Cardiologist Testifies: Dr Murray Messed Up Big Time
Cardiologist -- Dr. Alon Steinberg Testifies
Updated 10/12/11 at 08:45 AM
Dr. Alon Steinberg -- one of the leading cardiologists for the California Medical Board -- just told the jury ... Dr. Conrad Murray demonstrated an "extreme deviation" from standard practices in his care for Michael Jackson.
* Dr. Steinberg made it clear he is a cardiologist not an anesthesiologist.
* Dr. Steinberg said he reviewed Murray's case relying solely on transcripts from his police interview because he wanted "to judge Dr. Murray on his very own words."
* Steinberg found 6 separate and distinct deviations of standard of care – each one amounting to gross negligence.
* Propofol should only be used for procedures in a hospital and should never be used for sleep.
* Steinberg said he's never heard of anyone using Propofol for sleep.
* Murray lacked basic equipment in case of an emergency.
* Steinberg says Murray had no idea what he was doing. What he should have done is used Flumazenil, an antidote to Propofol, call 911 and started bagging him, to give him air ... instead he started giving him chest compressions which he didn't need since his heart was still going.
* Another huge mistake -- Murray didn't call 911. Steinberg told jurors the first thing Murray should have done was call 911.
* When he does finally call for help, he calls MJ's assistant.
* Steinberg says that for every minute of delay there's less and less chance the patient will survive.
* Steinberg called Murray's behavior "bizarre."
* Another huge deviation ... Murray did not take notes. This is important not only for insurance and legal purposes but also to make sure everything is documented so that no mistakes are made. Not one single vital sign was written down. When he was at the emergency room he couldn't tell doctors when or what he administered.
* Steinberg told the jury, the breeches in care directly contributed to the untimely death of Michael Jackson, saying if these deviations hadn't happened, Mr. Jackson would still be alive."
* Steinberg said that even if we assume MJ did take the fatal dose, Murray still would have been responsible for MJ's death. He said leaving MJ alone in that room was like leaving a baby on a countertop.
Judge Pastor Just Broke from mid-morning break... back in 20.
http://www.tmz.com/2011/10/12/people-vs-dr-conrad-murray-cardiologist-testifies-michael-jackson/
L.A. NOW
Southern California -- this just in
Jackson would be alive if not for Conrad Murray, expert says
October 12, 2011 | 10:53 am
A cardiologist who reviewed Dr. Conrad Murray’s care of Michael Jackson for the California Medical Board testified Wednesday that the physician’s treatment was riddled with egregious deviations from standard of care that contributed directly to the singer’s death.
Alon Steinberg, a Ventura County cardiologist and medical board reviewer, told jurors at Murray’s involuntary manslaughter trial that even if Jackson had given himself the anesthetic that caused his death, the doctor would be just as guilty of giving substandard care. Murray’s attorneys have contended the singer gave himself the anesthetic propofol and a second sedative while his doctor wasn’t looking, killing himself instantly.
“We don’t give opportunity for a patient to self-administer,” Steinberg said.
“When you monitor a patient, you never leave their side, especially after giving propofol. It’s like leaving a baby that’s sleeping on your kitchen countertop,” he testified.
Steinberg rattled off a long list of factors that led him to conclude that Murray’s actions were an extreme departure from standard of care — treating insomnia with a surgical anesthetic, administering propofol without the necessary monitoring equipment, delaying calling 911 and making ineffective resuscitation efforts once Jackson had stopped breathing.
“It’s basic knowledge in America, you don’t have to be a healthcare professional, that when someone is down you need to call 911 for help,” Steinberg told jurors.
The doctor delayed calling for emergency help for at least 20 minutes when paramedics were only four minutes away, he noted.
“Every minute counts?” Deputy Dist. Atty. David Walgren asked.
"Every minute counts,” Steinberg responded.
Steinberg said were it not for the deviations in standard of care, Jackson would have lived.
Murray has been stripped of his license to practice in California.
Also on Wednesday, an attorney representing Murray told the judge that despite indications at earlier hearings, the doctor’s defense had reached the conclusion that propofol would not have an effect if taken orally and would not be making the argument that the singer might have drank the anesthetic.
“We are not going to assert at any point in time in this trial that Michael Jackson orally ingested propofol,” attorney Michael Flanagan said.
http://latimesblogs.latimes.com/lan...-if-not-for-dr-conrad-murray-expert-says.html
Conrad Murray’s care of Jackson gross negligence, witness says
October 12, 2011 | 2:01 pm
Michael Jackson could still have been saved after he stopped breathing if the doctor now charged in his death had properly called for help and taken steps to resuscitate him, a cardiologist testified Wednesday in Dr. Conrad Murray's involuntary manslaughter trial.
Dr. Alon Steinberg, who reviewed Murray's treatment of Jackson for the California Medical Board, agreed under questioning by a prosecutor that the physician's care amounted to gross negligence. Steinberg testified the doctor's interview with police led him to the opinion that Jackson was "savable" when Murray discovered the singer had stopped breathing after using the surgical anesthetic propofol in 2009.
During cross-examination by defense attorney Michael Flanagan, Steinberg said Murray's recollection that his patient had a pulse, a heart rate and was warm to the touch meant that Jackson could have been saved if the doctor had immediately called 911.
"It makes logical sense to call 911 if he doesn't have any of the appropriate equipment," Steinberg said.
One of the number of things that Murray failed to do, Steinberg said, was get his patient's written, informed consent before administering a powerful anesthetic in an unmonitored, risky setting. Any logical person, if informed of the risks, would have declined the drug, the witness said.
Flanagan asked, to much objection from a prosecutor, whether he was aware of Jackson's drug use or that he was a "habitual user" of the narcotic Demerol.
Jackson's brother, Randy, muttered from the audience: "That's not true."
The judge barred most of that line of questioning, but did allow the attorney to ask, "When you make these conclusions ... do you know specifically anything about Mr. Jackson's propensities toward drugs?"
"No," Steinberg responded.
Flanagan also asked the witness about a 2010 study in China on the successful use of propofol on patients with severe insomnia. Steinberg said that because the study had not been published when Murray was treating Jackson with propofol in early 2009, the doctor's use of the drug was unethical.
"He was basically doing primary research with no overview," he said.
http://latimesblogs.latimes.com/lan...of-jackson-gross-negligence-witness-says.html
Defense drops theory Michael Jackson drank propofol
By Alan Duke, CNN
October 12, 2011 -- Updated 2034 GMT (0434 HKT)
Los Angeles (CNN) -- Dr. Conrad Murray's defense team has dropped its theory that Michael Jackson may have orally ingested the surgical anesthetic propofol that the coroner says killed the pop icon, his lawyers told the court Wednesday.
Lawyers for Murray, who is on trial for involuntary manslaughter, will instead focus on the theory that Jackson used a syringe to inject the fatal overdose through a catheter on his left leg while Murray was away from his bedside.
Murray's defense also contends that Jackson swallowed eight tablets of lorazepam, a sedative, in a desperate search for sleep the day he died.
Also Wednesday, Dr. Alon Steinberg, a cardiologist called as an expert witness by the prosecution, listed six examples of gross negligence by Murray that he testified contributed to Jackson's death.
Doctor: Should have called 911 faster "If these deviations would not have happened, Mr. Jackson would be alive," Steinberg testified.
Murray's deviations from medical standards of care include the doctor leaving his patient alone with propofol and lorazepam nearby, Steinberg testified.
"It's like leaving a baby that's sleeping on your kitchen countertop," Steinberg said. "There's a very small chance the baby could fall over, or wake up and grab a knife or something."
The Los Angeles County coroner ruled that Jackson's June 25, 2009, death was from "acute propofol intoxication" in combination with several sedatives, including lorazepam.
Prosecutors argue that Murray is criminally responsible for Jackson's death because his use of propofol to treat the singer's insomnia was grossly negligent and an extreme deviation from the standard of care required of physicians.
Murray should be found guilty even if jurors accept the theory that Jackson self-administered the fatal dose because the doctor was reckless for leaving the drugs near his patient when he was not around, Steinberg testified Wednesday.
The possibility that Jackson drank propofol arose during Murray's preliminary hearing in January, when a prosecution expert agreed with the defense that a higher level of propofol in his stomach compared to his blood suggested it could have happened.
Both prosecution and defense experts conducted tests on animals since January's preliminary hearing on the "bio-availability" of propofol if consumed orally. Defense attorney Michael Flanagan agreed Wednesday that the studies showed "propofol, when orally ingested, is not bio-available."
Another study, conducted over the summer on university students in Chile, concluded "if you drink propofol, it will have trivial effects on the person," Deputy District Attorney David Walgren said.
"Oral propofol did not kill Michael Jackson," he said.
The defense, in a rare moment in the trial, agreed.
"We are not going to assert at any point in time that Michael Jackson orally ingested propofol," Flanagan said.
With about three days of defense testimony expected, closing arguments could be just a week away. Steinberg is the first of three experts who will wrap up the prosecution's case.
Steinberg said he based his conclusions on Murray's own words to detectives in an interview two days after Jackson's death. That interview was played for jurors in the previous two days of the trial.
Jackson would be alive today if Murray had called 911 for help within two minutes of realizing Jackson was not breathing, instead of waiting about 20 minutes before asking a security guard to call, Steinberg said.
Earlier testimony revealed Murray did ask Jackson's chef to send a security guard upstairs to help him about five minutes after the time prosecutors suggest he realized there was a problem with Jackson. The chef, however, testified that she sent Jackson's 12-year-old son upstairs instead of security.
Steinberg said the use of propofol to treat Jackson's insomnia was another extreme deviation from standards that contributed to Jackson's death. He later acknowledged a recent report that anesthetic had been successfully used to treat chronic insomnia, but he suggested it needed more study to be accepted.
Steinberg based his conclusions on his belief that Murray had connected Jackson to an IV drip of propofol after he gave him an injection of propofol. That assumption, he said, was made because Murray told police he had used such a drip on most previous nights.
When Flanagan challenged him to show where in Murray's police interview he said he used a drip the day Jackson died, he eventually said "I will agree with you, it's not completely clear."
Steinberg also said it was gross negligence that Murray was not prepared for an emergency, such as having a generator in case there was a power failure.
A sleep expert and an anesthesiologist are expected to follow Steinberg on the witness stand Wednesday and Thursday.
The pathologist who conducted the autopsy on Jackson testified Tuesday that while it was physically possible that Jackson could have given himself the overdose that killed him, Murray is still guilty of causing his death because he gave him access to the dangerous drugs.
Dr. Christopher Rogers said Murray's admission in a police interview that he used propofol to treat Jackson's insomnia was a factor in his conclusion that it was a homicide, not an accidental death.
He said Murray's use of propofol in Jackson's home without proper monitoring and resuscitation equipment or a "precision dosing device" contributed to the singer's propofol overdose and subsequent death.
"Essentially, the doctor would be estimating how much propofol he would be giving," Rogers testified. "I think it would be easy under those circumstances for the doctor to estimate wrong and give too much propofol."
Murray, in the interview played for the jury over the past two days of testimony, told detectives he gave Jackson a series of three sedatives -- Valium, lorazepam and midazolam -- over a 10-hour period before finally giving in to Jackson's plea for propofol.
"I've got to sleep, Dr. Conrad," Murray said Jackson pleaded to him. "I have these rehearsals to perform. I must be ready for the show in England. Tomorrow I will have to cancel my performance, because you know I cannot function if I don't get to sleep."
Murray said he injected a small dose of propofol using a syringe, but the prosecution contends he also used a makeshift IV setup to keep Jackson medicated and asleep. That drip may have malfunctioned while the doctor was not monitoring his patient, they contend.
The propofol bottle that prosecutors say Murray used for the IV drip had a slit in the rubber top, which Rogers said is evidence it was part of the drip system.
On the recording, Murray insisted he kept a close watch on Jackson after he finally fell asleep. The physician never mentioned the long list of e-mails and calls that cell phone records later revealed.
Rogers testified it was unlikely that Jackson self-administered the deadly dose of propofol in the two minutes Murray said he was away from him, but he conceded under defense questioning that it was physically possible.
Jackson could have reached the IV port near his left knee to self-inject propofol, he said. If Jackson pushed the drug in quickly, it could have made his heart stop immediately, Rogers said.
Rogers later added, under questioning by the prosecutor, that he would still consider it a homicide even if Jackson administered the fatal overdose to himself since the doctor would have been negligent in leaving the drugs nearby.
His testimony also gave some support to the defense theory that Jackson orally ingested an overdose of lorazepam from a pill bottle next to his bed.
A toxicology study of Jackson's stomach contents, conducted in recent months, showed a level of lorazepam four times higher in the stomach that in his blood.
"There would have to be some oral lorazepam taken somewhere along the line," Rogers testified, after taking a moment to do some quick math while on the witness stand.
Murray was hired as Jackson's personal physician while the singer prepared for his "This Is It" comeback concerts in London, planned to start in July 2009.
If convicted of involuntary manslaughter, Murray could spend four years in a California prison and lose his medical license.
http://edition.cnn.com/2011/10/12/justice/california-conrad-murray-trial/
