Sunday, 23 October 2011

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 27th June 2009, two days after Michael’s death.

On June 25th 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 26th 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 27th 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.

25th June 2009

Murray spent every night at MJ's house (except Sundays). This was at the request of Jackson. On the 24th 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 25th 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 25th 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 25th 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 25th 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/


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