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Murray Trial- Day 15 -October 21st

xthunderx2 said:
but these things the loraz and the diaz are benzo's and not opiates,,,right? So they didnt test the brain at all for the concentrations of the benzo's and the prop? Sorry I am not very knowledgeable when it comes to these kinds of drugs,,,I just know what to much of them can do to you, and that is what they did to Michael.
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You have to remember in the weeks following Michael's death everyone claimed he was addicted to opiates, not benzos. Even when all the benzos were found at his house the general narrative was that Michael was addicted or withdrawing from opiates abused. As far as I know, benzos doesn't have the same chemical draining effects as opiates because people who take benzos usually don't take them to get high. It's usually the opposite.

As for testing the brain levels for propofol, I think this happened because the corona didn't think it was necessary. Until now, most if not all of us thought the blood level was the most important thing. Even so, however, that doesn't change the fact that all of Sheffer's test on the blood doesn't match self-injection or one shot. What Cheffon is arguing isn't really important in the grand scheme of things.
 
Dr Shafer

Chernoff :

shows the Astra Zeneca graph : the data was collected by Julianna Barr, Dr Shafer was Principal Investigator. At that time he was an assistant professor at Stanford. When he did the graph, he was a fellow of Dr Stanski (sp). A fellow is a student , it was a fellowship in pharmacology in anesthesia.

Chernoff If the data is not correct, graph and modelling can not be correct ? Yes, they can't be correct.

Chernoff wants to talk abut other studies Dr Shafer did :

propofol pharmacokinetics on children : was not PI. Did all of the analysis and the modelling

propofol and 2 other drugs : was Pi for the propofol study. Did human studies fo this paper

inhalation vs IV anesthesia : this paper fictitious debate, dr White chose Dr white as a fictional participant of the debate, because dr White is prominently associated with propofol

2 book chapers that he wrote : shows that Dr Shafer worked with DR White abOut intravenous anesthesia. Participated in the study at the request of dr White; Dr Shafer considers the books books are high quality books, but not authoritative; Athoritative woud be an original study. Dr White wrote the chapter on propofol.

Dr Shafer has known Dr White for 30 years., in 2009 dr Shafer nominated dr White for a award

Chernoff : when you were asked about White's alledged statement you said were disappointed : Dr Shafer : I was dispointed .

Chernoff : You know this trial is on TV ? Shown on an international level ? Objection sustained.

Chernoff : yoou said 1st pass effect was a first year student thing. Did you read Dr White's letter to Mr Flanagan ? . You know that Dr White wrote that it is speculated that Mr Jackson added a mixture of propofol and lidocaine to a fuit juice. Dr Shafer agrees , obection by walgren, overruled.

Chernoff : Do you know the circumstances of the letter , Mr Flanagan had to have it in 2 days, because he was threatened of contempt ? Objection, sustained

Sidebar

Chernoff : do you know that propofol was found in Mjs Stomach ? Yes

Chernoff : do you know the number : concentration 1.83

Chernoff, subsequently you sent the piglets study, informed Mr walgren that there was no human study ? Yes. Dr Shafer called dr Glen, on the suggestion of Dr White, Dr White also contacted Dr Glen.

Chernoff : then you contacted dr Sepulvedra, Mr walgren didnt ask you to do that : Dr Shafer agrees

Chernoff : do you know that the defense paid for a study on beagles , that Paul White did the study ? No I heard that Paul had ruled out bio availability.

Chernoff : who paid for the Chile Study ? :the study took 2 months, Dr Shafer paid 600 $, the students were volunteers. Dr Shafer sent the study to dr White, dr Glen, and presented during an international conference,

Chernoff : despite the fact that a 1st year student would know that ? Yes.

Chernoff : you worked a lot more on this than Dr White, you litteraly swallowed 20ml propofol yourself ? yes

Chernoff : you know that Dr White wuldn't say that MJ swallowed propofol? No I didn't know, that and I still don't know what Dr White is going to say.

Shows the 40 mg lorazepam graph

Chernoff : what dose this show ? It shows that repaeted boluses of lorazepam can produce the concentration on autopsy. Shows 10 IV injecetions evry 30 m, from midnight to 5am.

Chernoff : did you read the statement by security ? Yes

Chernoff : the first shot was at midnight , MJ was still at rehearsal : dr Shafer : yes. Offers to do another simualtion.

Chernoff : second shot at 12 30, MJ was in a blue escalade on his way back from rehearsals

Chernoff : third shot was a 1 am, MJ was almost home.

Chernoff : in the graph you originally had another line : one for responsive to painful stimulus, and another one for not responsive to painful stimulus.

Chernoff : lorazepam is not analgesic (pain killer), it's a sedative. If a patient is not responsive to painful stimulus, he's asleep. Dr Shafer agrees

Chernoff : by the 5th shot, patient has exceeded painful stimulus. Based on this simuation, MJ would be asleep from 2 30 to 11 00. Dr Shafer : No he's been exposed to benzos for 80 nights, makes it almost impssible to predict Mjs reactions to lorazepam.

Chernoff : how de you know MJ had benzos for 80 nights ? Based on pharmacy records, and CM interview. There was no medical records. Chernoff doesnt let him check Cms interview. An ampule was found, showed that what CM said was not possible.

Chernoff : the fact that the benzo were bought doesn't mean they were used.

Chernoff : in you report you say that CM did not give MJ 2X2 mg , the information suggests a higher dose, possibly 40mg. Dr Shafer : yes I stand by that statement. I took off the responsive to spainful stimuus line, for simplicity. Chernoff implies that Dr Shafer thinks the jurors are fools.

Chernoff : you did not simulate oral lorazepam ? No

Chernoff : what happens if you swallow atablet ? The tablet into the stomach, half a pill is absord in 22 mn, then goes to the liver, subject to first pass, biovailability is 92% then, goes to the blood stream, distribute into body tissues, aong others the brain, 25% of the metablite goes to the bile, a part of the metabolite goes back to the stomach.

Chernoff : metabolite for oral lorazepam is also glucoronide, the process is the same as IV lorazepam. Dr Shafer : yes

Shows the grah with the 2 X2 mg injection, shows a graph with both lorazepam graphs in one graph. (the 2X2mg and The 40mg)

Chernoff : you said that MJ couldn't have swallowed lorazepam in his last 4 hours, based on the 22 min of one tablet. Dr Shafer says yes, and adds details that i didn't understand, sorry.

Chernoff Are there oral versions of midazolam? : not that I recall

Shows the simulation 25mg over 1 mn propofol injection , shows another simulation that he did for Dr White, 25 mg over 5mn, then another one 25mg in one shot, all at once. The all at once one was used for the prosecution examination.

The induction dose in anesthsia is given over 2 mn , because it's less painful for the patient , for sedation the dose is given over 3 to 5 mn. Dr Shafer calculated these times, because there is a delay between the time the drug gets into the system and the drug's effect. He was concerned that phyicians would continue to run the drug until they saw the effect. 3 to 5 mn is the right rate.

What's the danger of a rapid infusion ? : apnea.

What was Mjs brain concentration of propofol : needs to look at the coroner's report. No measurement in the coroners report.

Recess until monday 8 45
 
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Ramona122003 said:
You have to remember in the weeks following Michael's death everyone claimed he was addicted to opiates, not benzos. Even when all the benzos were found at his house the general narrative was that Michael was addicted or withdrawing from opiates abused. As far as I know, benzos doesn't have the same chemical draining effects as opiates because people who take benzos usually don't take them to get high. It's usually the opposite.

As for testing the brain levels for propofol, I think this happened because the corona didn't think it was necessary. Until now, most if not all of us thought the blood level was the most important thing. Even so, however, that doesn't change the fact that all of Sheffer's test on the blood doesn't match self-injection or one shot. What Cheffon is arguing isn't really important in the grand scheme of things.
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I agree,,,Chernoff is only ttrying to discredit Shafer and create reasonable doubt about his findings. imo...he has NOT done that, Thanks for explaining about the tests.
 
Also let's not forget that Dr S. lost his father less than a week ago. He's been testifying intensely for the pros now for over 3 days and now is being grilled by the defense. I'm really impressed with him and if it seems he is now fraying a bit at the edges toward the end here, who can be surprised.
 
I missed a lot of today because I was at work but let me say this. From what I read and from what I can remember when a person says something you can't shake or dispute you attack the person. Sounds like something Ron Zonen did a lot of when Michael was on trial. Sounds like something Mark Geragos did a lot of during the Scott Peterson trail. Sounds like something Jeff Ashton did during the Casey Antony trail. And we all know how those trials turned out
 
I swear Chernoff's method is working! He got me sooo confused... I was reading bouee's notes (many, many thanks!! much appreciated!) and I just now realized that doctor Shafer was refferring to CM when he said that it is his opinion that one should not lie to UCLA doctors. It is so obvious, and yet it passed me by and thought he was talking about his hospital or something.

I give a big applause to this man for standing up to Chernoff.
All I had to do was to sit in front of a computer and I was still lost at some point... Imagine actually being there.
 
I worry about Chernoff. He throws out all kinds of questions, some of quite dubious or non-existent relevance (at least to me). To some of them Dr. S may respond with: that's incorrect or that's inaccurate and chernoff just keeps going and doesn't acknowledge the response. I worry that chernoff is asking so many questions and wandering all over the map that he will work in some significant question without anyone realizing that it is important until too late. I think I am trying to say that chernoff may seem to have no plan for where he is going but I believe he does. I worry that he will say something with that 'over the tops of his glasses' stare that will catch the good doctor flat footed.
I worry too much.
 
Popescu said:
I swear Chernoff's method is working! He got me sooo confused... I was reading bouee's notes (many, many thanks!! much appreciated!) and I just now realized that doctor Shafer was refferring to CM when he said that it is his opinion that one should not lie to UCLA doctors. It is so obvious, and yet it passed me by and thought he was talking about his hospital or something.

I give a big applause to this man for standing up to Chernoff.
All I had to do was to sit in front of a computer and I was still lost at some point... Imagine actually being there.
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Chernoff wanted things to be confusing. He went on for about 45 minutes about the different in IV set, which didn't make a bit of different. He also try to say that Sheffer assumed he had an IV that wasn't found, but only reaffirm that Murray could had hid it before he threw it away. He also didn't explain how that empty bottle of propofol had a spike instead of a needle mark, but Murray didn't suspend it.

It didn't help that he actively made fun of Sheffer by saying he didn't understand anything he said during the last two days and kept mispronouncing his field name and purposely putting gibberish in some of his medical terms. It was a painful to watch.

At least Fran, with his slow self, actually challenged the witnesses on their facts and opinions. We even got more flush out answers from some of the witnesses. Cheffron downright attacked Sheffon on certain points and belittled him to the point that he got reprimanded by the judge for his argumentative questions. Especially talking about White and his research if you can shallow propofol. Sounds like to me that Cheffon was the one who took it personally. It was almost as bad as what he did to Fleak when he almost if not downright stated that she hid or planted evident.

On the bright side, I love that Cheffron still can't seem to discredit that bodyguard. I bet Murray is kicking himself for not putting that bag away himself.
 
elusive moonwalker said:
i ment the IV injection theory shaffer created on his graph about giving injections every thirty mins. the graph started with th first injection at midnight..chernoff said the first three injections happened when mj was not even at home. so its no good as a theory
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Isnt it was said earlier you can't say was it taken orally or another way based on autopsy report, is it? If so, Shafer based on the same report and just simulated various scenarios - so MJ hypothetically could take a pill equivalent 4mg injection at midnight. Could it possible?
 
Popescu said:
I swear Chernoff's method is working! He got me sooo confused... I was reading bouee's notes (many, many thanks!! much appreciated!) and I just now realized that doctor Shafer was refferring to CM when he said that it is his opinion that one should not lie to UCLA doctors. It is so obvious, and yet it passed me by and thought he was talking about his hospital or something.

I give a big applause to this man for standing up to Chernoff.
All I had to do was to sit in front of a computer and I was still lost at some point... Imagine actually being there.
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Chernoff has a very bad temper. I remember at the beginning of the trail he talked about moving into a home with another family here in Cali the wifee and child at home in Texas...all of this is wearing on his nerves and it shows through his behavior. Chernoff also mentioned that he has indigestion or some kind of stomach problems, asked CM for a presription for his ailement, ha, slip his ass some propofol.
 
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Thanks guys I was not able to watch this live today and appreciated your summaries. I see I did not miss anything though. Shafer's testimony has not been shaken yet, if it ever will.
 
elusive moonwalker said:
shaffer was good but i think chernoff gained a few points in the later stages of the days hearing shaffer seemed abit off compaired to at the begining.chernoff gained by saying shaffer made alot of assumptions about how he came up with his theories as i said the above post re the loraz timeings when mj wasnt even at home.
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You can look at that two ways, In my view Shaffer scored by using 12oclock time, he chose a time....just any time to demonstrate how loraz could be given based on empty bottle in room. Now considering Chernoff was trying to imply that Shafer was assuming that Murray was guilty....with his IV demo, Tubing and
empty vial of Loraz can you imagine what a field day he would have had if the time had been 1oclock.
 
Chenoff got Dr.Schafer to admit he created the most possible scenario in his opinion assuming Murray used a 40mg lorazepam vial and 1000mg propofol vial. Because in his opinon they were there, they were empty thus he must have used them .To be more clear Chernoff was trying to tell the jurors he’s intentions from the very beginning were to create the WORST scenario possible for Murray. Did he manage to do that? the jurors will decide not us , they will decide when Chernoff completes his cross

Does the scientific evidence bolster Dr.Schafer's assumptions?

Flanagn asked Anderson about something called equilibrium, who else remember that? Using it The drip theory is not only not supported by evidence found at the scene IT IS SCIENTIFICALLY IMPOSSIBLE based on the concentrations found in MJ.
Propofol leaves an organ ,appears in the next organ. Blood then liver then urine, it does not vanish from the system . Schafer told the jury the drip started at 9 am that day .Which means 3 hours of propofol infuson .where did the 1000mg of propofol disappear?

White already told the defense MJ received something between 125 ad 150mg, he had his scentific reasons to back up that statement, right? If the defese has evidence SCIENTIFICAL evidnce that Schafer not only can't refute but would very likely agree with and eventualy be forced to declare his assumptions were wrong , if the sceintifc evidence is strong enough to make Schafer repeats what he already admitted to, that his focus was to create a theory around the empty vials then that would explain Chenoff's behaviour towards Dr.Schafer. He already told him this case is serious and someone's fighting for his life , so he believes he has the evidence to prove Dr.Schafer has been very unprofessional .

Chernoff not only going to discredit Schafer's findings , Alvarez and Fleak accounts,but he would be able to put into question Walgren's credibility .

so yes he might appear to many rude, does not know what he is doing, grasping at straws ...etc , but to me he's scoring points left and right.
 
You have got to be kidding. You can't be this bitter because none of this is turning out the way you said it would
 
You have got to be kidding​
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Unfortunately no. Did u see the calculations Dr.Schafer did based on White's request on a 25m of propofol infused for 3 to 5 minutes? the curve was no longer high enough to cause apena .

Dr.Schafer made a point yesterday under direct that a bolus injection of 25 would be enough to cause apena . But Chernoff got Dr.Schafer to admit he ignored the 3 to 5 minutes interval and assumed the injection was very rapid , given all at once , not as Murray claimed to give.


You can't be this bitter because none of this is turning out the way you said it would
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did you watch the cross?
 
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Oh no. I want justice for Michael :( I want to see criminal Murray in prison, and his license revoked. If all he gets is a slap on the wrist, I'm going to be so so sad.

I'm dreading the rest of the cross examination, and defense witnesses taking the stand next week. I can't stand the arrogance of Murray and his lawyers.
 
Soundmind said:
Unfortunately no. Did u see the calculations Dr.Schafer did based on White's request on a 25m of propofol infused for 3 to 5 minutes? the curve was no longer high enough to cause apena .

Dr.Schafer made a point yesterday under direct that a bolus injection of 25 would be enough to cause apena . But Chernoff got Dr.Schafer to admit he ignored the 3 to 5 minutes interval and assumed the injection was very rapid , given all at once , not as Murray claimed to give.
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The problem being that he clearly said it couldn't happened over a period of time because Murray turned the saline bag off, per his own statement. Which meant that even if he did it slowly, it wouldn't make a different because most of the propofol would be stuck in the tube.

Not also forget that he also clearly said that even with a rapid infusion the blood levels would be high and stop Michael's breathing, but his heart wouldn't stop. It would beat for at least 10 minutes and during that time the levels were quickly drop. So even if Murray pushed all at once, it still wouldn't had match the amount in Michael's blood. So Michael couldn't had died from either a slow or rapid infusion given the blood levels.

Even if Michael's heart stopped immediately after injection, Murray or self-injection, his blood levels, going by Sceffer's charts, should be much higher when he died. So slow or fast infusion, where did the extra propofol come from?
 
The problem being that he clearly said it couldn't happened over a period of time because Murray turned the saline bag off, per his own statement. Which meant that even if he did it slowly, it wouldn't make a different because most of the propofol would be stuck in the tube.
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Thank u for reminding me .

some were laughing at Chernoff bringing up the various IV systems Dr.Schafer talked about under direct. Well, first of all he brought the original IV system found at MJ's house. He got Dr.Schafer to tell the jurors the port used to inject drugs into, in the IV system he used yesterday was 3 feet long while the one found attached to MJ was 13cm long , to use their wordings significantly shorter.

He asked him how much lidocaine he gave with propofol, doctor schafer said 1to 1 , so that's in total 50mg , with short tubing he could have done it . See how is he scoring points while people r laughing at him ?

Not also forget that he also clearly said that even with a rapid infusion the blood levels would be high and stop Michael's breathing, but his heart wouldn't stop. It would beat for at least 10 minutes and during that time the levels were quickly drop. So even if Murray pushed all at once, it still wouldn't had match the amount in Michael's blood. So Michael couldn't had died from either a slow or rapid infusion given the blood levels.

Even if Michael's heart stopped immediately after injection, Murray or self-injection, his blood levels, going by Sceffer's charts, should be much higher when he died. So slow or fast infusion, where did the extra propofol come from?
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they will get to that later, so I prefer to wait . Let' discuess today's testimony
 
The defense theories offered (implying Michael gave himself a bolus?) are all predicated on the idea that IF Michael self-medicated, Murray is innocent. However, that is faulty reasoning. We've now heard THREE expert witnesses detail many, MANY instances of egregious failures of standard of care -- that were LIKELY to result in Michael's death, and DID result in Michael's death. Any one of these egregious failures of standard of care would most likely result in a guilty verdict, of Involuntary Manslaughter. But, there was not just one of these "failures." Dr. Shafer detailed (and demonstrated) no less than SEVENTEEN "failures."

I believe that testimony has already shown that it would have been impossible for Michael to give himself the fatal dose of propofol. But, IF he did? Murray ABANDONED him, yet another egregious failure. And Murray is STILL guilty.

Now, I guess there will be a parade of character witnesses for the defense? Saying what a "nice man" Murray is? The most important responsibility of a doctor is to "do no harm." I think it is already obvious to the jury, that Murray DID "do harm."
 
Soundmind;3516910 said:
Chenoff got Dr.Schafer to admit he created the most possible scenario in his opinion assuming Murray used a 40mg lorazepam vial and 1000mg propofol vial. Because in his opinon they were there, they were empty thus he must have used them .To be more clear Chernoff was trying to tell the jurors he’s intentions from the very beginning were to create the WORST scenario possible for Murray. Did he manage to do that? the jurors will decide not us , they will decide when Chernoff completes his cross

Does the scientific evidence bolster Dr.Schafer's assumptions?

Flanagn asked Anderson about something called equilibrium, who else remember that? Using it The drip theory is not only not supported by evidence found at the scene IT IS SCIENTIFICALLY IMPOSSIBLE based on the concentrations found in MJ.
Propofol leaves an organ ,appears in the next organ. Blood then liver then urine, it does not vanish from the system . Schafer told the jury the drip started at 9 am that day .Which means 3 hours of propofol infuson .where did the 1000mg of propofol disappear?

White already told the defense MJ received something between 125 ad 150mg, he had his scentific reasons to back up that statement, right? If the defese has evidence SCIENTIFICAL evidnce that Schafer not only can't refute but would very likely agree with and eventualy be forced to declare his assumptions were wrong , if the sceintifc evidence is strong enough to make Schafer repeats what he already admitted to, that his focus was to create a theory around the empty vials then that would explain Chenoff's behaviour towards Dr.Schafer. He already told him this case is serious and someone's fighting for his life , so he believes he has the evidence to prove Dr.Schafer has been very unprofessional .

Chernoff not only going to discredit Schafer's findings , Alvarez and Fleak accounts,but he would be able to put into question Walgren's credibility .

so yes he might appear to many rude, does not know what he is doing, grasping at straws ...etc , but to me he's scoring points left and right.
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you do know that propofol's action is primarily ended by redistribuion to lean tissue & adipose tissue right?? and then excreted slowly?? just like almost all IV anesthetics... it is most certainly not confined to the blood, liver, and urine as you are claiming here. so that's where the "rest" of the 1000 mg that was not accounted for in the urine in the bottle, urine in the bladder, and blood went. jeez. do you have any information showing it is "SCIENTIFICALLY IMPOSSIBLE"?

"The pharmacokinetics of propofol has been described by two-compartment and three-compartment models (Table 26-1). After a single bolus injection, whole-blood propofol levels decrease rapidly as a result of redistribution and elimination (Fig. 26-2). The initial distribution half-life of propofol is 2 to 8 minutes.[SUP][4,13][/SUP] Studies in which the disposition of propofol is described by a three-compartment model give initial and slow distribution half-lives of 1 to 8 minutes and 30 to 70 minutes and an elimination half-life of 4 to 23.5 hours.[SUP][14,15][/SUP] This longer elimination half-life indicates a deep compartment with limited perfusion, which results in a slow return of propofol back to the central compartment. Because of the rapid clearance of propofol from the central compartment, the slow return of propofol from this deep compartment contributes little to the initial rapid decrease in propofol concentrations. The context-sensitive half-time for propofol (Fig. 26-3) for infusions of up to 8 hours is less than 40 minutes.[SUP][16][/SUP]"

Translation: the "deep compartment with limted perfusion" = lean muscle & fat

source: Miller's Anesthesia, 7th edition (accessed online through my school's library)

edit: sorry if this sounds "argumentative", but as a medical student it really bothers me when seemingly baseless (w/o sources) medical opinions are stated as facts :(
 
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I wish I could read the jurors' brains. I will not get my hopes up.
 
Soundmind said:
Thank u for reminding me .

some were laughing at Chernoff bringing up the various IV systems Dr.Schafer talked about under direct. Well, first of all he brought the original IV system found at MJ's house. He got Dr.Schafer to tell the jurors the port used to inject drugs into, in the IV system he used yesterday was 3 feet long while the one found attached to MJ was 13cm long , to use their wordings significantly shorter.

He asked him how much lidocaine he gave with propofol, doctor schafer said 1to 1 , so that's in total 50mg , with short tubing he could have done it . See how is he scoring points while people r laughing at him ?



they will get to that later, so I prefer to wait . Let' discuess today's testimony
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As Sheffer pointed out, the length isn't all that important. All IVs sets works the same way. If it didn't, why would Sheffer see it as a red flag that Murray turned off the saline bag if some IV sets doesn't have that feature. He also went from Murray's own order list which had the IV he most likely used, which had the same stop feature. So, how did they score points about the IV other than pointed out that Murray could had easily walked off with it and threw it in the trash? Even with a short tubing most of the propofol would had been stop before reaching Michael, therefore no rapid infusion could had happened.

Also, if Murray did use one big injection, why are they fighting tooth and nail over if an infusion was use? You saw how badly they want to discredit the AA, can't spell his name, and how they went out of their way to say that bottle wasn't in the slice saline bag. Not to mention how they fought with one expert over if a infusion was used or not. It sounds really strange to fight so hard over something that didn't happen at all.
 
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