Conrad Murray's trial/ Day 10-20-2011

Witness: Murray gave Jackson 40 times more of the drug than he told police
October 20, 2011





Dr. Conrad Murray probably gave Michael Jackson 40 times more of the surgical anesthetic than he admitted to police, and left the drug running into the singer's veins even as his heart stopped beating, a leading expert on the drug testified Thursday.

The testimony of anesthesiologist Steven Shafer is the most direct refutation yet of Murray's account of what happened in the hours leading up to his famous patient's death.

FULL COVERAGE: The Conrad Murray trial

Shafer, a Columbia University professor, said mathematical modeling based on levels of the drug found posthumously in Jackson's body debunked Murray's statement that he gave only a single 25-milligram dose of the drug shortly before Jackson's death.

The only plausible scenario he found, Shafer said, was that the physician gave as a drip an entire bottle of propofol, containing 1,000 milligrams of the drug, and never realized Jackson stopped breathing.

"Is this the explanation that best fits all the data in this case?" Deputy Dist. Atty. David Walgren asked.

"This fits all the data in this case and I am not aware of a single piece of data that is inconsistent," Shafer said.

Shafer, the prosecution's final and main medical witness, is in his third day of testimony. He said his calculations ruled out any possibility that Jackson injected himself with the drug.


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Defense shows strain in trial of Michael Jackson's doctor
By Alan Duke, CNN
October 21, 2011

Tune in to HLN for full coverage and analysis of the Conrad Murray trial and watch live, as it happens, on CNN.com/Live and CNN's mobile apps.
Los Angeles (CNN) -- Cross-examination of the prosecution's anesthesiology expert is crucial for Dr. Conrad Murray, but his defense team's most knowledgeable lawyer when it comes to propofol will sit on the sideline Friday.
Michael Flanagan, who has handled the previous medical experts, has been replaced by lead defense lawyer Ed Chernoff for the questioning of Dr. Steven Shafer, Chernoff told the judge in Murray's involuntary manslaughter trial Thursday. The defense did not cite a reason.

Murray appeared visibly shaken by Shafer's testimony Thursday, especially when the prosecution's expert demonstrated to jurors how he believes Murray set up an IV drip to give singer Michael Jackson the drugs that killed him.
Jackson died because Murray failed to notice that his patient had stopped breathing while he was hooked up to an IV drip of the surgical anesthetic propofol, Shafer testified. The doctor should have realized Jackson had stopped breathing about 11:45 a.m. on June 25, 2009, he said.

"When you're there, you see it, you know it," Shafer said.
Phone records and testimony showed that Murray was on the phone with one of his clinics, a patient, and then a girlfriend about the time that Shafer calculated the oxygen in Jackson's lungs became depleted, causing his heart to stop beating.

"Had Conrad Murray been with Michael Jackson during this period of time, he would have seen the slowed breathing and the compromise in the flow of air into Michael Jackson's lungs, and he could have easily turned off the propofol infusion," Shafer said.

Murray could have then easily cleared Jackson's airways and restored his breathing by lifting his chin, he said.
Earlier testimony from paramedics and emergency room doctors said Jackson was clinically dead by the time an ambulance arrived at the pop icon's Los Angeles home nearly a half-hour after Murray realized there was a problem.
The last three prosecution experts, all medical experts, focused the Murray trial on the science surrounding Jackson's death, a contrast to earlier testimony from Murray's girlfriends and Jackson employees.

After the defense cross-examination of Shafer on Friday afternoon, Murray's lawyers will start calling witnesses, including their own anesthesiology expert.
Shafer demonstrated for the jury Thursday how he believed Murray set up the propofol infusion by hanging a 100-milliliter vial from a stand with tubing attached that would have led to a catheter port in Jackson's left leg.
"This is the only scenario that I could generate" that would produce the high level of propofol found in Jackson's blood during his autopsy, Shafer said.
"This fits all of the data in this case, and I am not aware of any data that is inconsistent with this explanation," he said.

Shafer examined and ruled out other scenarios, including Jackson injecting himself with propofol or Murray administering a fatal dose with a syringe. Computer model projections could not identify a scenario that would duplicate the high blood levels found, he said.
Although Murray told police he used an IV drip to give Jackson propofol on previous nights, the defense contends that he did not use it the day Jackson died. Instead, they say, Murray put Jackson to sleep about 10:40 a.m. with a single injection.

Sometime after that, Jackson woke and used a syringe to inject himself, the defense contends.
Shafer said the theory makes no sense.
"People just don't wake up hell-bent to grab the next dose in a syringe, draw it up and shove it in their IV again," Shafer said. "It's just a crazy scenario."
The Los Angeles County coroner ruled that Jackson's death was caused by a combination of sedatives with the propofol, which Murray admitted in a police interview that he used to help Jackson sleep.

The defense contends that Jackson swallowed eight lorazepam tablets, a claim based on testing of lorazepam levels in Jackson's stomach contents. Shafer discredited the defense lab tests, saying a new test showed the equivalent of only "1/43rd of a tablet" of the sedative in the stomach.
The level of lorazepam in Jackson's blood was far higher than what would be expected based on the dosages Dr. Murray told detectives he gave Jackson in the hours before his death, Shafer said.

Murray said he gave Jackson a total of 4 milligrams of lorazepam in two separate doses starting 10 hours before his death. Toxicology results indicated that Jackson was given 40 milligrams -- not four -- in a series of 10 doses, he said.
Although the defense recently abandoned the theory that Jackson may have swallowed propofol, the prosecution still worked to use its old theory to discredit Dr. Paul White, the anesthesiologist who will testify soon for the defense.

A report prepared by White in March concluded that oral ingestion of propofol could have killed Jackson, but Shafer testified that it ignores the "first pass effect" that is taught to first-year medical students.
The liver is a "powerful mechanism" for filtering propofol from the digestive tract so that only a very small percentage can reach the blood, Shafer said.
Shafer cited several studies on rats, mice, piglets, dogs, monkeys and humans that he said proves swallowing propofol would have no effect.

"There was no sedation at any time following oral consumption of propofol," Shafer said, describing the results of research he commissioned on university students in Chile over the summer.
The human study was done not only to prepare for the Jackson trial, Shafer said, but also to counter an effort by the Drug Enforcement Agency to consider tighter restrictions on propofol.
The drug is not currently a controlled substance, but publicity over the theory that Jackson's death might have been caused by oral ingestion prompted federal regulators to considered a new requirement that "it to be handled almost like morphine," he said.

"Patients will be hurt if it is restricted," he said. "Anesthesiologists have to have ready access."
The new study assures that if the drug is abused, it would be done only with the intravenous route, which only health care providers have, he said.
Shafer testified Wednesday that Jackson would be alive now but for 17 "egregious deviations" by Murray from the standard of care required of physicians.

Murray's use of propofol almost every night for two months to help Jackson sleep was so unusual, there is no documentation on the dangers, Shafer said.
"We are in pharmacological never-neverland here," Shafer said, "something that's only been done to Michael Jackson."
The trial, in its fourth week, is expected to conclude with the start of jury deliberations near the end of next week.


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Lifting Michael Jackson's chin could have saved his life, medical expert tells jury at manslaughter trial of Dr Conrad Murray
Jackson's private doctor criticised for lack of vital hospital equipment
Singer's mother Katherine Jackson seen shaking her head in public gallery

A simple medical technique could have prevented the death of Michael Jackson, a leading anaesthesiologist told jurors today.
Doctor Steven Shafer said lifting the chin of a patient under anaesthetic to clear the airwaves should be the first thing a doctor tries to revive someone who has stopped breathing.
The jury in the trial of Dr Conrad Murray, Jackson's private doctor, was also shown a dramatic video re-enacting how the singer stopped breathing after taking a deadly cocktail of drugs to help him sleep.

Dr Shafer, an Ivy League professor, told Los Angeles Superior Court that Murray didn't try the life-saving technique after Jackson stopped breathing on June 25, 2009 at his home.
Murray has pleaded not guilty to involuntary manslaughter.
Dr Shafer said: 'The most likely thing that happened was that his airways were obstructed. Michael Jackson was trying to breath but his tongue got stuck in the back of his throat.
'A simple chin lift or the use of an instrument to move the tongue may well have been all that was needed to save his life.'


Prosecutors claimed that Murray returned to the singer's bedroom after going to the toilet for two minutes to find his famous patient had stopped breathing and immediately began CPR.
The Columbia University professor listed a series of 'egregious' violations in the care of the singer, including the failure to have a machine with an alarm to check Jackson's pulse.

If Murray had the appropriate machine 'it would have saved Michael Jackson's life'.
Dr Shafer said: 'Michael Jackson died because he stopped breathing - that is expected when you administer intravenous sedatives. You just have to open the airways so oxygen can get through.'
He also told the court there was no evidence that Jackson was advised not to eat or drink anything for eight or nine hours before being given the powerful sedative Propofol.

Dr Shafer, a world expert on Propofol, added: 'He was not at average risk, he was at greatly increased risk of vomiting and having it go back into his lungs.'
He criticised Murray for having no suction equipment in Jackson's bedroom, telling the jury that the smallest amount of vomit in the lungs could prove fatal.
The lack of an infusion pump to control the administration of Propofol could have also have caused a lethal overdose.

The jury was shown a re-enactment of how the singer stopped breathing after taking a cocktail of drugs.
The film showed an actor suffering a cardiac arrest after being administered with Propofol, the powerful hospital anaesthetic blamed for Jackson's death. Life-saving techniques were demonstrated including CPR and attempts to ventilate the lungs.
Some of the more shocking elements were cut from the film following complaints from Dr Murray's defence lawyers.


The mock collapse in the video ends with the patient being saved by doctors.
In the public gallery, Jackson's mother Katherine, could be seen shaking her head as she saw how efficiently the doctors in the video worked to revive their patient with the proper equipment and a team of staff.
Prosecutors screened the video to show the jury how Propofol is administered in a hospital setting.

Defence lawyer Ed Chernoff objected to the screening, claiming it was a 'terrifying dramatisation of someone suffering a cardiac arrest'. He said it was being shown to try to inflame the jury.
He was overruled by Judge Michael Pastor, who nevertheless agreed to censor some of the more powerful scenes, including some in slow motion, saying they were irrelevant.
The silent video was taken inside an operating theatre. An anaesthesiologist is shown administering Propofol.
Prosecutors have accused Murray, 58, of being woefully unprepared when he administered Propofol to Jackson to treat the 50-year-old performer's chronic insomnia.

Experts have accused Murray of delaying too long before calling for help after discovering Jackson had stopped breathing and not having vital equipment on standby.
The video, 'An Overview of the Safe Administration of Propofol', was shown during the testimony of the prosecution's final witness, top anaesthesiologist Dr Steven Shafer.

Dr Shafer made the video and gave a running commentary on how the patient should be treated in an appropriate hospital setting.
He insisted all the steps and equipment should be used 'every time for every patient - no exception'.
Dr Shafer added that he was giving evidence for free because he was worried that the reputation of other doctors and anaesthesiologists would be tarnished by the trial.

He said: 'Every day I am asked, ''Are you going to give me the drug that killed Michael Jackson?'''
'Propofol is an outstanding drug. I want people to know that when people are given this drug by people who know what they are doing it is safe.'


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