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Southern California -- this just in
Conrad Murray's care of Jackson unethical, expert testifies
Dr. Conrad Murray’s care for Michael Jackson leading up to his death was so inadequate that it violated the Hippocratic oath and fundamental ethics all doctors swear by, an expert reviewer for the Medical Board of California told jurors Wednesday.
Nader Kamangar, a physician specializing in pulmonary critical care and sleep medicine, said at Murray's involuntary manslaughter trial that administering the potent anesthetic propofol outside a hospital setting was “inconceivable.”
Kamangar concluded in a report for the medical board that Murray’s conduct involved several extreme deviations from the appropriate standard of care.
“It’s imperative for the physician to be observing the patient at all times; this is just the basics of medicine,” said Kamangar, an associate professor and a physician for UCLA. “In this case it was clear there was a period of time when Mr. Jackson was basically left alone and was not being monitored. That in somebody that is receiving sedation is really not acceptable.”
Kamangar echoed the opinions of a cardiologist who testified earlier in the day that Murray’s delay in calling 911 and ineffective CPR were egregious violations that harmed his patient.
He also said the first thing the doctor should have done was not chest compressions -- given that Jackson still had a pulse -- but trying to help Jackson breath.
“When a patient is found out of the hospital in cardiopulmonary arrest ... the first rule of thumb in basic life support is to call for help,” he said.
Kamangar said the CPR that Murray performed -- on a soft surface with one hand -- could have been a “disservice” to his patient.
October 12, 2011 | 3:40 pm
http://latimesblogs.latimes.com/lan...re-of-jackson-unethical-expert-testifies.html
Murray's defense shifts strategies
Attorneys tell the judge they will no longer argue that Michael Jackson orally ingested propofol, saying the theory isn't supported by science.
By Victoria Kim, Los Angeles Times
October 13, 2011
Attorneys for Conrad Murray have long argued that Michael Jackson gave himself the lethal dose of a surgical anesthetic. But on Wednesday, they acknowledged that one scenario they had previously suggested is not supported by science.
Murray's attorneys told a judge in court, outside the jury's presence, that they would no longer argue that Jackson could have drunk the anesthetic propofol. That is a change in course from what they had argued at earlier hearings: that the singer's stomach contents strongly suggested that he swallowed the drug.
After consulting medical experts and commissioning an animal study, the defense announced it had ruled out that scenario.
"We are not going to assert at any point in time in this trial that Michael Jackson orally ingested propofol," attorney J. Michael Flanagan said.
That leaves Murray's defense attorneys with the other theory they had proposed — that Jackson injected himself with the propofol and swallowed another sedative when his doctor wasn't looking. As a result, they argue, Murray cannot be held responsible for the pop star's death.
"We believe the evidence will show you, the scientific evidence, that when Dr. Murray left the room, Michael Jackson self-administered a dose of propofol that with the lorazepam created a perfect storm in his body that killed him instantly," attorney Ed Chernoff told jurors during opening statements last month.
Two medical experts who reviewed Murray's care of Jackson for the California Medical Board said Wednesday that whether or not Jackson gave himself the fatal dose, the doctor was still guilty of egregious violations of standard medical care and responsible for his patient's death.
Cardiologist Alon Steinberg and pulmonary and critical care physician Nader Kamangar both testified that leaving Jackson in a situation in which he could give himself the drug was unacceptable practice on the doctor's part.
"We don't give opportunity for a patient to self-administer," said Steinberg, a Ventura County physician. "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."
Steinberg rattled off a long list of factors that led him to conclude that Murray's actions were an extreme deviation from standard medical care — treating insomnia with a surgical anesthetic, administering propofol without the necessary monitoring equipment, delaying calling 911 and making ineffective efforts at resuscitation once Jackson had stopped breathing.
"If these deviations were not to have happened, Mr. Jackson would have been alive," Steinberg said.
Flanagan asked, to much objection from a prosecutor, whether Steinberg was aware of Jackson's drug use or that he was a "habitual user" of the narcotic Demerol. 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.
Kamangar, an associate professor at UCLA who is also a specialist in sleep medicine, said that for Murray to have given the potent anesthetic to treat insomnia was "inconceivable."
"It's kind of beyond a departure of standard of care to something that we would never even fathom doing," he testified.
Echoing Steinberg and a coroner's medical examiner who testified before him, Kamangar offered the opinion that had Jackson given himself the propofol, Murray would be just as culpable.
"In either scenario, Conrad Murray played a direct role in causing Michael Jackson's death, those are your findings? Even under a scenario put forth by the defense that Mr. Jackson self-administered … that the risk of that happening should have been a foreseeable thing?" Deputy Dist. Atty. David Walgren asked.
"Oh absolutely," Kamangar replied.
http://www.latimes.com/news/local/la-me-conrad-murray-20111013,0,3651620.story
Experts focusing on Jackson doctor's missteps
ANTHONY McCARTNEY, AP Entertainment Writer
Updated 04:43 a.m., Thursday, October 13, 2011
LOS ANGELES (AP) — Experts repeatedly told jurors that Michael Jackson's doctor acted with "gross negligence" throughout his treatment of the pop superstar, a theme that will likely be repeated as prosecutors near the end of their involuntary manslaughter case against the physician.
The conclusion of the prosecution's case, which may come on Thursday but more likely will extend into next week, brings defense lawyers a step closer to revealing how they will counter damaging evidence presented through more than 30 witnesses so far. The defense case shifted Wednesday when a lawyer for Dr. Conrad Murray revealed he was abandoning the theory that Jackson swallowed the fatal dose of the anesthetic propofol.
The Houston-based cardiologist has pleaded not guilty, and his lawyers have repeatedly told jurors they will show Jackson self-administered either the anesthetic or the sedative lorazepam without Murray's knowledge. They had invested months before the trial on the theory that Jackson somehow drank propofol and caused his own death.
Defense lawyer J. Michael Flanagan stunned a judge and prosecutors before testimony resumed Wednesday that the results of a study he commissioned confirmed that if Jackson swallowed the anesthetic, its effects would be "trivial" and the issue wouldn't be raised with jurors.
Murray's lawyers may still argue that Jackson gave himself the fatal dose of the drugs, but a pair of experts told jurors that even if that happened, it didn't change that Murray went far astray from medical norms.
The experts, a cardiologist and a sleep expert who both practice emergency medicine, said Murray should have never been giving Jackson propofol as a sleep aid.
"It's beyond a departure from the standard of care into something unfathomable," said, Dr. Nader Kamanger, a UCLA sleep expert.
Kamanger said that even if Jackson did somehow give himself the fatal dose of a drug, Murray would still be at fault.
"Here you have a patient that may potentially have a substance abuse problem," Kamanger said. "It sounds like he had a substance abuse problem," the doctor said, noting that Murray left the singer alone in his bedroom on June 25, 2009 with a variety of drugs readily available.
Jackson's death, he said, was "a foreseeable complication."
Both Kamanger and Dr. Alon Steinberg, a cardiologist, said Murray's admission that he didn't call 911 for at least 20 minutes and his ineffectual resuscitation efforts left Jackson with little chance for survival.
"Every minute counts," Steinberg said, adding that even a five-minute delay in calling could be the difference between life and death. He called Murray's behavior "strange" and along with Kamanger criticized the cardiologist for trying to perform CPR on Jackson's bed rather than a hard surface.
Kamanger and Steinberg each listed multiple reasons for why they felt Murray acted with "gross negligence" while acting as Jackson's personal physician as the singer prepared for a series of comeback concerts in 2009. Steinberg noted that Murray lacked sophisticated medical equipment that is present in hospital settings where propofol is supposed to be administered.
Kamanger said there was no evidence that Murray attempted to diagnose the underlying reasons why Jackson couldn't sleep and was giving the singer sedatives that were addictive.
Kamanger will undergo cross-examination when court resumes on Thursday. Prosecutors are expected to conclude their portion of the case by calling anesthesiology professor and researcher Dr. Steven Shafer, who is a leading expert on propofol.
Defense lawyers will likely call several witnesses and are relying on another anesthesiologist, Dr. Paul White, to try to counter the prosecution experts. White sat in the courtroom Wednesday, occasionally conferring with Flanagan and Murray's other defense attorneys.
The cardiologist faces up to four years behind bars and the loss of his medical license if convicted.
AP Special Correspondent Linda Deutsch contributed to this report
http://www.timesunion.com/news/article/Experts-focusing-on-Jackson-doctor-s-missteps-2215066.php
Propofol expert testifies next in trial of Michael Jackson's doctor
By Alan Duke, CNN
October 13, 2011 -- Updated 0903 GMT (1703 HKT)
Los Angeles (CNN) -- An anesthesiologist will testify Thursday that Dr. Conrad Murray's treatment of Michael Jackson was so grossly negligent that it was criminal, an opinion that echoes two other medical experts called to testify by prosecutors Wednesday.
Dr. Steven Shafer, who may be the last witness called before the prosecution rests its case in Murray's involuntary manslaughter trial, is expected to echo the testimony of a cardiologist and a sleep expert who took the stand Wednesday.
Murray's delay in calling 911 for help as soon as he realized Jackson was not breathing may have cost the pop icon his life, according to cardiologist Dr. Alon Steinberg.
Steinberg and Dr. Nader Kamangar, a UCLA sleep expert, both presented a long list of what they said were instances of Murray's extreme deviation from the standards of medical care, including his failure to immediately call for paramedics.
"If these deviations would not have happened, Mr. Jackson would be alive," Steinberg testified.
Murray's lawyers contend that Jackson used a syringe to inject the fatal overdose through a catheter on his left leg while Murray was away from his bedside. They dropped the theory pushed earlier that Jackson may have orally ingested propofol that the coroner says killed him.
Murray's defense also contends that Jackson swallowed eight tablets of lorazepam, a sedative, in a desperate search for sleep the day he died.
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 propofol and lorazepam near his patient when he was not around, 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."
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 from China that the anesthetic had been successfully used to treat chronic insomnia, but he suggested it needed more study to be accepted.
Kamangar, the sleep expert, testified later Wednesday that propofol has no therapeutic value in treating insomnia, and to use it is unethical and an extreme deviation from the standards of care.
"It is beyond comprehension," Kamangar said. "It is frankly disturbing,"
Steinberg said he 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.
Murray 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 prosecution has been unable to produce the tubing that would be a critical piece of an IV system, although they did show jurors an opened saline bag into which they contend Murray placed an opened propofol bottle.
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.
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/2011/10/13/justice/california-conrad-murray-trial/?hpt=ju_c2
Southern California -- this just in
Conrad Murray's care of Jackson unethical, expert testifies
Dr. Conrad Murray’s care for Michael Jackson leading up to his death was so inadequate that it violated the Hippocratic oath and fundamental ethics all doctors swear by, an expert reviewer for the Medical Board of California told jurors Wednesday.
Nader Kamangar, a physician specializing in pulmonary critical care and sleep medicine, said at Murray's involuntary manslaughter trial that administering the potent anesthetic propofol outside a hospital setting was “inconceivable.”
Kamangar concluded in a report for the medical board that Murray’s conduct involved several extreme deviations from the appropriate standard of care.
“It’s imperative for the physician to be observing the patient at all times; this is just the basics of medicine,” said Kamangar, an associate professor and a physician for UCLA. “In this case it was clear there was a period of time when Mr. Jackson was basically left alone and was not being monitored. That in somebody that is receiving sedation is really not acceptable.”
Kamangar echoed the opinions of a cardiologist who testified earlier in the day that Murray’s delay in calling 911 and ineffective CPR were egregious violations that harmed his patient.
He also said the first thing the doctor should have done was not chest compressions -- given that Jackson still had a pulse -- but trying to help Jackson breath.
“When a patient is found out of the hospital in cardiopulmonary arrest ... the first rule of thumb in basic life support is to call for help,” he said.
Kamangar said the CPR that Murray performed -- on a soft surface with one hand -- could have been a “disservice” to his patient.
October 12, 2011 | 3:40 pm
http://latimesblogs.latimes.com/lan...re-of-jackson-unethical-expert-testifies.html
Murray's defense shifts strategies
Attorneys tell the judge they will no longer argue that Michael Jackson orally ingested propofol, saying the theory isn't supported by science.
By Victoria Kim, Los Angeles Times
October 13, 2011
Attorneys for Conrad Murray have long argued that Michael Jackson gave himself the lethal dose of a surgical anesthetic. But on Wednesday, they acknowledged that one scenario they had previously suggested is not supported by science.
Murray's attorneys told a judge in court, outside the jury's presence, that they would no longer argue that Jackson could have drunk the anesthetic propofol. That is a change in course from what they had argued at earlier hearings: that the singer's stomach contents strongly suggested that he swallowed the drug.
After consulting medical experts and commissioning an animal study, the defense announced it had ruled out that scenario.
"We are not going to assert at any point in time in this trial that Michael Jackson orally ingested propofol," attorney J. Michael Flanagan said.
That leaves Murray's defense attorneys with the other theory they had proposed — that Jackson injected himself with the propofol and swallowed another sedative when his doctor wasn't looking. As a result, they argue, Murray cannot be held responsible for the pop star's death.
"We believe the evidence will show you, the scientific evidence, that when Dr. Murray left the room, Michael Jackson self-administered a dose of propofol that with the lorazepam created a perfect storm in his body that killed him instantly," attorney Ed Chernoff told jurors during opening statements last month.
Two medical experts who reviewed Murray's care of Jackson for the California Medical Board said Wednesday that whether or not Jackson gave himself the fatal dose, the doctor was still guilty of egregious violations of standard medical care and responsible for his patient's death.
Cardiologist Alon Steinberg and pulmonary and critical care physician Nader Kamangar both testified that leaving Jackson in a situation in which he could give himself the drug was unacceptable practice on the doctor's part.
"We don't give opportunity for a patient to self-administer," said Steinberg, a Ventura County physician. "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."
Steinberg rattled off a long list of factors that led him to conclude that Murray's actions were an extreme deviation from standard medical care — treating insomnia with a surgical anesthetic, administering propofol without the necessary monitoring equipment, delaying calling 911 and making ineffective efforts at resuscitation once Jackson had stopped breathing.
"If these deviations were not to have happened, Mr. Jackson would have been alive," Steinberg said.
Flanagan asked, to much objection from a prosecutor, whether Steinberg was aware of Jackson's drug use or that he was a "habitual user" of the narcotic Demerol. 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.
Kamangar, an associate professor at UCLA who is also a specialist in sleep medicine, said that for Murray to have given the potent anesthetic to treat insomnia was "inconceivable."
"It's kind of beyond a departure of standard of care to something that we would never even fathom doing," he testified.
Echoing Steinberg and a coroner's medical examiner who testified before him, Kamangar offered the opinion that had Jackson given himself the propofol, Murray would be just as culpable.
"In either scenario, Conrad Murray played a direct role in causing Michael Jackson's death, those are your findings? Even under a scenario put forth by the defense that Mr. Jackson self-administered … that the risk of that happening should have been a foreseeable thing?" Deputy Dist. Atty. David Walgren asked.
"Oh absolutely," Kamangar replied.
http://www.latimes.com/news/local/la-me-conrad-murray-20111013,0,3651620.story
Experts focusing on Jackson doctor's missteps
ANTHONY McCARTNEY, AP Entertainment Writer
Updated 04:43 a.m., Thursday, October 13, 2011
LOS ANGELES (AP) — Experts repeatedly told jurors that Michael Jackson's doctor acted with "gross negligence" throughout his treatment of the pop superstar, a theme that will likely be repeated as prosecutors near the end of their involuntary manslaughter case against the physician.
The conclusion of the prosecution's case, which may come on Thursday but more likely will extend into next week, brings defense lawyers a step closer to revealing how they will counter damaging evidence presented through more than 30 witnesses so far. The defense case shifted Wednesday when a lawyer for Dr. Conrad Murray revealed he was abandoning the theory that Jackson swallowed the fatal dose of the anesthetic propofol.
The Houston-based cardiologist has pleaded not guilty, and his lawyers have repeatedly told jurors they will show Jackson self-administered either the anesthetic or the sedative lorazepam without Murray's knowledge. They had invested months before the trial on the theory that Jackson somehow drank propofol and caused his own death.
Defense lawyer J. Michael Flanagan stunned a judge and prosecutors before testimony resumed Wednesday that the results of a study he commissioned confirmed that if Jackson swallowed the anesthetic, its effects would be "trivial" and the issue wouldn't be raised with jurors.
Murray's lawyers may still argue that Jackson gave himself the fatal dose of the drugs, but a pair of experts told jurors that even if that happened, it didn't change that Murray went far astray from medical norms.
The experts, a cardiologist and a sleep expert who both practice emergency medicine, said Murray should have never been giving Jackson propofol as a sleep aid.
"It's beyond a departure from the standard of care into something unfathomable," said, Dr. Nader Kamanger, a UCLA sleep expert.
Kamanger said that even if Jackson did somehow give himself the fatal dose of a drug, Murray would still be at fault.
"Here you have a patient that may potentially have a substance abuse problem," Kamanger said. "It sounds like he had a substance abuse problem," the doctor said, noting that Murray left the singer alone in his bedroom on June 25, 2009 with a variety of drugs readily available.
Jackson's death, he said, was "a foreseeable complication."
Both Kamanger and Dr. Alon Steinberg, a cardiologist, said Murray's admission that he didn't call 911 for at least 20 minutes and his ineffectual resuscitation efforts left Jackson with little chance for survival.
"Every minute counts," Steinberg said, adding that even a five-minute delay in calling could be the difference between life and death. He called Murray's behavior "strange" and along with Kamanger criticized the cardiologist for trying to perform CPR on Jackson's bed rather than a hard surface.
Kamanger and Steinberg each listed multiple reasons for why they felt Murray acted with "gross negligence" while acting as Jackson's personal physician as the singer prepared for a series of comeback concerts in 2009. Steinberg noted that Murray lacked sophisticated medical equipment that is present in hospital settings where propofol is supposed to be administered.
Kamanger said there was no evidence that Murray attempted to diagnose the underlying reasons why Jackson couldn't sleep and was giving the singer sedatives that were addictive.
Kamanger will undergo cross-examination when court resumes on Thursday. Prosecutors are expected to conclude their portion of the case by calling anesthesiology professor and researcher Dr. Steven Shafer, who is a leading expert on propofol.
Defense lawyers will likely call several witnesses and are relying on another anesthesiologist, Dr. Paul White, to try to counter the prosecution experts. White sat in the courtroom Wednesday, occasionally conferring with Flanagan and Murray's other defense attorneys.
The cardiologist faces up to four years behind bars and the loss of his medical license if convicted.
AP Special Correspondent Linda Deutsch contributed to this report
http://www.timesunion.com/news/article/Experts-focusing-on-Jackson-doctor-s-missteps-2215066.php
Propofol expert testifies next in trial of Michael Jackson's doctor
By Alan Duke, CNN
October 13, 2011 -- Updated 0903 GMT (1703 HKT)
Los Angeles (CNN) -- An anesthesiologist will testify Thursday that Dr. Conrad Murray's treatment of Michael Jackson was so grossly negligent that it was criminal, an opinion that echoes two other medical experts called to testify by prosecutors Wednesday.
Dr. Steven Shafer, who may be the last witness called before the prosecution rests its case in Murray's involuntary manslaughter trial, is expected to echo the testimony of a cardiologist and a sleep expert who took the stand Wednesday.
Murray's delay in calling 911 for help as soon as he realized Jackson was not breathing may have cost the pop icon his life, according to cardiologist Dr. Alon Steinberg.
Steinberg and Dr. Nader Kamangar, a UCLA sleep expert, both presented a long list of what they said were instances of Murray's extreme deviation from the standards of medical care, including his failure to immediately call for paramedics.
"If these deviations would not have happened, Mr. Jackson would be alive," Steinberg testified.
Murray's lawyers contend that Jackson used a syringe to inject the fatal overdose through a catheter on his left leg while Murray was away from his bedside. They dropped the theory pushed earlier that Jackson may have orally ingested propofol that the coroner says killed him.
Murray's defense also contends that Jackson swallowed eight tablets of lorazepam, a sedative, in a desperate search for sleep the day he died.
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 propofol and lorazepam near his patient when he was not around, 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."
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 from China that the anesthetic had been successfully used to treat chronic insomnia, but he suggested it needed more study to be accepted.
Kamangar, the sleep expert, testified later Wednesday that propofol has no therapeutic value in treating insomnia, and to use it is unethical and an extreme deviation from the standards of care.
"It is beyond comprehension," Kamangar said. "It is frankly disturbing,"
Steinberg said he 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.
Murray 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 prosecution has been unable to produce the tubing that would be a critical piece of an IV system, although they did show jurors an opened saline bag into which they contend Murray placed an opened propofol bottle.
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.
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/2011/10/13/justice/california-conrad-murray-trial/?hpt=ju_c2
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