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/