Dr Safer
Walgren
IV set up demonstration ; dr Shafer has brought the same equipment or equivalent as what CM used (based on Sea Coast reports, and equipment found at MJ's house) :
bag of saline , hangs it on IV pole
infusion set (tubing), stick the spike into the saline bag
in the infusion set, there's an injection port with a rubber stopper where you can stick a needle, to give medication.
Dr Shafer is aware that there was no propofol in the long tube, only in the short tube below the y connector, that makes sense to him.
22 gage catheter (type and size that was used on MJ) : has a metal needle, the catheter remains in the vein, the needle doesn't.
Dr Shafer attaches the catheter to the tubing and shows that the fluid goes through quickly
A non vented system is an Iv tubing where there is no way to introduce air (there is no need for a vented tubing with the saline, as the saline bag will shrink)
It is not a complete set up for an infusion of propofol, you would need another long tubing, vented (that would allow air to come up)
CM bought vented infusion sets , cf Sea Coast records
Dr Shafer shows a vented infusion set, similar to what CM bought; it has a hole on the top near the chamber to allow air to come in.
This tubing was designed to be used with an infusion pump, but there was no pump
The spike of this tubing would have been stuck into the bottle, consistent with the tear in the propofol bottle found at Mjs house
Sticks the spike into a bottle of propofol, hangs it on the pole with a sort of plastic handle. Propofol found at Mjs house had the same plastic handle.
Stipulation : the handle of the bottle was lifted for demonstration, when it was found, it was still attached to the bottle, unused;
CM said he turned off the saline before infusing propofol with a syringe: Dr Shafer shows the clamp, and shows how you can stop the flow with the clamp.
Infusing 25mg of propofol with a syringe as CM said he did : Dr Shafer sticks a syringe with propofol into the injection port , or y connector. What happens is that the propofol doesn't come out of the tube, because the saline is turned off. The saline is not coming down to push the propofol out. So CM's description of 3 to 5 minutes is not possible if he had turned off the saline as he said. If you unclamp the saline, the propofol comes out.
Puts the tube with the spike into the propofol bottle : dr shafer closes the vent, and closes everything, a little propofol comes out, but it stops. If you open the vent, the propofol runs though. Now he can hook the vented line with a needle to the y connector. Dr Shafer says it's an extremely unsafe setup, gravity rules, there is «*gravity competition*» between the two bags : if you lift a bag, there is more force in this bag, the other slows down. If the saline stops , propofol speeds up. The only way to control the speed is the clamps, there is one on each tube.
Slit bag : in case CM didn't know there was a handle or didn't want to use it. Dr Shafer has never seen it done, but demonstrates that it's possible; and says it doesn't make a difference;
From this point, the clamp is the only thing you have to control the speed of the propofol.
Thats why the long tubing found at the house didn't test positive for propofol, but the short tubing did : another long tube was connected to the popofol bottle.
If you change the rate of saline, it changes the rate of the propofol. That's why this system is very dangerous.
Says something about the tube wide tube/narrow tube, i didn't catch it, sorry
Dr Shafer has dissmantled the long vented tubing that had propofol in it , it fits in the hand. This tubing is a large one because of infusion pump device , the tubing would fit in the pocket.
Walgren does a recap of Dr Shafer's testimony s far :
Noted 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, simulated the IV set up , and that the infusion line could be compacted in one hand;
CM was the direct cause of MJ's death even if MJ had self injected and swallowed lorazepam . CM still would be the direct cause of MJ's death : CM brought propofol, CM started the IV line, left access to the medication to a patient who was probably dependent on benzos, CM was entrusted by MJ for his safety. CM is responsible fr every drop of propofol or lorazepam.
Recess until tomorrow 12 45 LA time
