether Shafer is a scientist or a prosecution advocate.
-Chernoff states that prosecution cannot prove a crime. When Chernoff asked Shafer about oral Lorazepam ingestion, Shafer stated that MJ's stomach held 1/300th of a tablet. Chernoff states that defense knows MJ orally ingested Lorazepam, and that's Shafer's exhibits are nothing representative of any proof, it represents nothing.
-Chernoff states that there are two reasonable scenarios about Lorazepam. First is MJ went into his bathroom and swallowed Lorazepam and Murray didn't know. Chernoff states that if this case were about anyone else, Murray wouldn't be on trial.
-Chernoff states that Murray's patients were willing to come to court and testify in front of cameras for him. People that know Murray believe that he could never have a disregard for human life as prosecution has claimed.
-Chernoff states that if Murray is such a liar, why did he tell LAPD he had been giving MJ propofol for 60 days straight?
-Definition of criminal negligence: prosecution has shown negligence, in many different respects. Three aspects of criminal negligence (as stated on jury instructions) #1 With the act (of propofol in a home), is it the direct cause of MJ's death, and #3, is it the natural probable consequence of the act (the death).
-Chernoff states that it's easy in hindsight to say that Murray is a lousy doctor, but the prosecution witness doctors have never walked in Murray's shoes. It's easy to judge when people have a miniscule amount of compassion, but do not question his motives. Murray's biggest personality defect is his also his greatest strength; he thought he could help MJ, he thought he could help him sleep. But Murray was wrong, he was a little fish in a big dirty pond.
-Chernoff states that Murray had no idea why when he came back in the room, MJ looked like he was dead. Chernoff states that Murray should not have been expected to call 911 first, but to try to revive the patient (MJ) first. Chernoff states that Dr. Steinberg stated that maybe two minutes for revival, after that, it's a felony not to call 911.
-Chernoff states that Murray injected MJ with Flumanezil, runs down and gets Kai Chase, and then says that Chase got Prince I (MJ's oldest son), not Murray.
-Chernoff states that Steinberg stated that Murray performed substandard CPR, but it's based on testimony that the compressions were done on the bed. Chernoff states that compressions with Murray's hand behind MJ's back, and one hand compressing MJ's chest is not a violation of standard of care. Chernoff states that the prosecution stated Murray deviated from care from the standard of care because he did not provide sufficient for MJ, but Chernoff states that an ambubag was on the floor. Chernoff states that every single thing Murray did, the prosecution claimed that it was a deviation from the standard of care.
-Chernoff states that the prosecution brought in MJ's kids to gain sympathy. He states that the prosecution brought in Nicole Alvarez for no reason. He states that the prosecution wants to paint a perfect villain and a perfect victim, but there are neither. Chernoff states that the only reason that the fact that Murray helped with the press release at the time of MJ's death was because the defense brought it into testimony.
-Chernoff states that it is believable that Murray wanted to back to MJ's house from the hospital the day MJ died because his car was there, and it was believable that he wanted to go eat. What is not believable is that Murray wanted to go back to the house to get some cream, that Amir Williams was so disturbed by that, that he locked the house down, but never mentioned it to the police.
-Chernoff plays the voicemail from Frank Dileo to Conrad Murray again (6/19/09 stating that MJ had an episode, he was sick and Murray should get a blood test on MJ)
-Chernoff states that MJ was under tremendous, abnormal, impossible pressure from AEG. Chernoff concedes that giving propofol in the home was not an appropriate thing to do. But Murray gave an uncontrolled substance, not Demerol, to MJ. Chernoff states that when Murray went home, the other life of MJ took over.
-Chernoff repeats Steinberg's testimony that Murray giving propofol to MJ was "like a baby on a countertop". Chernoff states that this was insulting MJ, as if MJ was a baby, couldn't make contracts for himself, couldn't raise his children for himself, because he was just a baby. Chernoff asks if Murray was supposed to watch MJ all the time to save him from himself?
-Chernoff states to take this case away from MJ, in a psych unit, and some patient kills himself, overdoses. If jury is going to hold Murray responsible, don't do it because it's MJ. This is not a reality show, it's reality, and it's how it affects a real person and the people who love him.
David Walgren Rebuttal Closing
-Walgren states that they are not on trial because the victim is MJ.
-Criminal gross negligence, giving propofol, which is known for respiratory depression, as a one man operation, no safety measures, nothing. Bizarre, unethical, unconscionable behavior that has never been seen before, and that is why Murray is on trial.
- Murray's patients who were witnesses had the benefit of a hospital, a team, monitors and were being treated for heart conditions, MJ did not have any of those benefits. MJ was being treated for insomnia that Murray knew nothing about.
-Walgren questions why the witnesses that were called who were Murray's patients were patients from over a decade ago. Walgren questions why none of Murray's current patients were called to testify.
Walgren: "Poor Conrad Murray. Everyone is just working against him." Defense blamed Elyssa Fleak, Alberto Alvarez, Shafer, AEG, Randy Phillips, Michael Amir Williams, Kai Chase. "Poor Conrad Murray." Walgren states that witness Mr. Ruben states that Murray was grieving, Walgren states that is because it's about Murray and nobody else.
Walgren states defense contends that Alvarez and Fleak are lying, Shafer is a cop, Kai Chase failed to get security, and "if allowed more time I'm sure they would find a way to blame Michael's son, Prince." Everyone is to blame except for Conrad Murray, according to defense. If Alvarez wanted to lie, he could have done a lot better than a bizarre story with an IV bag and propofol inside of it. Walgren states defense is claiming it's a conspiracy between LAPD, bodyguards, and others to pin this on Murray. Poor Conrad Murray. Everything Conrad Murray did in his treatment was bizarre. Waited 20 minutes to call 911, bizarre. Gave propofol in home setting for 60 days, bizarre. Lied to EMT's and UCLA doctors about giving propofol, bizarre. Is it surprising that Murray had some usual setup for the saline bag? Walgren states nobody knows, but that MJ was sensitive to getting all of the medical stuff cleaned up each day so the children did not see it. Everything Murray did was bizarre, and none of it was consistent with a trained competent medical doctor, who was putting his patient first.
Walgren states defense blames MJ, that Murray left him alone. MJ sought out propofol to sleep, but only one doctor said yes to administering it. Poor Conrad Murray. MJ is dead. Poor Conrad Murray. Nobody knows what it's like to walk in his shoes. Walgren: "You got that right. Because I haven't seen a doctor in this case that said they would ever do what Conrad Murray did. Ever. Including the defense experts."
Walgren states that defense closing arguments said nothing about Dr. White's testimony because it was junk science. Shafer on the other hand, did this pro bono, and showed true science to show how MJ died.
Walgren states that Murray had a legal duty to provide the standard of care for his patient, MJ. If Murray hadn't have left the room, this wouldn't have happened. If Murray had attached a monitoring system to MJ, this wouldn't have happened. If Murray knew how to effectively revive a patient, this wouldn't have happened. The law says that causation only be a natural and probable consequence. If you administer propofol in a bedroom, a natural and probable consequence is that there could be death. It's a respiratory depressant, it has unpredictable effects as both Shafer and White says, it's dependent on your fasting, how much food you ate, other drugs in the system, how dehydrated you are. It is entirely foreseeable and predicatable that death would occur. White, defense witness stated that if he had a patient that liked to push propofol, he would not leave him alone.
Walgren states that Alvarez could have easily made up easier lies. There's no evidence that Alvarez had any animosity toward Murray, thought he was a good doctor until MJ died. Alvarez nor Fleak have any position in this case, no reason to lie.
Walgren states that Shafer provided all graphs and data to the defense at their request. Shafer told the truth.
Walgren states MJ's fingerprints were not on the syringe. Alvarez fingerprints aren't on the saline bag. Conrad Murray's fingerprint is on the propofol bottle found in the saline bag.
Walgren asks the jury to evaluate the lies Murray told: Murray lied to Ortega, Gongaware, Phillips, Jorrie that MJ was in great health. Murray emailed Bob Taylor in London and lied about MJ's health. MJ lied to EMT's , to UCLA Dr. Cooper and Dr. Nguyen. Murray lied to Tim Lopez, about the propofol being shipped to his clinic rather than Nicole Alvarez apartment. Murray lied when he said he insisted on an autopsy, when he played no role in that whatsoever. Murray lied when he said he got a social group together for the family at UCLA, when it is UCLA protocol. Murray lied when he said he pulled Katherine Jackson aside and asked if there was anything he could do, she asked what happened, and he said he didn't know. Poor Conrad Murray.
Walgren states law is clear about causation. Defense theory does not fit causation. Murray said he knew MJ was dependent on propofol, Murray said MJ liked to push the drug, and Murray was the one who gave MJ the valium, midazolam, lorazepam and the propofol and abandoned Michael Jackson.
Walgren concedes that the People cannot prove exactly what happened behind the doors. But jury knows what happened every night, propofol being shipped, and that MJ died. It was a foreseeable and predictable consequence, and what is unusual is that MJ lived as long as he did receiving propofol in this setting.
Walgren states that if Murray was so concerned, why did he record Michael in his bedroom? This was supposed to be a relationship based on trust, and MJ clearly trusted Murray. Murray brought propofol into the house, administered, abandoned MJ, failed monitoring, failed to call 911, Murray is responsible. Murray is criminally negligent not because this is MJ, but because he behaved in a criminally negligent way. Murray was a substantial factor in MJ's death.
Walgren asks to jury to consider all evidence, and that he trusts that the jury will find that Murray was criminally negligent, because this was a pharmaceutical experiment in a bedroom. Walgren asks the jury to come back with the only right and true verdict in this case, and the only just verdict in this case. Walgren asks that the jury come back with a guilty verdict for the solitary count of involuntary manslaughter based on Murray's actions and his actions alone.
November 7 , 2011 Verdict Day
On the second day of deliberations and after deliberating for 8.5 hours jurors reached to a verdict of GUILTY in Conrad Murray trial. DA Walgren asked Conrad Murray to be remanded without bail. Judge Pastor citing that Murray was a danger to the public and he had contacts out of State of California remanded Conrad Murray without bail. Conrad Murray was handcuffed by Deputy Jones and later taken to prison awaiting sentencing. Sentencing hearing is set for November 29, 2011 8:30AM PST.
Video of the verdict
Picture of Conrad Murray being handcuffed
DA Press Conference
On the second day of deliberations and after deliberating for 8.5 hours jurors reached to a verdict of GUILTY in Conrad Murray trial. DA Walgren asked Conrad Murray to be remanded without bail. Judge Pastor citing that Murray was a danger to the public and he had contacts out of State of California remanded Conrad Murray without bail. Conrad Murray was handcuffed by Deputy Jones and later taken to prison awaiting sentencing. Sentencing hearing is set for November 29, 2011 8:30AM PST.
Video of the verdict
Picture of Conrad Murray being handcuffed
DA Press Conference