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Murray Trial - 12 October - Day 11 - Discussion

Insomnia is a problem that is often secondary... insomnia is associated with underlying diseases like substance abuse, pshychological etc etc

therefore most important is to get a DETAILED medical history of the patient...
 
Insomnia is very often a problem that is secondary to another disease, co morbidity:
underline medical disease
psychological problems
substance abuse
as well as certain sleep disorders

The most important part is to get a complete history. The duty is to exclude secondary causes, before ruling it a primary insomnia.
 
General info on insomnia: unrestful sleep over a period of 4 weeks, or longer, broken afterward in patterns:
problems falling asleep
problems with sleep maintenance.

The underlying conditions must be ruled out (even environnemental causes such as a room which is lit)
 
Another good witness! Also knows his stuff. Currently talking about the different types of insomnia.
 
General patient history information: when did they go to sleep, what time do they wake up, at what time, what medications were part of the history. A sleep diary/log really helps the diagnosis. Were there strenuos circumstances, stress, he jokes about not sleeping last night because he was coming to testify; anxiety and depression; sleep apnea. Seeing how much daytime sleep the patients have; limb movement disorders.
 
He had patients that took pills for migraines that contained caffeine and they didn't know, so it's important to rule out medications from OTC but also prescribed and illegal, methamphetamines and such.
 
A physical exam is also important - patients with asthma or with congestive heart failure, the ones with diabetes who wake up early to urinate, as well as bladder problems or enlarged prostate.
 
If he had suspicions or knowledge that the patient was not candid, he wouldn't do urine test for basic drug testing. He would also not want to move forward and treat the patient .
 
again talks about importance with medical history and be able to root out underlying problems before treating ppl with insomnia

about other doctors.. if the patient wont tell u if he/she is seeing other doctors, as a doc you should try to find out if your patient is seeing other docs... if the patient doesnt wanna tell u etc then u shoul refuse to treat the patient

u shld try to get every detail and every single medical record
 
If he does find an underlying condition, the next step would be to treat that problem. Gives various problems, treat asthma to control wheezing or if it's an environnemental, sleeping in the wrong place or with his kids.

CM acted with gross negligence. To treat insomnia without ruling out secondary causes and dealing with the root problem is key before starting to treat patients.

CM knew there were other doctors and stated that he saw IV marks - if the patient does not provide info and the doctor is suspicious, he should try and obtain more information, and if he fails, he should simply refuse treatment.
 
The patient's past is so pertinent, so ignoring it is really unethical.

So in going directly to infusing these dangerous substances extreme and unethical violation of standard of care? Yes, there were secondary issues to be addressed.
 
He talks about CBT (cognitive behavioral therapy), patients that have primary insomnia have this fear of going to sleep because they just can't do it, but there are many CBT techniques that deal with that fear. CBT also treats secondary insomnia.

Jumped to sleep hygiene, controlling stimuli - making sure that people go in their bed only to sleep.
 
Sleep restriction - patients who spend a lot of time in bed, they limit the amount of time in bed; relaxation therapies; biofeedback.

This goes to show that there were a lot of techniques that work better than pharmacological therapies.
 
I wonder what cm is thinking as he hears all of this...he should just give up his license and go fishing.
 
Does he have info that a behavior approach was taken in the case of Mr Jackson? No.

There are 8 standard agents that are FDA approved in the treatment of insomnia, one is benzodiazepines. From that group, there is also a sub group that is non benzodiazepine such as Ambien, newer drugs.

Melatonin derived drugs can be used for a long time, since the potential addictive is less.
 
I feel sorry for the transcriber having to type all this medical jargon and medicines he's naming..

4 drugs FDA approved for insomnia - all in oral form not intravenous, are other drugs for treating underlying cause, should use least amount of drugs
 
I like this guy. He is explaining very well and looking at the jury like having a conversation. The first witness seemed to do that too from the footage I have seen awhile ago.
 
Lists the benzos approved; it's a small list. There are also other benzos, but there are used to treat an underlying condition. They should be used for a short time.

Are the FDA approved drugs in oral form? yes.

Is he aware that CM was treating with IV administration? Yes.
 
Is it appropriate to treat insomnia with IV? No.

Oral Lorazepam can be used for short term basis, for patients that have psychiatric problems, but it's a highly addictive drug. There could be problems if administered for more than 3-4 weeks.
 
Lorazepam and Midazolam - extreme deviation from standard of care, particularly via IV.

Propofol has NO role for the treatment of insomnia. It's inconceivable.
 
"...it is beyond comprehension, it is extremely disturbing" - if one takes a step back and looks at the situation it's inconceivable and unethical. It's beyond any standard of care, any reasonable person would not do that.
 
says lorazepam and other benzos should only be used for a short time treatment (up to 3 weeks?) as it's highly addictive, and to treat insomnia with lorazepam through an iv is not acceptable
 
...failing to monitor, abandoning his patient, delaying to call 911 - list of motives, hopefully Bouee will list them all.

Here we have a patient who might of have had substance abuse problems, and putting potent drugs in the system, what happened was very foreseeable.
 
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