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Murray Trial Day 21, October 31st - Discussion

Very underhand of the defence not to get white or addiciton doc to do a report. So all walgren had was a 3page letter from march from white. He's done brilliantly flying blind. I suppose the first they knew that mj died of a heart attack was from the defence opening statement.
 
apparently this happened

IJCSLYMJ86 You Are Not Alone MJ
Ok from fan inside courtroom said that Walgren told Pastor that Dr. Whites testimony needed to be from facts and not hearsay. Flanagan said

IJCSLYMJ86 You Are Not Alone MJ
Cont it wasn't fair to ask the question because it was so long ago. @JudgePastor said to@TheFlanagan "NICE TRY" and the courtroom laughed
 
Petrarose said:
He is crumbling but I just heard some woman (think she is a former DA) on In Session say words to the contrary.
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From what the lawyers said he isn't really crumbling because he hasn't gotten that emotional and doesn't come across like the addiction expert, who completely lost his cool and killed his credibility.

They said he is being very clever in sneaking in bits of his talks with Murray, like Michael bring in his own propofol supple and how the jury had now heard this statement. Although, the next question that brings up is where was this stash and why didn't anyone find it. How did the LAPD and the DEA track down all of Murray's sale receipts, but not Michael. More importantly, who was buying this other stash since Michael wouldn't just to into Walgreens and buy it himself.

Really to me, White made himself look like a fool.
 
Dr White
Walgren

Dr White is retired after 30 years of clinical care, teaching and research

He's an expert in the use of propofol, not expert in pharmacokinetics and dynamics modelling, uses other people to do that, among others, asks Dr Shafer

He wrote over 100 papers about the use of propofol

There are instances Dr Murray deviated from standards of care on june 25th and the preceding 2 months : Dr White agrees

What's your understanding about CM interview, based on that interview, was he giving both boluses and infusions : for 6 weeks, yes. Walgren corrects : Cm says in his interview «* nearly every night*»

Based on CM's interview, Dr White understood 25mg to 50 mg + 5 CC of lidocaine , he sometimes did 2 injections. Based on interview, could not say how CM administered the drip.
It could be with several tubings as described by dr Shafer : there could be a number of possibilities, that's one of them

Agrees giving propofol without correct bedside monitoring , could be dangerous, could result in cardiorespiratory depression

Would you administer propofol without airway equipment ? The most important thing is an ambu bag, that's the minimum

Has never given propofol in a bedroom, has never heard of it.
Have you ever given it outside of hopsital setting ? : depends has given it in offices, clinics that don't have the same equipment as hospitals.0

is a suction apparatus necessary ? it's desirable , but vomiting is fairly rare.

You need to prepare for the worst case scnario ? some situations may not be covered in every venue.

Pulse oximetry is essential, blood pressure cuff is important, but not necessarily automated. For an infusion you measure BP every 5 mn, for boluses with minimal sedation, every 15 mn.

For Bolus + infusion :dr White uses electrogardiogram. Capnography is not utilised everywhere, finds it useful but not very precise.

Failing to maintain charts : is it an egregious and unconsionable deviation from stanadrd of care ? charts are necessary, but in this case it didn't contribute to death, objection , stricken,re asked
It's a deviation, doesn't know if it's extreme , it's between minor and mediate.

Do you maintains medical records ? : having old medical records is helpful.

What is pre procedural assement ? evaluates the patient overall condition, evaluates the airway, any factor that could accentuate the cardio repiratory depression..

Propofol complications : respiratory depression is rare , happens when narcotics are presents. The effect is much stronger when narcotics are present , benzodiezpine are less dangerous because they have additive effects

Dr white has been paid 11 000 $ so far, hopes to recive more. Normally charges 3 500 a day for court appearances, but hasn't asked that because the defense doesn't have the resources, is not going to bill that.

Have you had a patient stop breathing after propofol ? For genreal anesthesia yes, objection, yes or no : yes. I assist with bag and mask, or endotracheal intubation,or laryngeal mask.

Doctor patient relationship : it's understanding the patient's medical condition, compassion, treat them appropriately

1st oath of a doctor is «* do no harm*» Do you think CM violated that oath giving propofol for 2 months ? he did no harm. CM was offered money to be MJ's private physician.

Who's the final decision maker : both the patient and the physician share the responsibility. The physician has the possibility to walk away.

Dr White says he would never administer something he considers inappropriate , would walk away.

Sedation : it's easy to go from a level of sedation to the other . When you are adminitering an infusion or repeated bolus , you need to monitor ? Dr White agrees , but says that 25 mg propofol is a very minimal dose , it would have worn off after 15mn. You monitor the patient for 15mn minimum, ideally 30mn. After that, it's ok to leave the patient. That would be in a hospital setting , because that's the only place he's done that.

What's the use of a pulse oximeter without an alarm when you're out of the room ? : if you have observed them for 25 to 30 mn , propofol doesn't have effects anymore. Pulse oximeter has no value when you 're aout of the room.

What if benzodiazepines are on board : if they have been given hours before, they would have little effect. Especially if only 25 mg propofol is given over 3 to 5 mn.

Would the fact that benzos are present alter your level of care : 30mn is adequate for 25mg given from 3 to 5 mn,.
Even if a patient has no monitor and no staff ? This was an unusual case, the goal was sleep, it's acceptable.

If your patient had said he liked to push the propofol : Dr White would not left the room.

You can't justify failure to call 911 : No I can't. CM found MJ in full cardio pulmonary arrest, it's stressful. Would have done things differently, would have called for help. Initiated CPR immediately. Would have called 911, but it was not a typical situation , you have to know the adress, it wa snot easy access the house . Walgren ask if it's better to leave a voicemail on MAW'w voicemail ?

Dr White says CM should have called 911 sooner, but it wouldn't have made a difference in this case

How long would it take you to call 911 ? He start ressusitating, and call 911 within 3 to 5 mn.

Dr White says he doesn't tthink everything CM told the police is true.

In an emergency situation, it'ss often difficult to recall details. CM overlooked propofol. Didn't do it in a devious way. Walgren suggests the other option is that he lied, Dr white reluctantly agrees

A letter containing preliminary thoughts is the only doc he gave the defense, he did talk to them.

Sedatives analgesic increase the risk of propofol.

Benzos increase the risk : it depends on when they were given .

Dr White says that a gigh concentration of lorazepam + 25mg propofol given too fast causes arrythmia, and a rapid demise.

CM bought propofol , but Dr White says that MJ had his own stocks of propofol.

Walgren : where is it in CM's statement ? CM told that to Dr White

Showing defense's VV (long vented tubing) : the cap was broken off. A plastic cap that covers the hole is missing. Dr white didn't do that. Now people 157 (recovered from scene) , has the cap in place.

David Walgren shows that peoples 157 is easily concealable, fits in the hand, in the pocket. Dr White admits to that.

Speculated that MJ drank propofol, now rejects that's the cause of death , there was propofol in the stomach, now rejects that MJ drank propofol because Dr Shafer explained why there could be propofol in the stomach. Mentions the Chilean study, were one subject was a little sedated after drinking propofol.

Back to the March 8th 2011 and his 3 page letter : Dr White did it in a very short time , Flanagan needed something in writing within 2 days. Had recieved experts reports and other material to prepare it. Did not write any other report in 7 months. He doesen't say in the letter it's a preliminary opinion. In the letter, said MJ self administered, either injecting himself, or orally. Prior to writing the letter, did a search for oral propofol , but did not find anything, had seen there was propofol in stomach content from autopsy report.
Mr Flanagan raised the issue of oral propofol before he wrote the letter.
You came with the only option to blame the victim ? If CM had only given, there has to be something else.

Now you blame MJ for Lorazepam : yes , after Dr Shafer's report .

You took everything that CM said as the truth ? Yes

Dr White said MJ died of a rapid bolus, but never wrote it in a report/letter.

Have you come up with any theory aother than attributing the drug intake to MJ ? No

CM possibly overlooked the propofol, or lied. Dr White takes evrything CM says about the drug administration as the truth, because it's consitent with the autopsy report

Dr gabriella Onellis : she'e a Phd, biomedical engineering.met her for the first time last week. Asked her if she could calculate the amount of free propofol you would expect the urine after a 3 hour 100 ml infusion.

Break
 
Can someone tell me who is ruffelo?

And what is that about blood on the iv and being screwed with by the defense???
 
WOW! White just put his foot in his mouth saying that he will not administer propofol in his home because of time involved. Walgren got him! Meaning, implying that he will do it although it is unethical.
 
Ps guys dont you think like i do, that even with 11000 he will pay after this, dr white. The community of anesthelogist will not accept this behaviour right? I dont think shaffer will let this go, he was very passioned about this. So he will make dr white pay for saying such things as a doc!
 
Hahaha, White is so self-serving. When Walgren asked if Dr Ian Glen is called the Father of Propofol, he said he is sometimes called that. He is making a big fool of himself! What big ego. He should learn how one should carry themselves and behaves. A bit of humility would help.
 
Ramona122003 said:
From what the lawyers said he isn't really crumbling because he hasn't gotten that emotional and doesn't come across like the addiction expert, who completely lost his cool and killed his credibility.

They said he is being very clever in sneaking in bits of his talks with Murray, like Michael bring in his own propofol supple and how the jury had now heard this statement. Although, the next question that brings up is where was this stash and why didn't anyone find it. How did the LAPD and the DEA track down all of Murray's sale receipts, but not Michael. More importantly, who was buying this other stash since Michael wouldn't just to into Walgreens and buy it himself.

Really to me, White made himself look like a fool.
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Romana not that lawyer I am talking about. I am talking about the Black woman former prosecutor, who was essentially saying Walgren was not doing well with White and he should not be aggressive. I do not know if you heard that part because she comes and goes. She always seem to have a pro-defense stance in my view and the Black guy who acts as the anchor likes her very much. They are different from the blond woman who basically sticks to facts.
 
Now we into the time and length of time Muarry left the room in relation to Michael self injecting.
 
I am so baffled as to WHY White is so argumentative with Walgren...he was hired to give his expert testimony on Propofl and Loraz..NOT to argue with the pros about where Murray was,,,,OR to try and sneak in private conversations he may of had with Murray, He refuses to answer yes or no questions. White is an embarrassment to to the medical profession.
 
Ingelief said:
thx so why is white mentioning him?
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To justify his initial speculations about the oral propofol, maybe.

Ruffalo made a silly mistake in the prelim. on units of measure (took miligrams for micrograms) and at a precise moment (probably shocked by his mistake) he admitted to defense oral ingestion of propofol may have been a possibility, which obviously had nothing to do, but defense took advantage of his mistake.
 
white just said after phonecall from cm and being to the bedroom 2 min he did it himself. the fatal selfinjection.

BUT that cant be, because the timeline of death would be wrong. The call is earlyer than 11???
 
smoothlugar said:
To justify his initial speculations about the oral propofol, maybe.

Ruffalo made a silly mistake in the prelim. on units of measure (took miligrams for micrograms) and at a precise moment (probably shocked by his mistake) he admitted to defense oral ingestion of propofol may have been a possibility, which obviously had nothing to do, but defense took advantage of his mistake.
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didnt know that, thx
 
Yes! Walgren is getting to the situation of HOW White assumes MJ was able to self administer.

I swear fo' God if ppl dont stop coming into my office Imma pop. Ive been waiting for this testimony and now everybody wants to call and come into my office for crap. FFS!

Thank you to everyone whose providing updates.
 
Oh Ha Walgren asking him if Michael has a condom cat, his Iv and walking around the room, and the idot White agrees.
 
But which time are they talking about????????????????? Pls help me out

because if that is before 11. than michael would be death for an hour in white oppinion?!
 
He's getting to all the stuff we talked about this weekend on the board. A lot of that stuff is getting covered! Go Walgren!!!
 
Petrarose said:
Oh Ha Walgren asking him if Michael has a condom cat, his Iv and walking around the room, and the idot White agrees.
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Lol.... n did he see how messy that room was. It would have been hard for him to maneuver through the room. N is this supposedly before or after the 8 lorazepam pills
 
which time dr white was talking about?? the one cm was on the phone 40 min? he said michael had the time to inject himself the lethal dosis. But if this was before 11 am then michael would be death more then 1 hour in dr white oppinion.

SO Please help out??
 
back from dinner break

when mj self injected the 25mg in your senario thats not the time murray said he left? did that happen when mj left for 2 mins or was that another time murray left mj alone? it could be another time says white. when mj took the tablets does that assume murray left mj alone aswell? whites goes on about i understand mj was walking around. motion to strike substained re asks the question. presumably murray was in some other part of the room. becasue there was different rooms ie bathroom/bedrooms. do u believe murray was unaware that mj took the tablest. so its fair to say murray wasnt watching or left the room. answer yes. yet murray said in his statement the only time he left the room was for those two minutes says walgren. so we have murray left the room around 7am for the tablets and we have the 2 minutes when murray found mj. but based on whites report its a different time. white says about the phonecalls murray probably wasnt there as mj was trying to cleep. so common sense say walgren that murray wasnt there. walgren says your assumeing at some point murray left the room. and as whites showed on friday mj got a syringe and filled it with lidocaine and dip. white says murray draw it up.(based on murrays interview with white) white claims murray draw up the drugs and left the syringe in the bedroom infront of mj!! . so murray leaves the room with a syringe next to mj. white says i didnt say where murray left the syringe. white keeps saying murray said he left the room to make phonecalls. walgren says murray never said he left the room to make phonecalls. . but you (white) dont believe all this could have happened in 2 minutes?.yes agrees white. so how long would murray have to leave the room for mj to self inject. white believes the self injection happened while the phonecalls were taking place. yet murray never says he left the room. white created the senario. white says mj did it through the side port in the IV. was the syringe left in the port? dont have an opinion on that maybe was left in the side port.. walgren says so if the syringe was on the chair and when murray came back in and found it in the y port wouldnt murray realise what the problem was? .whites trying to say

white says yes murray wasnt watching mj and accodring to white murray left the syringe in the room near mj and walgren says so mj wakes up finds the syringe and self injects . so mj falls back in the exact same location he was when murray left. whites says he mj returned to bed! u know he had a condom catheter on and he had an iv on? walgren says so mj was walking around with a catherter on pushing an IV pole and murray is somewhere else on the phone? is that what you are assuming dr white? its a possible senario. wlgren says another senario is murray did it. and white says if murray wanted to harm mj. os mj wanted ot harm himself? mj didnt realise the dangers says white.

is it your testimony mj wanted light sedation. yes says white. walgren says lee said mj wanted to be knocked out. white says thats a term ppl use. walgren ask the question again that mj wanted light sedation? white says no. walgren says it makes no sense for mj to want light sedation becasue in light sedation you have normal responce to verbal stimulation (and murray was on the phone) does it make sense walgren asks white? white wont answer to walgren goes through the whole senario of murray giving it for 2 months.. white says mj wanted sleep. maybe not deep sedation.. every night for 2 months its your opinion that murray was doing deeper sedation? according to white on the 23rd/ it was light sedation what about b4 that says walgren? white speculates it was min to moderate sedation.white talks again about murrays interview with him about how murray mixed the drugs in the saline bag. walgren catches him out. testimony striken.

MAC monitoring anestheia care... is done in minimal sedation aswell
 
Court is back


Walgreen asks White if he met with Dr. Ornelle's just last week, White says yes he first spoke to someone from the defense who recommended this Dr. Ornelles (sp?) says she's an expert in pharmacokonetics
Walgren says you only provided the computer code to me, not the software, White says yes I wasn't asked to provide the software, Walgreen asks if he ever told told her to provide the software as well, White says idont recall, Walgren asks again if he knew that the code alone would do nothing for the prosecution. White says he doesn't what walgren's expertise is, says it means something to Shafer and that Shafer is able to figure it out for them. Walgren asks if he had ever heard of
Ornelles before the defense mentioning her. White says no.




Walgren asks him about lorazepam, and theories that it was taken before 8 am, asks if he was aware that lorap has a peak of two hours, and that it would perfectly fit with their claim that mj self injected around noon.
White says no I wasn't aware of that, Walgren asks if they purposely claimed the oral lorazepam was taken at 7am so that it could fit as the 10 am doesnt fit.
Walgren asks him if the 10 am theory is still in there or not, or did they deliberatly changed so it could fit, after what Shafer testified.
White says the 10 am wasn't his theory he doesn't know where it came from.
Walgren asks him if he'd consider taking the job, giving mj diprivan everynight, white says no I wouldn't because of time, lack of time, Walgren asks him if the only reason he'd decline was because he didn't have enough time. white says yeah because of time and other things.




(missed something in the middle stream went off)


Walgren asks him about his models, says what the time period was in his models, if he'd use the two mins, said by murray in his interview, white says no a different time period of murray not being there was used.
says he never asked Dr. Ornelles to make him the simulatins specifically


Walgren asks him when he prepared the study on animals and propofol, asks if he was in any way involved with the piglets study white says no flanagan had some veteranian in indiana who done the study, white says he didn;'t even overlook the study, that he had no direct involvement at all, that it was all flanny's doing.
Walgreen asks what kind of animals were used white says at first they were considering piglets but then used beagles.


walgren asks him about ian glan. asks him if he is aware that he is called the father of propofol, asks if its true that ian glan told him there is no bio availibility on propofol , white says I dnt know, some ppl call me the father of propofol
Walgren cuts him off, asks if it's right tht ian glan is called the father of prop, white agrees, but says he didn't ask him










walgren asks if he was aware of first pass metabolism, and still claimed mj drank it, white says that was a possibility as there was no study conducted on animals or humans before shafer's, walgren reasks white says well shafer conducted one, because he thought it had some kind of relevance like I said there were no studies before.
walgren makes him to admit that Dr. Ian Glan's study in the 80s was actually about oral propofol.
Walgren asks if he just accepted the negative report from the beagles study flanagan commision without asking for data, white says, walgren asks if it was done like this just to save face, so that he could say it wasn't due to shafer's study, defense objects, judge sustains
walgren aks him if his study was based in the two min time frame or another time frame when mj self injested the lorazepam himself.white says it he doesn't know the exact time frame, but it could have been in another time.
walgren asks if it's his understading that all that happened within the two mins. white says well we have to consider that he was walking around too.
walgren asks him if he is aware of the two mins in the bathroom that cm mentioned inn his interview, white says yes, walgren asks if it's fair to assume that murray calling around, he wouldn't be standing around in mjs presence, white says yes that's fair to assume
Walgren asks him who he thinks drew up the meds in the syringes, michael or murray, white says he assumes it was murray.
walgren asks him if he thinks all this took place during the two mins cm mentiones white says no i think that took place during the phonecalls. walgren says according to murray's mouth himself that's not evidence. judge says calls are in evidence, walgren reasks asks if he believes that occured during the 40mins of phonecalls, white says yes.
Wal aks white if he believes mj injected in the side y port, white says he didn't make any assumption walgren asks him if he assumes, that murray wasn't present in the time somewhere on the ohone, white says yes.
walgren asks if he assumed that mj was wearing a condom catheter, was hooked onto an iv stand, and was walking around, white says well the iv stand is mobile walgren asks again, white is forced to admit that it was his assumptions.
Walgren asks if he thought mjs wanted light sedation white says yes that's my assumption, walgren asks him if he is aware if he is aware of mj telling nurse lee and other docs that he wanted to be knocked out, says with light sedation u'd have normal response to verbal stimulation, asks if this makes sense to him, white asks him to be more specific.
walgren reasks and asks if it's true that he is assuming that there was no iv on the night he died, white says yes that's my assumptions, says he believes murrays statement of murray not giving him any propofol on june 24, says there was only little prop in the urine so he believes cm.
white says he thinks there was no prop or little prop in the nights of 23rd, 24th and 25th.
white says he thinks he was given an iv in the six weeks before, explains how it was done, walgren says how come you know how it's done now but didn't when I asked u before, white says he was instructed by the jduge not to comment on his info he gained from murray's convo in court, walgren says u violated the court oder now.
asks again what time of sedation murray was providing to michael before white says from his understanding it was light to minumum sedationn, or therapeutic sedation.
 
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something else I thougt off,,,,Murray said to the police that he gave Michael a bolus of propofol...for the 3-5 minute time window. We know that this is a lie...because in that same police report..Murray told them that he didnt have a watch on. We KNOW that is a lie..by the pics that we have seen at the hospital. Lies...lies...lies...
 
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