People vs. Conrad Murray - Day 13

We have now entered week 4 of the trial and day 13 of proceedings. Court was cancelled Friday due to scheduling problems. Monday was cancelled due to death of the witness’s father. Tuesday was cancelled due to scheduling problems. Court resumed on Wednesday 19th October.

Dr Steven Shafer

Today's testimony came from Dr Steven Shafer, a Propofol expert. Dr Shafer is the last of the prosecution witnesses. Dr Shafer was hired by the pharmaceutical company that makes Propofol 20 years ago to calibrate the correct dosing of the drug. Dr Shafer also helped write the guidelines that are on each bottle of Propofol.

During his testimony Shafer stated he found 17 "egregious violations" of standard medical care by Conrad Murray which contributed to the death of Michael Jackson.

Shafer started by discussing the dosing of Propofol. Shafer testified that giving the exact dose is crucial. Even the smallest discrepancy in a dose will change whether a patient sleeps for minutes or hours. It has already been stated in this case that Murray had no equipment for ensuring the correct dosage of Propofol was administered. Dr Roberts, the pathologist who conducted Michael Jackson autopsy, stated that because of this is was very likely Murray had given Jackson too much Propofol which then contributed to his death.

Propofol video

The court was then shown a video of how Propofol should be correctly used in an operating room. The video also showed what medical staff should do if the patient was to do into cardiac arrest. The video showed that Murray did not have the right sort of equipment present if a medical emergency, such as if Michael were to stop breathing. Dr Shafer also detailed how Propofol should correctly be administered. A regulatory pump must the only equipment used to infuse Propofol to avoid an overdose. Murray was administering a powerful drug without the proper administering, monitoring or lifesaving equipment. Shafer stated Murray’s actions were an egregious violation of care and were a contributing factor in Jackson's death.

A topic that has been discussed on a number of occasions during the trial is whether a doctor should still undertake procedures that a patient does not need just because the patient has asked for it. Some people believe that if the patient has asked for it then they know the risks and if something were to go wrong then it was an informed choice. Others believe it is unethical for doctors to partake in this. Dr Shafer told the court that a sign “Informed Consent” form is needed with treatments as this confirms that the patient has received from the doctor details of the risks, benefits and alternatives to the procedure. He also stated that a verbal agreement is not binding. Even though Michael had asked for Propofol Shafer states Murray acted like an “employee” and not a doctor. Shafer stated "saying 'yes' is not what doctors do…A competent doctor would know you do not do this." Dr Shafer also reiterated, as have a number of the medical experts who have testified, that keeping up to date medical record is paramount. The fact that Murray did not have any notes is something Shafer think is “unbelievable.” Dr Shafer testifies that when Jackson was under sedation from Propofol Murray should have been writing notes minute by minute. By not doing this is was a denial of Jackson’s rights.

Propofol guidelines

Dr Shafer told the court the importance of following the guidelines (that he helped to produce). Shafer stated that even when administering a small dose of Propofol the guidelines must be adhered to as there are potential disasters that can happen when a patient is sedated if a doctor “cuts corners.” If a disaster were to occur, such as in this situation when Michael Jackson stopped breathing, the first thing a doctor should do is call for help. Murray took 20 minutes to call for paramedics, of which Shafer said "I almost don't know what to say. That is so completely and utterly inexcusable."

Dr Shafer also stated that Propofol must be used on an empty stomach. If not the patient may vomit and may choke to death, or the vomit may enter their lungs. Shafer states there is no evidence that Murray had told Michael to not eat for 8 – 9 hours before he was due to have the procedure. Shafer said “he was not at average risk, he was at greatly increased risk of vomiting and having it go back into his lungs”. Dr Shafer also criticised Murray for not having any suction equipment available if Jackson were to vomit. This could have proven fatal.

When speaking about Michael’s death Dr Shafer stated that “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.” This is yet another witness who has stated that if Murray had performed basic medical procedures properly and called help right away that Michael Jackson would be alive today. To hear this from one witness would be a bold statement. To hear this from several makes it a tragedy.

Dr Shafer went on to say that a doctor should never multi-task when monitoring a patient that is sedated. Shafer said "A patient who is about to die does not look all that different from a patient who is OK."
The fact that Murray left the room, to either use the bathroom as he states or make phone calls as his phone records and numerous witnesses testify, Murray effectively “left the steering wheel”. Shafer labelled Murray as “quite clueless.”

Shafter also stated that the 15.5 litres of Propofol Murray had purchased to use with Michael Jackson was “an extraordinary amount” for one person. Shafer also said that many articles have been produced about Propofol but only one has been written about Propofol and insomnia. Shafer told the court "we are in pharmacological never-never land here, something that was done to Michael Jackson and no-one else in history to my knowledge."

Dr Shafer also stated that he uses Propofol every day in his job and every day a patient will ask “are you going to give me the drug that killed Michael Jackson?” Shafer blames Conrad Murray for giving Propofol a bad public reputation.


Summery

This is yet another damning testimony and yet another blow to Murray. The prosecution left Dr Shafer til last as he is a Propofol expert and they knew his testimony was vital to their argument. It seems no matter what was you look at the events that took place on 25^th June 2011 it always comes back to the fact that Murray was underprepared for a medical emergency and didn’t really know what he was doing when administering Propofol. His actions after Michael stopped breathing were also inexcusable and most importantly completely ineffective. The fact that multiple medical experts have testified that Michael Jackson would be alive today if Conrad Murray had acted accordingly is shocking.

At this time in the trial I believe Murray will certainly receive a guilty verdict. The sentencing is the part that is still undecided.

Dr Shafer's testimony will conclude on Thursday. This will then close the prosecution’s argument. The defence will then call forward their witnesses.

The trial continues tomorrow.

Sophie Dewing

 http://exploredreamdiscoverblog.blogspot.com/

People vs. Conrad Murray - Day 12

Today was day 12 of the People vs. Conrad Murray trial in relation to the death of Michael Jackson. Dr Nadar Kamangar, a sleep expert, resumes his testimony. Today’s session was very short and adjourned early.

Dr Nadar Kamangar

Dr Kamangar continued his testimony today under cross-examination. Michael Flanagan, one of Murray’s defence lawyers, questioned Dr Kamangar about a doctor’s role and responsibilities. Flanagan asked if it is a physician’s responsibility to find out why their patient is refusing certain treatments and asking for inappropriate treatments. Dr Kamangar stated he would make sure his patient received the right care and would not undertake treatments that are not in the patient’s best interest, even if they were asking for it. Kamangar stated it was an “extreme violation of care” that Murray did this with Jackson.

Flanagan then pointed out that doctors could perform a treatment, even thought it would be considered bad medicine, and it doesn’t mean that a bad outcome would occur. Kamangar said that this does not make it acceptable; it is still grossly negligent if a doctor were to work like this. Dr Kamangar also pointed out that Murray was administering very potent drugs without appropriate monitoring equipment. This was a recipe for disaster. Administering a cocktail of drugs in an inappropriate setting was a perfect storm for Michael’s demise. Dr Kamangar was also critical of Murray not having written any notes about the drugs he was administering or Jackson’s vital signs. Kamangar stated that this was a contributing factor in Michael’s death.

The defence then questioned Dr Kamangar about insomnia. Kamangar stated it was obvious MJ was suffering from insomnia. He also stated that Jackson’s dependency on other drugs and anxiety could have caused his insomnia. Flanagan put forward that if used in a clinical setting Propofol is an acceptable treatment for insomnia. Dr Kamangar stated he did not have enough information to answer but it is still incomprehensible to use Propofol in a home setting. The defence then mentioned a study conducted in Taiwan in 2010 where patients suffering from insomnia were successfully treated with Propofol. Dr Kamangar pointed out this study took place a year after Michael Jackson’s death and was conducted in a hospital.

Dr Kamangar then testified that Lorazepam has no role in treating insomnia. He takes this stand point as patients can become dependent on it therefore making an inappropriate treatment for sleep problems. Kamangar stated he would only prescribe oral Lorazepam for patients with anxiety, and only for short term use.

Dr Kamangar then went on to discuss Jackson’s drug dependency. He was critical about Murray not addressing Jackson’s addiction. As Murray mentioned in his police interview Michael would visit Dr Arnold Klein three times a week and would come back ‘wasted’ and had slurred speech. Kamangar states if your patient was in this state you should discuss this with them. Kamangar also states that if people had mentioned a change in Jackson’s behaviour or concern about Michael, Murray should have looked into it.  From previous testimonies we know that Frank DiLeo had asked Murray to get blood tests as he was concerned about if Jackson was taking drugs. Kenny Ortega also had voiced concern to Murray about Jackson’s wellbeing. Murray then told Ortega to mind his own business, Michael was fine. And in his own police interview Murray stated that MJ’s production team worried about Michael after he returned from visits to Dr Klein.

Dr Steven Schafer

The last person to testify was Dr. Steven Shafer, an anaesthesiologist and a leading Propofol expert. Dr Shafer had only just taken to the stand when the court was adjourned due to scheduling conflicts. Court was also postponed until Monday morning. Dr Shafer’s testimony will continue then.

News reports

In the press this week there have been some interesting stories about the case. One report suggests that Conrad Murray would not be on trial now if he had not himself requested to speak with police. We heard earlier this week from Detective Scott Smith that the first time the police heard about Propofol was from Murray himself. Prosecutors were not going to push for a case as they believed there was no way they could prove Murray administered Propofol to Jackson. But Murray himself admitted this and also that he had been doing it for two months solid.  This went on to prove that up until the 25^th June 2009 Murray had administered 5 gallons of Propofol to Jackson.

Detective Smith had testified that the police had no idea Murray had put a bag with Propofol bottles in MJ’s closet. When police informed Murray of this Smith stated Murray looked ‘shocked’. It seems Murray realised at that point the police didn’t know as much as he thought and he had now incriminated himself.

The police were also alerted when they realised parts of Murray’s interview were lies. This caused suspicion and lead to charges being filed.

The prosecution's argument is Murray acted recklessly and was negligent. By his own account to police Murray incriminated himself. Administering Propofol in a home setting is reckless.

Reduced sentence?

At this stage of the trial it is almost certain Conrad Murray will be found guilty. But media reports are suggesting that Murray may not spend much time in prison, if he spends any time at all. A new law was brought into effect in California on the 1^st October which states if someone commits a non-violent felony crime they cannot be sent to a State prison due to overcrowding. Instead they will be sent to a county jail. If found guilty Murray would be sent to a county jail because of this.

Currently Murray could face up to 4 years in prison. An LA County Sherriff told the media that Murray would probably only serve half of this sentence. This would make his sentence 2 years. But as there is a problem with overcrowding in county jail  non-violent prisoners with no previous criminal history will be eligible for house arrest. As Murray fits into this category he may end up spending whatever sentence he is given wearing an electronic tag but living at home.  The Sherriff did state that Murray would serve some time in prison as they would not allow him to be living under house arrest straight away.

I think it is very easy to get caught up in the verdict and forget the sentencing. It seems inevitable that Conrad Murray will be found guilty but his sentence is still something that is unsure. A possible four year sentence could be drastically reduced to an electronic ankle tag. It will be interesting to see what the outcome is.

To read more about these reports visit here.

Summery

I had previously mentioned in my post about the opening statements that I thought the jury may be hung due to what their stand point is regarding doctors giving unnecessary treatments to patients even though the patient has requested it. I found it interesting today that Michael Flanagan brought this point up. I am happy that Dr Kamangar stated that it does not matter what the patient requests, it is unethical for a doctor to perform treatments that are unnecessary and risky. Particularly when they are not in an appropriate environment. It does very much seem in the US there are two ways of thinking when you are a doctor. The doctors who are there to cure sick people, and the doctors who are there to make money. In this case it shows that Murray is in no way unique by performing unneeded procedures on patients. As we have heard with Jackson alone he had multiple doctors throughout the years prescribe him many different drugs and administer Propofol. Lest we forget this will be happening with many patients and doctors across the US. But it does bring hope that the whole of the medical care system is not corrupt when many of the doctors who have testified so far have condemned Murray’s actions and ethics.

I do find the defence’s arguments to be a bit scattered. First they suggest that other people were to blame for not reacting quick enough, then they suggest Michael administered the dose himself and now they talk about the liability of who is responsible if a patient has asked for a treatment. Instead of having one argument and sticking to it the defence seem to be flimsy and whenever the evidence stacks against them they change their argument. It does seem as if they know Murray is guilty of negligence and reckless behaviour but need to try to persuade the jury in any way that maybe he is less accountable due to other circumstances. As I mentioned before it does seem now that the trial is merely a formality. The defence know Murray will be found guilty but his sentence may be reduced if they can try and make other people or circumstances accountable.

The trial enters week four and resumes on Monday.

Sophie Dewing (@sophiedewing)

http://exploredreamdiscoverblog.blogspot.com/

People vs. Conrad Murray - Day 11

The trial has now entered day 11 of proceedings and the prosecution are getting towards the end of their witnesses.

Dr Alon Steinberg

The first person to testify today was Dr. Alon Steinberg, one of the leading cardiologists for the California Medical Board. Dr Steinberg made it clear that he was a cardiologist and not an anaesthesiologist. The key point Dr Steinberg made was that he found six separate deviations of standard of care from Conrad Murray in regard to Michael Jackson and each one showed “gross negligence”.

Dr Steinberg testified that he reviewed the case by reading the transcript of Murray’s interview with the LAPD so he could “judge Dr. Murray on his very own words." The main comments Dr Steinberg made were that Propofol should only be used in hospital and using it would require an anaesthesiologist. He said he had never heard of anyone using Propofol to treat insomnia. Steinberg stated it is gross negligence to use Propofol in this way. He also stated it was unethical. He went on to say that using Propofol in a home without proper medical equipment or staff is also gross misconduct. Because Murray did not have the correct essential medical items he was not prepared if complications were to arise. The equipment he did have, like the pulse oximeter, did not have an alarm so unless constantly monitored this device is useless. Dr Steinberg believes Murray should have had an assistant at all times.

Dr Steinberg then went on to discuss the events that took place on the 25^th June 2009. Steinberg stated that Murray should have called 911 immediately. Help could have arrived in 4 minutes. Crucially Dr Steinberg testified that if Murray had done this Michael Jackson would be alive today. Steinberg told the jury that "for every minute of delay there's less and less chance the patient will survive." It took Murray 20 minutes to call paramedics. During these 20 minutes Murray tried to save Michael’s life himself. The methods he used were inappropriate according to Dr Steinberg. Steinberg testified that when Murray noticed MJ was not breathing he started chest compressions. This was completely wrong because when people stop breathing their heart is still pumping. They do not need chest compressions. Instead Murray should have used an ambubag straight away and administered Flumazenil to try to reverse the affect of the Propofol and the other sedatives. The priority was to get oxygen into Michael and the fact that Murray performed CPR was 'inexcusable'. Murray also wasted time by calling Michael Amir instead of getting an ambulance. Dr Steinberg said Murray’s reaction and behaviour were “bizarre”. Dr Steinberg also stated that even if Jackson had self-administered the Propofol Murray had still failed to monitor him properly and this negligence still makes Murray accountable.

Dr Steinberg then went on to detail other errors Conrad Murray made. Murray did not make any notes. This is vital so the patient can continue to receive the right care in the future but also important for legal and insurance purposes. Records can also be checked to see if mistakes were made. The defence did try to argue that Murray did not need to write notes as he only had one patient. Dr Steinberg stated that Murray should have still been writing notes because when he arrived at UCLA he couldn’t remember what he had given Jackson so was unable to tell the doctors. This can make the difference between a patient living and dying.

A very interesting point Dr Steinberg made was that Conrad Murray was not board certified on June 25 2009 when MJ died. This is huge. This basically means that in California (at least, I am not sure about other states) Conrad Murray was not registered as a doctor.

Dr Steinberg went on to further criticise Murray for leaving Michael on his own as he states "it's like leaving a baby that's sleeping on your kitchen countertop,". Steinberg also said that according to the transcripts Murray gave Michael a drip of Propofol in addition to the 25mg he had already given him. The drip would have been needed to keep Michael under and to remain asleep.

Steinberg stated Murray's breeches in care "directly contributed to the untimely death of Michael Jackson."

A major development then occurred. Murray’s defence team announced they were no longer contending the Michael Jackson drank Propofol. They still will argue that Jackson gave himself the fatal dose but not orally. This is a crucial point in the trial and it will be interesting to see just how the defence will now alter their argument.

The defence also suggested that the two minute toilet break that Murray told of in his police interview wasn’t accurate. Murray’s statement is improbable and it had previously been testified that it would be difficult for someone who is sedated to suddenly sit up and then have the knowledge, skill and ability to administer Propofol themselves, particularly in a two minute timeframe. Previous phone call records and numerous testimonies from people who spoke to Murray that morning have already proven that in the hour leading up to Jackson’s death Conrad Murray was on the phone for 46 minutes. The police also never believed Murray only left for a two minute break. The admittance that Murray may have been out of the room for longer may play into the defence’s hands as it gives more time for Jackson to have self-administered Propofol. Although with testimonies from medical professionals who state this is still very unlikely it seems implausible that this is a strong enough argument to turn the case in Murray’s favour.

Dr. Nadar Kamangar

The final testimony of the day came from Dr Nadar Kamangar, a pulmonary and critical care doctor who specializes in sleep medicine. Dr Kamangar stated that he uses Propofol on a daily basis but it is a drug that can be extremely unpredictable especially when used with other sedatives. Kamangar testified that patients who have been administered Propofol need to be closely monitored as their condition can change rapidly. Dr Kamangar also stipulated the importance of using an automated pump when administering Propofol so the dosage can be regulated. This is vital as Propofol is so powerful.

Dr Kamangar then went on to discuss Conrad Murray directly. Dr Kamangar testified that he found "multiple extreme deviations" in Murray's standard of care calling his use of Propofol "inconceivable," "unethical," and "disturbing." Murray's use of Propofol outside of a highly monitored facility was "inconceivable." Kamangar stated Murray's treatment of Michael Jackson amounted to "gross negligence."

Dr Kamangar told the jury Murray should have never given Jackson any sedatives at all because he was dehydrated. This means his blood pressure was already low. Kamangar stated Murray’s CPR was poor and in violation of standard of care. Much like Dr Steinberg, Dr Kamangar believes Murray wasted time calling Michael Amir instead of 911 and not calling them right away was an "unconscionable deviation of care".

Kamangar also stated that by withholding information from the doctors at UCLA Murray broke the first rule of medicine – putting your patient first. Kamangar also believed it was unethical for Murray to ignore signs of Michael’s drug dependency.

Summery

Today was a turning point in the trial as the defence have admitted that Jackson did not drink Propofol. They still will argue that Jackson killed himself but the Propofol was not taken orally.

The past few days have also seen Conrad Murray come under very harsh criticism from many medical professionals. Multiple testimonies have stated that Propofol is inappropriate to use in a home setting and that many standards of care were not met. The key phrase seemed to have been ‘gross negligence’. Seeing as the prosecutions argument is that Murray was negligent and abandoned Jackson when he was administering a risky treatment, currently it is almost certain Murray will be found guilty. The witnesses to testify so far have solidified the prosecutions argument.

The trial continues tomorrow with Dr Kamangar finishing his testimony.

Sophie Dewing (@sophiedewing)

http://exploredreamdiscoverblog.blogspot.com/

People vs. Conrad Murray - Day 10

We are now on day 10 of the trial and have entered the third week of proceedings.  Today the final section of Conrad Murray’s interview with police is to be heard in court.

‘They cried and cried and cried

In the first part of the audio recording of Conrad Murray’s police interview, played last week, Murray detailed what happened on the 25^th June 2009 until Michael Jackson was pronounced dead by the doctors at UCLA hospital. Today the audio recording picks up from the point where Murray tells Michael’s children he is dead. Murray told the police that he consoled Prince, Paris and Blanket and said the children ‘cried and cried and cried’. Paris Jackson told Murray she didn’t want to be an orphan and how she 'will wake up in the morning and I won't be able to see my daddy.' Murray told Paris ‘'I tried my best.' According to Murray Paris responded, "I know that, Dr Murray. At least I know. I know you tried your best, but I'm really sad".'

Murray then spoke of how Michael’s children asked to see his body. A social worker said this was a good idea as it would give them closure. Katherine Jackson, Michael’s mother, did not want to view the body. Murray said during this time members of the Jackson family started arriving at the hospital. Joe Jackson, Michael father, did not show up.

A member of the Jackson family asked Murray if he knew why Michael died. Murray replied ‘no’.

Murray then joined Jermaine Jackson and the family’s lawyers to help draft a press release. Murray then left the hospital.

Murray cites Dr Arnold Klein

In Murray’s interview he told police that MJ visited other doctors. Murray stated that he had no idea what drugs the other doctors were prescribing as Jackson never spoke about these visits. Murray testified that Michael would visit Dr Arnold Klein, Michael’s dermatologist, three times a week. When Michael returned from these visits he would be ‘wasted’ and would need 24 hours to recover. Jackson’s production team had complained about this and Murray stated the worse days at rehearsals were the days after Jackson had visited Dr Klein. Murray also said that Klein regularly prescribed Jackson drugs.

Medical history

During the interview the police ask Dr Murray about Michael’s medical history. Murray said MJ had a bad fungal infection in his toes and very bad callouses. He also thought Jackson’s eye sight was so bad that he was legally blind.

The police then asked about medication’s that Jackson used. Murray told the police that his medical bags containing the Propofol were still in Michael’s closet. The police then revealed that at Jackson’s house they found rancid cannabis and an empty cigarette packet. Murray was shocked at this and stated Jackson was not a smoker.

The audio recording then finished.

Detective Scott Smith

After the audio recording finished one of the detectives who performed the questioning took to the stand. Detective Smith had previous testified that he did not speak to Conrad Murray at UCLA hospital. When he tried to call him that night Murray’s phone went to voicemail. On the 27^th June 2009, two days after Michael’s death, Murray’s lawyers contacted LAPD to say that Murray wanted to speak with them. Detective Scott Smith stated that the interview was just to try to find out some information as they knew nothing at the time. It was not an interrogation. At this point the coroner’s office was still the lead agency. LAPD were just assisting them. Smith also said that at no point in the interview did Murray or his lawyers try to restrict or not answer certain questions.

Smith testified that the first time Murray mentioned Propofol was during this interview. Smith stated that Murray seemed surprised, and his eyes grew wide, when he learnt that LAPD had not recovered his medical bags from Jackson’s house which contained the Propofol.

On the Monday following the interview the LAPD issued search warrants on MJ’s house and the tow yard where Murray car was parked. No Propofol was found in Murray’s car, only his contract and business cards.

The LAPD also got search warrants for various addresses associated with Murray. They searched Murray’s home, Murray’s practice and in Murray’s self-storage unit. Propofol was not found at any of these addresses. Once the LAPD recovered Murray’s invoices from a pharmaceutical company they then searched Murray's girlfriend home in Santa Monica, as this is where the delivery address was. No Propofol was found here either.

Smith then went on to say that Michael’s house was not locked down in the days after his death. Chernoff stated that anyone could have then ‘rummaged around’.

Detective Smith also stated that Alberto Alverez did not mention putting any items into a bag until four days after the cause of death was released in August 2009.

Defence attorney Ed Chernoff accused Detective Smith of taking shoddy notes during his search. Smith admitted that in his notes he did not mentioning finding a bottle of Propofol inside the IV bag that was found in Jackson’s closet. This has been a reoccurring theme as people such as Elissa Fleak, the coroner’s office investigator who conducted the investigation at Jackson’s house, also did not mention this in her notes.

           

Dr Christopher Rogers

Next to testify was Dr Christopher Roger, a pathologist, who conducted Michael Jackson’s autopsy.

Dr Rogers started by testifying about the condition Jackson was in. He stated Michael Jackson weighed 136 pounds. He was thin but his body mass index was within a normal range. The court was then shown a photograph of MJ’s body during the post-mortem. This was quite shocking and I had been assuming throughout the trial that during the pathologists testimony that photos of the autopsy would be shown. To be fair in my opinion although MJ looks thin he did not look as unhealthy as I was expecting.

Dr Rogers went on to say that Jackson was healthier than most people his age. Jackson did not have heart disease and did not have any build-up of fat or cholesterol in the blood vessels in his heart. This is unusual for a person his age.

                                   

Dr Rogers said he could not determine the cause of death from the post-mortem. He ordered toxicology tests and read a transcript of Murray’s police interview to get a clearer picture. He also tried to get Jackson’s medical records from Murray so he could see what meds had been administered that day. He was unable to view these. Eventually Rogers concluded that a combination of sedatives caused Jackson’s heart to stop. He declared that the official cause of death was acute Propofol intoxication with contributing factors from other sedatives.

A vital moment in Dr Rogers testimony was when he stated there was no liquid, and specifically no white liquid (as is Propofol) in Jackson’s mouth, oesophagus or stomach. This is yet another huge blow to the defence’s argument that Michael drank the dose of Propofol that killed him.

Dr Rogers later determined the manner of death was a homicide because the Propofol was administered by another person other than the patient. Rogers also dismissed the defence’s claims that Jackson drank the dose of Propofol that killed him whilst Murray was using the bathroom. Dr Rogers stated that it was a too-short amount of time for Michael to self-administer the drugs and for it to then have enough time for it to stop Jackson breathing.

Rogers went on to say that it was not appropriate to give someone with sleeping troubles Propofol as the risk is too great. The setting was outside a hospital or clinical environment and Murray lacked the necessary equipment to keep Jackson alive in case of an emergency, such as if he was to stop breathing.

Dr Rogers told the court that Propofol needs to be constantly dripped into the patient and around 2 – 3 tablespoons of Propofol would be needed an hour to keep a patient asleep. There were no precision dosing devices found in Michael’s house so it would have been easy for Murray to administer too much Propofol.

Summery

It seems over the past few days of the trial each testimony becomes more and more damning against Murray. There have been so many testimonies, ranging from Dan Anderson and the toxicology report to Dr Christopher Rogers, the pathologist, that state that there is no way an oral dose of Propofol killed Michael Jackson. In fact they both testified that Propofol wasn’t even ingested orally at all. This makes the defence’s argument that Jackson killed himself completely implausible. It will be interesting to see how the defence will regroup as their key argument has now been completely torn apart.

I thought that was it very interesting that in Murray’s interview he mentioned Dr Arnold Klein many times. During the opening statements the defence put forward one of their arguments that Dr Klein is responsible for addicting Michael Jackson to drugs. Even if this is the case, and it is obvious that throughout the years many different doctors had prescribed drugs to Jackson and some had even administered Propofol to him, this case is about what happened on the 25^th June 2009. Because of that it doesn’t really matter if Dr Arnold Klein did get Michael addicted to drugs as he was not the doctor who administered a fatal dose of an unneeded drug on that day. As I have previously mentioned the case is solely about did Conrad Murray react appropriately to a situation and did his actions lead to Michael Jackson dying. Therefore it is irrelevant what other doctors did, although I would argue their actions did play a part in the lead up to Jackson’s tragic end.

It does feel like the defence are clutching at straws. At times it feels as if the trial is just formality. The defence seem to know the evidence against Murray is overwhelming but as they are representing Murray they have to put some sort of argument forward. They are trying to see if any little irregularity that will create a crack in the prosecutions argument and it is a tough job.

We are drawing ever closer to the final prosecution witness testimonies. It is predicted in the next few days the defence will be able to start calling their witnesses. I believe it will be very interesting to see who the defence call to testify and if the defence change their arguments at all, as the evidence so far has disproved a lot of their theories.

The trial continues tomorrow.

Sophie Dewing (@sophiedewing)

http://exploredreamdiscoverblog.blogspot.com/

People vs. Conrad Murray - Day 9

Today the second week of the trial draws to a close. Day 9 was due to be interesting as a two hour interview the LAPD conducted with Conrad Murray was due to be played.

Dan Anderson

Dan Anderson took to the stand again. Anderson started where he finished yesterday. He stated that no drugs were found in the saline bag that was attached to the IV stand but there was liquid in it.

Flanagan then started questioning Anderson about Propofol. Flanagan asked if the levels of Propofol were in a therapeutic range. Anderson said this was beyond his expertise but everyone tolerates drugs differently.

Flanagan then questioned Anderson about Lorazepam. Anderson was shown a bottle of Lorazepam. The directions state to take 1 x 2mg pill by mouth at night for treatment of insomnia. Anderson states that a lot more pills would need to be taken to have the same effect as an IV dose.

MJ had 11mgs of Lorazepam in his body. Anderson states that Lorazepam cannot get into the stomach via post-mortem redistribution. Anderson stated he tests for lots of drugs found in people’s stomachs that don’t get there orally.

Anderson testifies that he quickly concluded that Propofol was the most important drug in this case even though there were large quantities of Lorazepam. He thinks Lorazepam was important but the amount didn’t raise a red flag with him. However the levels of Propofol were not in a therapeutic range given the setting.

States that the level of Lorazepam in Jackson’s stomach was 1/43rd of a 2mg pill of Lorazepam.

Elissa Fleak

Elissa Fleak was recalled to the stand. She was asked to discuss some of the photographs that were shown yesterday. Fleak stated that she has since reviewed the images to determine what date they were taken on. Nothing significant or new came out of this testimony.

Scott Smith

Next to testify was Detective Scott Smith, an LAPD detective who interviewed Conrad Murray on 27^th June 2009, two days after Michael’s death.

On June 25^th 2009 at 3.30PM Smith was told Michael Jackson was dead. He went straight to UCLA hospital and stayed until 7PM. Smith did not see Murray. Smith stated that he did speak to Alberto Alvarez and Faheem Muhammad briefly at UCLA.

After leaving he went to Jackson’s house. At the time it was a death investigation and there was no information on the cause of death. The coroner’s office were the lead agency. LAPD were just there to assist Fleak and be an extra pair of eyes. It was only at a later date, after the autopsy, did the case become a homicide investigation.

Smith left the property at the same time as Fleak and MJ’s security team took over securing the house.

On 26^th June 2009 Smith attended Michael’s autopsy. There were no signs of trauma on the body.

Smith went back to MJ’s house after he heard from the coroner’s office that some items had been given to the coroner by Jackson’s family. This was a shaving kit that contained some rotten cannabis and empty prescription bottles of Temazepam. Smith stated these items had no significance whatsoever.

When at the house Smith found some empty pill bottles of Diazepam and Lorazepam in the master bathroom. Smith stated the bathroom was messy and had notes taped to the mirror.

Police interview

Smith was told on Saturday 27^th June 2009 by Murray's lawyers they wanted to meet with the detectives. Smith went with Detective Orlando Martinez and met with Ed Chernoff and Conrad Murray at 4pm at the Ritz Carlton, Marina del Ray. Smith recorded the interview. The interview was then played in court. Judge Pastor did inform that some parts of the interview had been removed as they were irrelevant.

The audio recording revealed the following;
Murray said he was Michael’s doctor since 2006 when he treated Michael’s children for the flu. In 2009 Michael’s assistant called Murray and said MJ wanted him to be part of the tour in London. Michael was elated that Murray was joining the trip.

The police asked about the health of Jackson. Murray stated Michael was very thin. Murray conducted a physical examination and there were no problems except a subluxation to the right hip (this means the ball can easily slip out of the socket and may be a few millimetres out of the socket). Michael also had a fungal toe disease but suffered no systemic illnesses. Murray believed Michael was seeing other physicians without him knowing.

25^th June 2009

Murray spent every night at MJ's house (except Sundays). This was at the request of Jackson. On the 24^th June 2009 Conrad Murray was telephoned by Michael Amir to let him know they were finishing the rehearsal and that MJ wanted Murray to be there by the time he got home. Murray arrived at the house at 12.50am on 25^th June 2009. Murray said the night went as usual. He went to Jackson's room and waited for MJ, who arrived shortly after.  After Michael arrived they spoke about MJ's day. Murray stated Michael was tired and fatigued. MJ said he was treated like a machine. Michael then showered, came back to room and then Murray then put on a cream that is used to treat vitiligo.

Murray place Jackson on a drip as MJ loses a lot of fluid during rehearsals. Murray placed an IV placed on Michael’s leg. Murray also gave Jackson a sedative of Valium. The dosage was one 10mg pill. Murray then gave a 4mg dose of Lorazepam mixed with saline around 2AM. The Lorazepam was pushed slowly through the IV. Murray stated he watched and observed Jackson. Michael continued to be awake for more than an hour. Murray testified 'I wanted to be cautious'. Murray watched Michael to see if the drugs affected him. After an hour there was no change and Michael complained about not being able to sleep. Murray then administered a different agent. He gave a 2mg doze of Midazolam which was injected slowly. This was around 3AM.

Murray continued to observe MJ who was still wide awake. Murray asked Jackson to mediate and changed the lighting to low setting and turned down the volume of the music that MJ had playing. Murray states Michael's eyes closed. Murray was grateful for that. Around 3.20AM Michael fell asleep. Within 10 minutes Jackson jumped right back up and was wide awake. Murray asked Michael to try meditating again. Jackson stated when he meditated he didn’t think about work.

At 4AM Jackson was still awake. At 4.30AM Jackson complained. He stated he had rehearsals to attend and must be ready for the show in England. He would have to cancel the performance and trip if he couldn’t function because he didn't sleep. As Murray had given Jackson Lorazepam at 2am he thought at 5am it would be reasonable to give additional 2mg doze of Lorazepam. Murray stated that did not help MJ relax. Jackson complained again that he couldn't perform and would have to cancel rehearsals. He wouldn't be able to satisfy his fans if he was not rested well. Murray stated Jackson put a lot of pressure on him to give him meds.

Murray then waited. At 7.30AM Jackson was still awake. Murray gave an additional 2mg of Midazolam. This had no effect. Murray then cautiously checked the IV site on MJ's body to ensure the IV was flowing into Jackson and not onto the bed. Murray wanted to find out why Michael was not responding to the drugs. Beyond 10AM still nothing had worked. Michael was really complaining that he could not sleep. What Murray was doing was not working. Jackson would be forced to cancel everything. Michael then said 'I would like to have some milk'. Michael stated that this was all that really worked for him. Police asked what ‘milk’ was. Murray told them Propofol. Murray explained to the police that Propofol is a sedative that can be used for anaesthesia. It is used in IV form.

At around 10.40AM Murray gave Jackson Propofol. Murray remembered the time because he checked to see if administering Propofol at that time would ensure that Michael's day could still be productive as he needed to get up for rehearsal. Jackson stated 'just make me sleep no matter what'. Murray agreed to switch to Propofol. Murray stated he would give small amounts to get Jackson to sleep. He administered 25mg of Propofol diluted with Lidocaine (this is needed as Propofol creates a burning sensation when administered on its own). Murray stated he slowly infused the medicine over 3 - 5 minutes. Michael fell asleep.

Murray told police he took all the precautions available to him. He made sure there was oxygen and he had a pulse oximeter to check oxygen saturation levels and Michael’s heartbeat. Police ask if Jackson had asked for milk before. Murray stated he had given Jackson Propofol before. On the 25^th of June 2009 he took precautions and gave a lower dose than usual as he had been administering different drugs to MJ throughout the night. He would usually give a higher dose without the use of other agents. The most Murray had ever given Jackson was 50mg.

History of Propofol use

The police ask Murray how many times he administered ‘milk’ to Jackson. Murray stated he had given it more than ten times, much more. Murray states he was administering Propofol to Jackson for the whole two months he had been working with him. Murray continued by saying it was 30 days of the month, every day with the exception of the three days leading to Jackson’s death. Murray testified during that time he was trying to wean Jackson off of Propofol.

Ed Chernoff (Murray’s lawyer, who was present at the interview) asked if Murray was aware if MJ was taking Propofol before Murray started working with him. Murray stated he was surprised by the amount of pharmacological knowledge Michael had. He knew about a lot of medications use for insomnia. Murray stated most people don’t know what Propofol is. Michael told Murray he had been given Propofol before. Murray also stated Jackson called Lidocaine ‘anti-burn’ as it is used to stop the burning sensation from when Propofol is injected into the vein. Jackson stated without ‘antiburn’ Propofol is very uncomfortable. Murray said Michael used Propofol in Germany and many other places. Murray states that although Jackson never administered Propofol to himself the other doctors allowed him to infuse it into himself. Jackson asked to do this but Murray refused. Jackson said he loved to push it [the syringe].

Chernoff stated ‘milk’ was Jackson’s idea. MJ knew what it was, what to do and how to inject. Murray continued by saying Jackson knew it was the only treatment that worked for him. Murray was cautious about using Propofol as a treatment and thought it would be better to not use it and try to get Michael back into a normal sleeping pattern. Murray wanted to try to reduce the frequency that Michael used Propofol.

Police then asked who was Jackson's doctor was before Murray was hired. Murray testifies that MJ told him there were a few doctors in Germany he had used. At this point Murray stated that Michael's veins were sclerotic, clogged up and he could barely find sites for IV's. Michael had been given too many IV over time.

In March / April 2009 Michael called Conrad Murray to say he was in Las Vegas with his children to see a show. Michael told Murray he could not sleep. MJ asked if Murray could help him to sleep. Murray asked if Michael had any Lorazepam or Midazolam. Michael said they didn't work. Murray than stated that MJ told him he had meds from Dr Klein and Dr Metzger and they didn't work. Murray then told Jackson he didn't have anything he could offer. MJ then asked for Propofol. Murray asked Michael why we would ask for Propofol. Michael stated it was the only thing that worked. Murray told MJ that Propofol was not a medicine and he didn't have access to those sorts of products and it was a weekend so he couldn't order any.

Michael then asked if Murray knew Dr Adams. Michael told Murray that Dr Adams had given him Propofol in Vegas many times before. MJ then called Murray back with Dr Adams telephone number and requested Murray phone Dr Adams to ask if he could help him. Usually Dr Adams would take Michael to a plastic surgeons office. The office stated that Dr Adams and Jackson couldn't use the surgery unless MJ had a cosmetic procedure. Michael could be asleep whilst they do the procedure. Dr Adams could not get cosmetologist to open on that day so Conrad Murray allowed Dr Adams to use his office where he had oxygen, a crash cart and a pulse oximeter to treat Jackson. Murray testifies that he met them and then left them.

Murray stated when he returned to his office Jackson told him he felt wonderful as he had slept. Jackson said when he sleeps for 15 - 18 hours he feels good. Michael went on to say then when he is on tour he has trouble sleeping. He knew that 15 – 18 hours was too long a time for one doctor to monitor him so he would need two doctors. Murray was then asked if he wanted to be a part of this two doctor team. Murray stated he wasn’t sure but then agreed. Dr Adams was very keen to go to England and told Murray he was going to ask for $1, 2 or 3 million to do so. Murray also claimed that Dr Adams told him that Michael loved Propofol.

The tour in UK would be a year contract. MJ said he wanted Conrad Murray to be around forever. Jackson told Murray he wanted to open a hospital and for Murray to be the medical director.

Michael stops breathing

The police questioning then returned back to Jackson's bedroom on the 25^th June 2009.  Murray stated he was monitoring MJ who was asleep but not snoring (so not in a deep sleep). Murray thought Michael might suddenly jump out of his sleep, as this was a regular occurrence. The police asked if Propofol needs continual administering. Murray stated it is dripped in slowly over time.

Murray then needed to go to bathroom so went on a 2 minute break. When he came back Michael wasn't breathing. Murray checked the pulse oximeter which gave a reading of a 122 pulse rate. Jackson’s body was warm and there was no change in colour so Murray assumed everything happened quickly. Murray immediately found a pulse in the femoral (groin) region. Murray started doing CPR and mouth to mouth resuscitation. Murray told police he did apply medicine but not at this stage. At first he wanted to ventilate and compress Jackson. He performed single man resuscitation. Murray says he saw MJ's chest rise and fall so knew he was getting oxygen into Michael.

Whilst doing this Murray looked for a phone. There were no working phones in the house. Murray stated to call 911 he would have to leave MJ. Murray couldn't move Jackson off the bed on his own so he improvised. The bed was firm but not firm enough to be effective. Murray put his hand under Michael's body to be able to give firmer chest compressions. Whilst doing this Murray used his cell phone to call Michael Amir, MJ’s PA. Murray states he told Amir to send security immediately as they had a problem. Murray didn't tell Amir to call 911 as Amir would worry about what was up.

Murray then lifted Michael's legs to put blood back to the heart. He continued CPR and mouth to mouth. He also got a syringe and Flumazenil as it is an antidote to Propofol. As Jackson also had Lorazepam and Midazolam in his system Murray needed to reverse the effects of them in case they were working together with the Propofol. Murray administered 0.2mg of Flumazenil straight into Jackson. He then continued chest compression to circulate the medication. Murray hoped the Flumazenil would reverse the meds and Michael would breathe. The Flumazenil didn't work.

Murray testified he then ran out of room and went to the kitchen. He saw the chef (Kai Chase) and said there is an emergency, get security. Security came and Murray said get 911. Murray confirmed the security was Alberto Alverez. Murray wanted Alverez to help him move MJ to the floor. After Alverez called 911 they moved MJ to the floor. Murray and Alverez did CPR and mouth to mouth until the paramedics came.

When the paramedics arrived they hooked MJ up to a pulse oximeter and intubated him. Murray states Michael was PEA (pulseless electrical activity). This means there is no need to shock patient. Instead they need to treat the underlying condition. Murray states the paramedics gave Jackson drugs; Atropine, epinephrine and bicarbonate.

Murray told police he wanted the paramedics to carry on. He stated he felt a femoral pulse soon after Michael stopped breathing. The paramedics didn’t think they could get Jackson back but Murray didn’t want them to pronounce Michael as dead.

Murray did chest compressions all the way into the ambulance. When they arrived at UCLA they went into the operating suite. There were lots of medical professionals present. They tried to save Jackson for an hour. Murray states that doctors at the hospital would have given up if Murray hadn’t of given MJ a ray of opportunity. They did everything they could for Michael but they couldn't get him back.

When pronounced dead Murray said he didn’t want to sign the death certificate as he didn’t understand what the cause of death was. No one knew why they couldn't get Jackson’s oxygen levels up. Murray told them they could not rule out pulmonary embolism (a blood clot). Murray recommended a post-mortem.

Murray told police 'I love Mr Jackson. He was my friend. And he opened up to me in different ways. I wanted to help him in any way I could. He was a single parent. You don't hear that in men'…'I loved him. We had a good relationship'.

Weaning off of Propofol habit

Murray told police that after joining the team Michael wanted nightly doses of Propofol. Murray would be there if something was to go wrong and to care for MJ. At this point Murray realised this could be a
habit. Murray stated if you are accustom to any agent it could become a dependency. He wasn’t aware of this before he started as he had never spent long periods of time with MJ. Murray also claimed he has never seen anyone addicted to Propofol.

Three days before Jackson's death Murray started to wean MJ off of Propofol. Murray did this with Michael's knowledge but Michael was reluctant. Michael was worried he wouldn’t be able to sleep. Murray told him if he could sleep more naturally it would be better for him. Michael said he just wanted to sleep. Murray could be certain he could get MJ to sleep but they needed to try.

On the first night Murray gave Jackson less Propofol plus Lorazepam and Midazolam. Michael slept for a reasonable time but MJ wanted long hours of sleep.

On the second night (the night before Michael died) Murray told Michael he had slept pretty well the night before. This night Michael couldn’t sleep. Murray then gave Michael Propofol. Murray told police this was because he cared about Michael and didn’t want to see him fail.  

The court was then adjourned.

Summary

Today was a very interesting and a major moment in the trial. In the audio recording of the police interview Conrad Murray seemed genuine. But we must remember that interview was conducted two days after Michael Jackson died, and as Ed Chernoff was there I assume Murray and Chernoff had decided what they would say before they entered. Nonetheless it does come across that Murray did not intend to kill Michael Jackson.

I also found it interesting that until this point I had viewed Murray as a bit of a bumbling idiot who had no clue what he was doing. During the interview Murray came across as a lot more intelligent and more qualified than previous testimonies or articles would suggest. Murray’s account also did seem to show that Michael was manipulative to get Propofol. He put a lot of pressure on Murray by saying the rehearsals and maybe the tour would have to be cancelled if he didn’t sleep. But just because a patient wants something doesn't mean you should give it to them (particularly if you are not trained in the field or in a clinical setting).

On the other hand there were many inconsistencies in Murray’s account. The biggest one being that Murray told police he only left Michael for two minutes to use the bathroom. Testimonies from mobile phone providers and various witnesses prove that Murray was on his phone. The court were told in the hour leading to MJ’s death Murray was on the phone for 46 of those minutes.

Murray also implied that he called paramedics rather swiftly considering the circumstances but the paramedics and phone records show Murray waited 20 minutes.

There was a few other comments Murray made that I found unusual. As Murray seemed to state that he didn’t think it was right that someone use Propofol if they were unable to sleep then why would he give Dr Adams access to his Las Vegas surgery to conduct this procedure? Why would Murray then agree to be Michael’s doctor and to carry out this procedure for two months?

Murray implied that pretty much as soon as he started working for MJ that he thought Michael may have a dependency on Propofol. Is this is the case why not inform anyone? Earlier in the trial we heard an audio recording of Frank DiLeo stating Murray needed to give Michael a blood test to ‘see what he is doing’. This implied DiLeo thought Michael had a drug problem. If Murray was pretty sure he did then why didn’t he mention this to DiLeo? Also when Kenny Ortega confronted Murray about Michael’s health and wellbeing Murray told Ortega that he was a doctor and Ortega should mind his own business, Jackson was fine. If Murray thought Jackson had a Propofol addiction then why didn’t he agree with Ortega and together they approach AEG?

I also found it interesting that Murray mentioned Dr Klein and Dr Metzger had given previous given MJ drug in his interview with the police. It seems this may be a tactic to pass the buck as one of the arguments the defence will being is that it was Dr Arnold Klein that got Michael addicted to drugs. Lest we forgot that over the years many doctors had been prescribing drugs to Jackson that he didn’t need and various doctors had administered Propofol to him. It seems unfair that Murray be the only doctor who is held accountable to this as it seem they all played apart. But at the same time this court case is about what happened on the 25^th June 2009 which caused Michael Jackson to die. Under those circumstances Murray can be the only one accountable (although as I have previously mentioned a lot more people are culpable in this case. Murray is just the fall guy it seems)

I also found is quite disgusting and exploitative when Murray mentioned the cosmetic surgery office would only let Dr Adams use their surgery if Michael had a procedure. This further proves how vital it is that the US health care system be looked at. It is disgraceful that medical professionals are willing to not only perform unnecessary treatments or give unneeded drugs but in some circumstance even force treatments onto people just to make more money. This horrifies me. Of course Jackson was asking for Propofol but he was an addict and addicts will go to any lengths to get their fix. But it is a chicken and egg situation. Jackson would never have gotten addicted to Propofol unless doctors had gone against ethics and repeatedly administered it to Jackson when he didn’t need it.

The final part of Conrad Murray’s interview with the police is due to be played in court on Tuesday. It will be interesting to see how the prosecution act to this and hear Detective Scott Smith’s account.

There will be no court on Monday as it is a holiday in the US. The trial resumes on Tuesday.

Sophie Dewing

http://exploredreamdiscoverblog.blogspot.com/

People vs. Conrad Murray - Day 8

We have now entered day 8 of the People vs. Conrad Murray trial. Today the coroner investigator, Elissa Fleak, is due to continue her testimony.

Elissa Fleak

The day starts with Fleak retaking to the stand to complete her testimony in regard to the coroner’s investigation she conducted in regard to Michael Jackson. The investigation inside Michael’s house was conducted on the 25^th and 29^th of June 2009.

Yesterday Fleak was asked to confirm if the evidence produced in court were items she found at the scene in Michael’s bedroom and adjoining rooms. There were a great number of items that took up almost the prosecutor’s entire desk.

Medical records

Today Fleak discussed how Conrad Murray was subpoenaed to release Jackson's medical records. The coroner investigator is responsible for concluding whether a death was natural, suicide, homicide or accident. As well as conducting an investigation at Jackson’s home Fleak would also need background information to conclude what the circumstances of Michael’s death were. As well as Jackson’s medical records Fleak also requested radiology and psychiatric records. Fleak got medical records from Dr Conrad Murray, Dr Arnold Klein, Dr Alan Metzger, Dr David Adams, Dr Tadrissi, Dr Rosen, UCLA hospital and others.

The court were shown medical records for Omar Arnold and Paul Farnce. These were aliases for Michael Jackson. Yesterday in court evidence of prescription bottles that were found in the bedroom were shown to Fleak. Some of these were prescribed to these aliases. Not all of the documents shown referred to Arnold and Farnce. Some documents directly referred to MJ. The medical records shown go up to 2007. Conrad Murray stated he was the only doctor treating MJ since 2006. If this is the case it is unusual that Murray did not have medical records. This is something that has already been brought up in court. Dr Joanne Praschard told the court the importance of keeping medical records for the ability of other medical staff to have a detailed history of a patient so they can then treat appropriately. Murray never kept any notes from the two months he was treating MJ before his death. (I am unsure as to whether he kept any notes from before this time. Although if they weren’t presented in court I he did not).

Cross-examination

The defence then questioned Fleak about a number of inconsistencies between her testimony and photo evidence. Chernoff wanted to discuss photos that were shown in court and how some items had been moved. The main examples discussed were there was a bottle of Flumazenil that was photographed on the bedside table. Fleak had testified it was on the floor when she found it but she moved it for the photograph. Fleak admitted this was an error. Fleak did not in her original notes write that she found a bottle of Propofol inside a saline bag. Fleak told the court she was unsure of when she told the prosecution about the Propofol in the saline bag. Fleak also stated she destroyed her notes once they were written up. This is a usual occurrence.  

Chernoff tried to pick holes in Fleaks testimony and state that there were a number of errors in her report. Fleak stated this was incorrect. 

When recross-examined by Walgren he asked Fleak if she intentionally put items together. Fleak stated she did because the items were found together. Walgren also asked if Fleak conducted a perfect investigation. Fleak stated no. Walgren asked had she ever conducted a perfect investigation. Fleak stated no. Walgren concluded with asking in hindsight would Fleak have done things differently. Fleak stated she did her best but yes she would.

 Fingerprint analysis 

After Fleak stepped down Walgren read a three page stipulation regarding fingerprint analysis conducted by LAPD. The analysis found a left index fingerprint on a bottle of Propofol which belonged to Conrad Murray.

On a 20ml Propofol vial the analysis found fingerprints but could not ID them. A number of other items found in the room were fingerprinted but also could not be identified.

Jackson’s fingerprints were not found on anything or identified as being on anything. This will go against the defence as they state that Michael drank a bottle of Propofol and this was what killed him. With no fingerprint evidence of this is seems highly implausible that this could be the case and even if it was it would be nigh on impossible to prove.

Dan Anderson

Next to testify was Dan Anderson, a toxicologist and supervising criminologist for the county coroner's office. Anderson explained his role is to test for toxins in the body and to supervise the toxicologists in the coroner's office where he works. He has overall responsibility for the toxicology team.

Anderson explained that an autopsy is conducted by a pathologist. The pathologist will collect specimens that are relevant to the case (for example stomach contents). The toxicology lab then receives these specimens and they are logged into the toxicology system. The toxicology team then perform tests and assess the case. In regard to Michael Jackson all members of the toxicology team were involved in assessing the specimens.

A number of areas of the body are used for specimens. On MJ specimens were taken from central blood (heart blood), femoral blood (leg blood), liver, gastric contents (stomach contents), urine samples and vitreous fluid (fluid from the eyes). Blood from the vials that Fleak collected from UCLA hospital were used as well as blood collected during the autopsy.

Anderson stated on Friday 26th June 2009 an autopsy was conducted on Michael Jackson. Anderson attended the autopsy to let the officers know what specimens he needed. On 26th June the toxicology team started screening the specimens using the ELISA screen system. This system gives a yes or no answer as to whether a series of drugs are present in the specimens. As these tests take a while to conduct the results weren’t evaluated until Monday morning. 

Toxicology report

An eight page toxicology report was created. Most of the analysis comes from the central (heart) blood. Sometimes other specimens are needed such as femoral blood, liver etc. Anderson broke down the different types of specimen.  

Central blood is blood from the heart. Central blood is the main source for analysis.

Femoral blood is blood taken from the leg. Not much blood can be taken from here. A maximum of 10ml.

A vitreous specimen is made up of fluid from the eyes. This is a clean specimen and holds onto drugs well.

A liver specimen consists of a piece of the liver will be given to the toxicology team from the pathologist for analysis.

Gastric contents are also known as stomach contents.

Urine samples

Anderson stated that blood tests are more valuable than urine tests.

Results

The following is a breakdown of what the results showed. I will try to give additional detail or information where applicable.

Femoral blood

Positive for;

Lidocaine - 0.84 micrograms per ml (ug/ml)

Lorazepam - 169 Nano grams per ml (ng/ml) - which can be written as 0.169 micrograms per ml (ug/ml)

Propofol 2.6 ug/ml

Heart blood

Positive for;

Lidocaine - 0.68 ug /ml

Diazepam (valium) - < 0.10 ug/ml

Lorazepam (Ativan) - 162 ng/ml

Midazolam - 4.6 ug/ml

Nordiazepam (happens in body) - <0.05 ug/ml

Carbon Monoxide - <10% saturation (this reading states Carbon Monoxide was not really present. Smokers may have up to 10% saturation)

Haemoglobin A1C - 5.1% (relates to diabetes)

Propofol - 3.2 ug/ml

  

Blood from the hospital vials

Lidocaine - 0.51ug/ml

Diazepam - present

Propofol - 4.1 ug/ml

Liver specimen

Lidocaine - 0.44ug/g (results written per gram as it was liver matter)

Propofol - 6.2 ug/g

Stomach - (amounts show what have not been absorbed into the system just yet)

Lidocaine - 1.6mg

Propofol - 0.13mg

Urine - Autopsy

Lidocaine - present

Midazolam - 6.8 ng/ml

Ephedrine (a type of methamphetamine) - present

Propofol - 0.15ug/ml

Urine - Scene

Lidocaine - Present

Midazolam - 25 ng/ml

Ephedrine - Present

Propofol - <0.10ug/ml

Vitreous specimen

Propofol - <0.40ug/ml

Anderson also discussed the drugs that were tested for but found negative. No results were found for Demerol, alcohol, barbiturates, antidepressants, cocaine, cyanide, methamphetamine, amphetamine, marijuana, morphine, codeine, vicodine, oxycodone or PCP.

Some of the aforementioned drugs were specifically tested for due to media reports.

Anderson then gave a summary of the report. Propofol was found in all 8 specimen samples. Lidocaine was in 7 out of 8. Diazepam was in 2 out of 8. Nordiazepam was in 1 out of 8. Lorazepam was in 2 out of 8. Midazalam was in 3 out of 8. Ephedrine was 2 out of 8.

Anderson testified that there was more Lidocaine in Jackson’s stomach than Propofol.  The amount of Propofol in Jackson’s stomach was equivalent to a few grains of sugar. This result is negligible compared to the amount of Propofol found in blood specimens.

  

Anderson stated a few medical items were also tested. A 10cc syringe with plunger from the nightstand was tested. It was found to have liquid in the syringe which equated to 0.19grams of material (almost 4 drops). The liquid was a mixture of Propofol and Lidocaine.

Also tested saline bag and long tubing, wire connector and short tubing, syringe with needle, tip that had been cut off tubing. The results were;

Syringe - Propofol, Lidocaine and Flumazenil 0.17g

Short tube – Propofol, Lidocaine and Flumazenil 0.47

No drugs in long tube.

No drugs in saline bag.

Explaining findings

The defence questioned Anderson about why they have different samples. Anderson explained that post-mortem redistribution occurs in the blood stream. This explains the different concentrations of drugs found in different parts of the body.

Flanagan wanted to discuss some of the results that were low. Flanagan asked about the vitreous results, which found low levels of Propofol. Anderson states this is because it is only a small sample. Anderson also states that the results from the urine sample which contained less than 0.1 ug/ml of Propofol were negligible.

Flanagan also asked about the Ephedrine that was found. The results showed there was no Ephedrine in the blood but there was in the urine specimen. Anderson states that this is because traces of drugs can be stored in the bladder for days. The Ephedrine may not have been taken on the 25^th of June. Flanagan then stated that the Propofol and Diazepam found in the urine at scene could also be from days ago. Anderson agreed but stated they could also be recent. Anderson testified that the urine sample from the scene can’t really be used as a reliable piece of evidence because there is no way of knowing if the specimen actually came from Michael Jackson. It could be anyone’s.

The defence then took a different tact and stated there were significant levels of Lorazepam in the body. Anderson states it is actually within the upper therapeutic range. At no point were the levels of Propofol discussed.

Some interesting points were then made by Anderson. He stated that you cannot tell the route of administration of a drug from a blood sample. You also cannot tell what time before death the drugs were taken or administered. Each drug will have a half-life which can be used to give an estimate but often the half-life time can be plus or minus 5 hours therefore not making it an accurate reading.

Anderson also stated that just because a drug is found in the stomach it doesn’t mean it was taken orally.

An interesting fact was that the IV that was found on the pole contained no Propofol. The only place Propofol was found was in the lower portion of tubing and the syringe. This may work in the prosecutions favour as Alverez stated a saline bag with a bottle of Propofol in it was taken off of the IV stand by Alverez and placed into a blue bag. This bag was then placed into a wardrobe. Fleak also testified that she found a saline bag with a bottle of Propofol inside a blue bag in the wardrobe.

Anderson finished his testimony on this day by stating that the proportions of Lidocaine and Propofol in the lower IV line and syringe cannot be found out.

Summary

The toxicology findings are very interesting and give a clear picture of the amount of drugs in Jackson’s system when he died. It seems to untrained eyes that there were significant amounts of drugs, notably Propofol, as well as a concoction of other drugs in his body. Seven different drugs (although one is made by the body itself) were found in MJ’s system by the toxicologists. Out of the eight specimen’s Propofol was found in all eight. This is a big blow to the defence’s argument as it seems there were already excessive amounts of Propofol in MJ’s body.

Today was the first day the defence could properly start to lead towards their proposed argument that Jackson killed himself by drinking Propofol. It was apparent that the defence were trying to argue that many of the toxicology results were either negligible (because they were a small quantity) or could have been leftover traces from previous days. It was interesting that they only addressed the less important samples and did not discuss the main sample, the central blood. This may be down to the fact that large quantities of Propofol and Lidocaine were found in the central blood which goes against their argument.

The defence state that MJ drank Propofol and this is what killed him. The fact that there was 0.13ug/ml of Propofol in MJ’s stomach (approximately the same quantity as a few grains of sugar) but up to 6.2ug/ml of Propofol in other specimen’s seems to imply that the defence’s theory is highly unlikely. Anderson also stated that just because a drug is found in a person’s gastric contents this does not mean it was ingested orally. Anderson went on to state the amount of Propoofl in MJ’s stomach was negligible. Therefore I presume that this cannot have been the dose that killed MJ. It will be interesting to hear the defence present their argument after this testimony and the implications it has against their case.

I found Anderson to be very clear. He made everything understandable. Anderson did become annoyed with the questioning by Flanagan. A lot of witnesses have been obviously annoyed with the defence’s cross-examination. The only witness so far that has answered both prosecution and defence questioning in a calm and balance way has been Alberto Alverez.

Sometimes the defence’s question does seem aggressive and as if the defence are accusing the witness of being accountable. But at the same time it is the defence’s job to see if they can find any holes in witness testimonies and this often happens by using hard questioning. It is worth noting that Judge Pastor on occasion has scolded the defence for their somewhat muddled questioning and often sustains objects about the defence’s questioning from the prosecution. I think that Murray’s defence team know there is a mountain of testimonies and evidence against Murray and they are trying to put witnesses under pressure to see if they can find any holes in the testimonies that they could use to work in Murray’s favour.

Flanagan is a more aggressive lawyer but does seem to be more clear and knows what he is doing. Chernoff is often confused and doesn’t even know himself the point he is trying to make. I can understand by listening to his questioning why professional witnesses and Judge Pastor have become annoyed. I think Chernoff comes across as unprepared and it is damaging for Murray to have a lawyer like this. If your lawyer cannot present their argument or questioning in a clear and concise manner it damages your chances of getting your point across without it being able to have holes picked in it. If your lawyer confuses the witnesses and the jury is also makes it difficult for the jury to be able to have a balanced view of the case as they may not have followed what the defence have presented.

The prosecution lawyers, Walgren and Brazil, have been excellent. They are well prepared, well informed and have a very clear picture of what they are trying to paint a picture of. Because of this they know exactly the right questions to ask. Lest we forget that Jackson’s team have millions to hire the best lawyers in the world. Murray, who is virtually bankrupt, will not be in the position to hire the very best lawyers. I think this is very apparent in what we have seen in the court case so far.

The trial continues tomorrow.

Sophie Dewing (@sophiedewing)

http://exploredreamdiscoverblog.blogspot.com/