Today was day 14 of the trial and the last prosecution witness, Dr Steven Shafer, continued his testimony.
Dr Steven Shafer
Dr Shafer, a Propofol expert, took to the stand yesterday to discuss the correct methods of how to administer Propofol and if Conrad Murray had adhered to these. Shafer’s account stated that Murray was not using Propofol in a safe, or an ethical, way. He also stated Murray was unprepared for a medical emergency. Shafer explicitly said Murray’s actions contributed to Michael Jackson’s death.
Self-administration
Dr Shafer continued today by completely debunking the prosecution's original claim that Jackson killed himself by drinking Propofol. Shafer stated this would not have been possible as the liver would have eliminated 99% of the Propofol before it got a chance to go into the bloodstream.
The defence’s new argument is that Jackson did still take a fatal dose of drugs that killed him, but this was not an oral dose of Propofol. Murray had admitted to police that he had previously used a drip to administer Propofol to Jackson but in the days leading up to Michael’s death he was trying to wean Michael off the drug, as he believed Jackson had developed a dependency. Murray told police on the 25th June 2009 he put Jackson to sleep at around 10.40AM with a single injection of Propofol. The defence are now arguing that sometime later Michael awoke and injected himself with Propofol.
Shafer stated that this theory makes no sense. Shafer testified "people just don't wake up hell bent to grab the next dose in a syringe, draw it up and shove it in their IV again…it's just a crazy scenario." Dr Shafer went on to say that Jackson would not have had enough time to perform this without the doctor noticing. Even if he did, (bear in mind that Murray was out of the room for 46 minutes in the hour leading up to Jackson’s death), Michael would have had to of self-injected 6 shots of Propofol of more than 100ml to reach the level of Propofol that was found in his blood after he died.
Dr Shafer also dismissed the argument that the 8 Lorazepam tablets they claim Jackson swallowed were not enough to kill him. Shafer referred to the toxicology report that showed that the amount of Lorazepam in Michael’s stomach was trivial, the equivalent of only "1/43rd of a tablet.”
Anaesthetic research
Last week the defence stated they would no long contend that Jackson had drunk Propofol. The defence will call their own anesthesiologist to the stand in the coming weeks to testify. His name is Dr Paul White and the prosecution asked Dr Shafer about Dr White’s findings.
In March Dr White prepared a report that stated oral ingestion of Propofol could have killed Michael Jackson. Dr Shafer stated this was incorrect as it does not take into account the “first pass effect”. This effect discusses how the liver would filter the Propofol out of the digestive tract. Therefore only a very small percentage of Propofol would then reach the bloodstream. He stated that this is taught to first year medical students.
Dr Shafer cited tests that had been conducted on animals to see what the effect is when Propofol is taken orally. The results showed there were no negative effects, in fact there were no effects at all, not even sedation. A human study was also conducted, not only in preparation for this trial, but also as tighter restrictions may be placed on Propofol by the Drug Enforcement Agency. Shafer said this would be damaging as “anesthesiologists have to have ready access." Yesterday Shafer had testified that Murray had tarnished the public’s opinion of Propofol and it seems this case may have a wider knock-on effect on the use of Propofol.
Dr Shafer’s theory
Dr Shafer presented his theory as to what happened. Shafer stated that Murray would have started Jackson on a 100ml drip of Propofol at around 9AM. This then caused Jackson to die around noon. Dr Shafer testified that as Michael struggled to breath Propofol was still flowing into his body.
Dr Shafer believes that as Murray did not use an automated pump to regulate the dosage of the Propofol that was being administered, the IV could have infused the drug at a dangerous rate. Shafer stated "this is the only scenario that I could generate… this fits all of the data in this case and I am not aware of a single piece of data that is inconsistent with this explanation.” Shafer believe this is the only way such high levels of Propofol could have been in Jackson’s blood stream.
A number of possible theories had been tested out on a computer generated projection but this is the only one that fits.
Shafer then showed a demonstration of the IV set up that Murray used on Jackson. A 100ml Propofol vial was infused via a drip that attached to an IV stand. Tubing then attached the IV to Michael via the catheter that was in his leg. Without a regulatory pump the Propofol could have dripped rapidly into Jackson’s body.
Drug dose abnormalities
Dr Shafer also testified that he believed Murray gave Jackson larger dosages of the drugs he administered than he has admitted. As previous mentioned Shafer believes that only viable scenario was that Murray administered 100ml of Propofol, instead if the 25ml he told police.
Murray had also told the police he had given Jackson a total of 4mg of Lorazepam in two separate doses. The toxicology report indicated that there was 40mg of Lorazepam in Michael’s body, ten times the amount Murray had said.
Shafer testified that it was also unusual for Murray to quickly decide to give Michael the antidote drug Flumazenil to reverse the effects of Lorazepam if it was such a small dose. Shafer stated “it doesn’t fit.” Dr Shafer believes the only reason Murray would go straight for Flumazenil is that he knew he had given Jackson a large amount of Lorazepam.
Shafer said that Murray’s actions show that he had no real knowledge of the drugs and how they were to be used. Shafer told the court that when other drugs as used in conjunction with Propofol (for example Midazolam which is commonly used with Propofol) they are used in a way where it is safe and in a safe environment. If one drug is not working you do not keep giving more and more sedatives. Creating a cocktail of drugs is very dangerous. Shafer stated “in this setting there are so many variables that make it impossible to predict the response to a dose of Propofol that there is no safe dose.”
Summery
It seems the prosecution saved their strongest witness until last. Dr Shafer slayed Conrad Murray.
Dr Shafer was very good on the stand. He was informative, clear, concise but also very critical of Murray. It will be interested to see how Dr White, the anaesthesiologist that the defence will call to testify, will respond to some of Shafer’s arguments.
I found Dr Shafer’s testimony interesting as it touched upon many of the aspects of the case that I personally find important. Shafer touched upon how by agreeing to give Michael Propofol that it compromised medical integrity and reduced Murray to being a member of Jackson’s staff and not a doctor.
Shafer also touched up Jackson’s drug dependency and Murray’s inaction to resolve this. Instead Murray continued with treatments that he was under qualified and ill equipped to do. When discussing this subject Shafer stated “could the patient have tolerance to Propofol? It’s not well documented cause nobody does this.” This shows that Jackson may have become dependent on Propofol through years of use and administration by many different doctors but it is a unique case as it is the first of its kind to discuss Propofol bring used in such an unethical way.
Something that shocks me time and time again during this trial is the assertion by medical experts that if Murray had reacted different Michael Jackson would be alive today. Before the trial I had always believed that no matter what the Propofol overdose would have killed Jackson in any circumstance. I never realised there was a chance he may have lived. Dr Shafer was yet another witness who confirmed this. Dr Shafer testified "had Conrad Murray been with Michael Jackson during this period of time, he would have seen the slowed breathing and the compromise in the flow of air into Michael Jackson's lungs, and he could have easily turned off the Propofol infusion." As Shafer testified yesterday if Murray had been present when Jackson stopped breathing Murray could have simply lifted Michael’s chin to open his airways. This could have been all it took to save Michael’s life.
I think one of the most important parts of Shafer’s testimony was when he discussed how from the day Murray first started working with Jackson until after Jackson had died Murray was looking out for his best interests and not Michael’s. “When Dr Murray agreed to treat insomnia with Propofol he put Dr Murray first, not Michael Jackson. When he showed up every night with bottles of Propofol and bags of saline he was not putting Michael Jackson first. He was putting Dr Murray first. In the emergency room at UCLA medical centre when he misrepresented the type of arrest that it had been and withheld information about the drugs that had been given he was not putting the patient first he was putting Conrad Murray first.”
The trial continues tomorrow where it is expected the prosecution will close their case. The defence will then call their witnesses to the stand. It will be very interesting to see how the trial develops and what key factors are brought up or are changed through the defence’s testimonies.
Sophie Dewing
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