People vs Conrad Murray - Day 7

We are now half way through the second week of the People vs. Conrad Murray trial, in relation to the death of Michael Jackson, and are on day seven of proceedings.

Sally Hirschberg

The first testimony of the day came from Sally Hirschberg, a medical supply representative who worked closely with Conrad Murray's office. Hirschberg stated the amount of orders she was receiving from Murray was out of the ordinary for what a cardiologist needs. It was also unusual for a cardiologist to buy Lidocaine and IV bags.

A huge list of drugs and equipment that was ordered by Murray for Jackson was shown to the jurors.

Hirschberg testified that she was asked by Murray to ship to a home address but Hirschberg refused as it was against policy to ship to homes.

On 26th June 2009 Hirschberg received a call to cancel all further medical supply orders.

Stephen Marx

The second person to testify was Stephen Marx, a computer forensic examiner. Marx had examined Murray's iPhone.

Most of Marx testimony centred on emails sent between AEG representatives (such as Paul Gongaware), Conrad Murray and Bob Taylor in the UK about Michael's health and specifications the insurers needed.

The insurers required lots of details about Michael’s present and previous medical health. Some of the questions in the emails asked if Michael had any medical issues such as back problems, lung problems, cancer, cosmetic procedures, anorexia. The insurers were keen to know if any speculative reports in the media about Jackson's ill health were fact or rumour. AEG were eager to get Michael to take any evaluations that the insurers needed and also thought it would be positive as they could then dismiss all the negative reports in the media about Michael's health.

The insurers were insistent that they would not insure Jackson for illness cover unless Michael carried out tests in a two hour assessment with them and they had thorough medial reports and a review of a rehearsal.

When Murray replied to these emails he stated that all reports about MJ's ill health were false to his knowledge. Murray also stated that MJ refused authorisation to release his medical records. Murray said he was the only doctor who was treating Michael since 2006.

It seems the defence will try to prove Jackson was already sick. Refusal to release medical records and no response to questions about media speculations could suggest there were medical conditions that were trying to be hidden. Also high profile conditions and illnesses or injuries that Michael suffered from that had been confirmed in courts of law or by Jackson's management had not been stated to insurers.

Audio recordings

The court was then played an audio recording from Murray's iPhone of Frank DiLeo, Michael Jackson's manager. In the voicemail from June 20th 2009 DiLeo states that MJ had an 'episode' last night and was sick. DiLeo said they need to do a blood test on Jackson to 'see what he is doing'. This infers that DiLeo was also aware MJ had a drug problem. I had previously mentioned that I feel a lot more people than Murray were aware of MJ's decline but no one did anything. This audio recording does imply that Michael's manager knew of the problem but was not doing much to stop it.

It is also interesting that DiLeo phoned Murray to discuss conducting a blood test to 'see what he [Michael Jackson] is doing' as this implies he may have thought MJ was taking some form of drugs without people's knowledge. In the case so far it seems to have shown that Michael was only using drugs that Murray administered or prescribed.

Marx then talked about an audio recording from the iTalk app, a digital voice recorder application on the iPhone. The recording was from May 10th 2009 and was an extended version of the slurred recording of Jackson that was played in the opening statements.

In the recording MJ talks about wanting to build a children’s hospital. Michael states children are sick because they are depressed. He spoke of how a hospital would be remembered more than his performance. Michael said 'I love them. I love them because I didn't have a childhood. I feel their pain. I feel their hurt'....'Heal the World', 'We Are The World, Will You Be There, The Lost Children these are songs I have written because I hurt. You know, I hurt'.

Murray then asked 'You OK?' Jackson replied 'I am asleep.'

This was a very sad recording to hear. It almost feels like Michael was asking for help and no one acknowledged it. It is sad that Michael would confide in Murray and even though it was obvious he was unhappy Murray never alerted anyone or tried to help resolve any issues. Instead he kept medicating Michael. As previously mentioned the people surrounding Michael knew that something was wrong (from testimonies from Kenny Ortega and a voicemail message from Frank DiLeo) but it seems it was almost easier for everyone to keep MJ sedated as it made him malleable to their needs.
 
Throughout the years I think Michael made it perfectly clear that he has problems that he was struggling with, (for example the very themes of the songs ‘Morphine’ and ‘Childhood’). Even when he clearly spelt out how he was feeling it got ignored. This would seemingly exacerbate the problems and can maybe point toward why Michael was having trouble sleeping and needing insomnia treatments. It could also be speculated that this could have also been one of the contributing factors to his drug use (although there are other suggested causes, for example the need for long term use of pain medication due to injuries such as his back injury which occurred after a stage prop malfunction during Earth Song in Germany in 1999)

In such a lucid state people often are brutally honest. It is amazing to think that even in such a state Michael's concern was the plight of sick children.

Elissa Fleak

The final testimony of the day was from Elissa Fleak, a coroner investigator for the LA county coroner's office. A coroner investigator performs death investigations to decide whether a death was a homicide, suicide, accident or natural.

Fleak stated on 25th June 2009 she went UCLA to examine Michael Jackson. The court was then shown a photo of Jackson on a gurney taken by Fleak. Fleak states she saw no obvious signs of trauma. Fleak then collected four vials of blood that were taken at the time of treatment at UCLA.

On 25^th and 29th of June 2009 Fleak went to Jackson's house to perform a scene investigation of where Michael died. The court was then shown photos of Michael's house and the bedroom in which he died. Fleak collected evidence that eventually was given to LAPD.

The prosecution presented evidence to Fleak to look at and confirm if these items were collected by her during the investigation. Fleak had to go through each item individually, leading to this section taking hours to complete as there were so many pieces of evidence.

Evidence

First the prosecution presented the evidence by the areas that they were discovered. First to be presented was a 20ml bottle of Propofol found next to the bed. Fleak states the bottle was empty. Also collected was an empty bottle of Flumazenil (a drug taken as an antidote to a benzodiazepine overdose for drugs such as Propofol). Also collected were 3 prescription drug bottles from the side table next to the bed. The drugs were Diazepam (prescribed by Conrad Murray, June 20th 2009), Lorazepam (prescribed by Conrad Murray, April 28th 2009), and Flomax (prescribed by Conrad Murray, June 3rd 2009).

On the lower shelf of the bedside table there was a wicker basket with additional prescription meds. These were; Clonazepam, Temazepam, Tizanidine and Trazodone. Some of these prescriptions were prescribed by a Dr Alan Metzger. Also some prescriptions used other people’s names (thought to be aliases of Jackson’s). Earlier in the proceedings an email sent by Murray in regard to insurance showed that Murray stated he was the only doctor treating Michael since 2006. This evidence would show that this was false as Dr Alan Metzger had prescribed drugs to Jackson.

On the left of the wicker basket was some Anthelios lotion, a high end sunscreen.

Also found in the bedroom were tubes of lotions. These were; Hydroquinone cream, Benoquin 20% and Lidocaine 4%. All three creams were prescribed by Conrad Murray. These are all skin bleaching creams. Previously Tim Lopez, a pharmacist, stated that Murray had spoken to him about needing skin whitening creams for African-American patients that suffered from Vitiligo.

There were also several oxygen tanks in the bedroom and one on a rolling dolly near the bed. Also on the floor was an ambubag. Under the ambubag was an IV catheter. Other medical supplies and needles were found nearby.

On a glass table near the bed was a 10CC syringe (with no needle), Lidocaine, alcohol prep pads, IV catheters, latex gloves and a box of syringes.

Also found in the bedroom was a syringe with a needles attached which was attached to a saline bag via tubes and hung on an IV stand.

In the closet

Fleak also searched the adjoining walk in closet. Inside the closet were various bags, including the bags Alverez mentioned in his testimony.

                                                                                                                                                                                          

Inside a black bag were a blood pressure cuff and 3 bottles of Lidocaine. 2 bottles were empty and one was half full. 

In a blue Costco bag was a pulse oximeter and a cut open saline bag with a 100ml bottle of Propofol inside it. Fleak states there was some liquid at bottom of saline bag. The Propofol bottle was more or less empty. Also found inside the same bag was an empty 20ml bottle of Propofol, a 10ml vial of Lorazepam, 2 bottles of Midazolam, a small bloody prep pad/gauze, and a plastic bag with medical debris. The blue bag was mentioned by Alverez in his testimony. Alverez stated that when he arrived into the bedroom Michael was lying on the bed. Murray then asked him to put some items, (specifically a Propofol bottle and a saline bag), into a blue bag. After Alverez did this he then called 911.

In a baby essentials bag there were 2 100ml Propofol bottles (full), 7 smaller 20ml Propofol bottles (4 unopened, 3 were opened but contained different levels of liquid), 3 Lidocaine bottles (1 unopened, 2 opened and partially consumed), 3 10ml vials of Midazolam (2 unopened, 1 opened), 4 bottles of Flumazenil (3 unopened, 1 opened and majority consumed), 2 bottles of Lorazepam (1 unopened, 1 opened and half full), a pill bottle containing Ephedrine, caffeine and aspirin, a lotion, eye drops, an IV tubing device, a blue tourniquet and 5 business cards for Conrad Murray.

Next to the bags were some lotions. There were 18 tubes of Hydroquinone and 18 tubes of Benoquin. In an earlier testimony during the trial it was stated that after Michael Jackson was pronounced dead at UCLA Murray was insistent he be taken back to Jackson's house to remove creams that Jackson wouldn't want the world to know about. I presume that these were the creams and Michael wanted them to be kept private as they were skin bleaching treatments.

Summary

By the end of the day nearly the whole of the prosecutor's table was taken up with vials of medicines, creams, bags and medical equipment. It is extraordinary just how many items Murray was using. It seems the treatments were almost out of control. To have nine medicines next to a bed that can be used as sedatives is incredible. How bad does someone's insomnia need to be that nine different medications need to be tried or used? I think it shows Murray was ridiculously overmedicating Jackson. Anything on this scale in an unregulated and non-clinical environment is an accident waiting to happen.

I have been interested to hear the coroner's office testify in this case as this investigation (as well as autopsy / toxicology reports) will define how Michael Jackson actually died. Combined with the coroner's investigation of the house it should give a good indication of what occurred on 25^th June 2009. As Conrad Murray and Michael Jackson are the only two people who actually know what happened that day this will be the closest we will ever come to knowing the events that took place. Fleak’s testimony is going to be one of the most crucial in the trial.

Tomorrow Fleak will continue her testimony.

Sophie Dewing (@sophiedewing)

http://exploredreamdiscoverblog.blogspot.com/

People vs Conrad Murray - Day 6

On day six of the trial we continue with prosecution witness testimonies.

Stacey Ruggles

The first testimony of the day was from Stacey Ruggles, an employee of Conrad Murray since 1997. Ruggles stated she spoke to Murray on the 25th June 2009. That was all the prosecution asked.

The defence asked about when Ruggles helped Murray open a medical office in Texas. The medical office was for people who couldn't afford a physician. Ruggles stated Murray didn't really make money out of this office. So far all testimonies by people who have worked with or been treated by Murray have been positive. A previous patient of Murray stated his treatment was first class, up until the time Murray went to work for Jackson, (at what point the patient claimed Murray 'abandoned' him).

Ruggles also testified that she was told in April 2009 that Murray would be working with Michael Jackson.

Ruggle's testimony only took 7 minutes.

Murray’s girlfriends testify

Next to testify were four of Murray's girlfriends.

Bridget Morgan, one of Murray's girlfriends, phoned Murray on June 25th 2009 but he did not pick up.

Michelle Bella, who met Murray in a Las Vegas nightclub, was texting with Murray on 25th June. She also confirmed Murray had told her a few weeks earlier that he would be working with Michael Jackson.

Nicole Alvarez

Nicole Alvarez, Murray's long term girlfriend and the mother of one of Murray's children, confirmed she had packages of Propofol delivered to her Santa Monica home. Alvarez stated that she did not know what was contained in the packages.

Alvarez was also asked about knowing about Murray's salary. Alvarez stated she knew the amount of $150,000 a month. Alvarez had earlier testified she didn't know about Murray’s salary. When Brazil (prosecution lawyer) grilled her over her changing statement Alvarez became flustered and said she was unsure.

Alvarez also said she met Jackson on a few occasions and introduced her and Murray's child to Jackson.

Alvarez testified that she was on the phone to Murray when he was in the ambulance with Jackson. Murray called her to tell her to not worry, everything was fine but she would probably hear about the story on the news. Murray then went on to call her four more times throughout the afternoon.

Apparently the LAPD have stated they believe Alvarez knows a lot more about what happened on that day than what she has stated to protect her child's father.

Sade Anding

Sade Anding, a girlfriend of Murray, was on the phone to Murray when Jackson reportedly got into medical trouble. Anding said she heard a commotion and then got cut off and couldn't get back in touch. This call was at 11.51AM. The ambulance wasn't called until 12.21PM, 30 minutes later. This fact does show that Murray did not act appropriately to the situation. If someone is to stop breathing every minute counts. After 30 minutes without breathing or pulse there is very little that could be done to save someone life.

In total Murray was on the phone for 46 minutes out of the hour before Michael Jackson reportedly stopped breathing. This strongly supports the prosecution’s claim that Murray was negligent and this negligence lead to Michael dying.

Tim Lopez

The final testimony of the day came from Tim Lopez, a pharmacist. In the lead up to the trial there was some worry about Lopez as he left the country (against orders) and disappeared to Thailand. Luckily he return to the US to testify.

Lopez testified that he sent large quantities of Propofol to Murray. Lopez first met Murray in 2008 when Murray asked for a skin whitening cream for African-American patients that suffer from Vitiligo (a disease Jackson suffered from).

Lopez went on to say in April 2009 Murray ordered 35 vials of Propofol. Murray kept some of the vials and sent the rest to a Santa Monica address (reportedly Nicole Alvarez's address). Between April - June 2009 Murray then kept ordering lots more Propofol.

The jury were showed receipts of the large amounts of Propofol that Murray purchased.

In total 225 vials of Propofol, 20 vials of Lorazepam and 60 vials of Midazolam (another treatment for insomnia and sedation) were purchased by Murray. This is an incredible, and unreasonably, large amount of drugs. Even to someone who is not an expert this seems absurdly excessive. This fact will be key to the trial.

The court was then adjourned early due to a possible weather condition.

A fair trial?

Outside of the courtroom the trial is also getting much discussion - and mainly down to Murray and the defence team! There have been reports that Murray was discussing the case with his barber over the weekend. As previously mentioned a gagging order has been put in place by the judge after the defence had been speaking to the media about the case last week. I think it is extraordinary that the defendant and his team are openly discussing the case outside the courtroom.

I think this shows the big difference between US and UK law. Under no circumstances in the UK can a case be discussed outside the courtroom and it cannot be televised.

Also last week LaToya Jackson had been tweeting live from the courtroom. In the UK people have gone to prison for doing this.

I really don't see how the jury are expected to cut themselves off from hearing about the case when everyone involved in the case is openly discussing it with the world. It also shows how cases in the US can be more trialled in public and press than in the courtroom. The recent Casey Anthony case was plastered all over the US media and anyone who had read or heard anything about that case had made their mind up about the verdict. And the majority thought Anthony was guilty.

When the verdict was reached and Anthony was found not guilty there was a huge public backlash against the jury. One juror came forward and said they just could not give a guilty verdict without having enough evidence. It seems the hype and reportage in the press whipped up a frenzy that convicted Anthony in the public’s eyes. Although the facts in the trial were very condemning it came down to the fact of was there enough evidence to prove guilt? The jury did not think this was the case. This does seem vital as Casey Anthony was possibly facing the death penalty.

There have been discussions in the media that the jury in this case may feel under pressure to give a guilty verdict to Murray even if they are not 100% certain from the evidence they have witnessed to avoid a public backlash, such as what happened to the jurors in the Casey Anthony case.

The trial continues.

Sophie Dewing (@sophiedewing)

http://exploredreamdiscoverblog.blogspot.com/

People vs Conrad Murray - Day 5

We have now entered the second week of the trial and are continuing with prosecution witness testimonies.


Day 5

Day 5 started with no real developments or news. The first two testimonies came from two representatives from mobile phone service providers testifying about the call records from Murray's phone.

I did not view these testimonies so am unable to comment fully on these.

Dr Thao Nguyen

The third testimony was from Dr Thao Nguyen, a cardiologist from UCLA hospital where Michael Jackson was taken. Dr Nguyen stated that when she arrived in the trauma room she was directed to Conrad Murray to be briefed as to the situation with Michael Jackson. Murray was the primary source, not Dr Cooper, the ER doctor (who testified on Friday). Hence why Dr Nguyen was directed to him. Dr Nguyen asked Murray if any sedative had been administered to Jackson. Murray only mentioned Lorazepam. He did not mention Propofol. This is what Murray also told paramedic Senneff but is at odds with what Murray told paramedic Blount and Dr Richelle Cooper. Murray only told these witnesses that he had given MJ saline to treat dehydration.

Dr Nguyen also stated that 'it didn't look like time was on Mr Jackson's side' and she believed he was already dead. The only reason the team continued resuscitation attempts was because Conrad Murray told the hospital team he had felt a pulse earlier. Dr Nguyen stated Murray sounded 'desperate' and 'looked devastated'. Murray asked them to 'not give up easily and try to save his [Michael Jackson's] life.’ After an hour of trying to save Michael's life Dr Nguyen said the team tried to use a balloon to resuscitate Michael, even though they believed that it was not going to be successful. The team then had to convince and prepare Murray that they were not going to continue any more attempts and pronounce Michael Jackson as dead. 

Dr Nguyen was then asked a lot of detailed questions about certain drugs and the effects they have. This was a very interesting section. Dr Nguyen talked about orally and intravenously (IV) administered drugs. Dr Nguyen stated to treat insomnia she would use orally administered Lorazepam.  She would not use an IV (as was the method the Murray told her he had used).  She states 2- 4mg of Lorazepam would be needed for insomnia. Murray claimed he gave an IV of 4mg of Lorazepam to get Jackson to sleep. An IV has a much quicker effect and the result lasts longer.

Dr Nguyen explained an IV dose of Lorazepam takes 5 - 7 minutes to put that patient to sleep. It has a half-life of 14 hours - plus or minus 5 hours. From this they can then try to judge when Michael was given the Lorazepam (although this is nothing something Dr Nguyen would be able to testify about as she would not have conducted this test).

When questioned about insomnia treatments Dr Nguyen stated a 1 or 2mg pill of Lorazepam would make someone sleep all night without waking up. Of course this depends on the host and their tolerance to drugs. A benzodiazepine addict (alleged as someone like Michael) would probably need to take more than 4mg to sleep.  Dr Nguyen states if someone is not sleeping and need a higher dosage then they need to be closely monitored and the higher the level the higher the risk of side effects.

The defence than asked about a 20mg doze. Dr Nguyen seemed shocked they were asking about such a large amount. Dr Nguyen said 20mg is a large dose that she had never used. The defence asked if this amount could kill someone. Dr Nguyen said it could but went on to explain how Lorazepam works. Dr Nguyen states Lorazepam affects the brain. It makes the host very sleepy. One danger is if the brain becomes so sleepy that it tells the diaphragm not to work so the patient would stop breathing. Dr Nguyen confirmed that 20mg would depress consciousness very quickly and stop the patient breathing. Dr Nguyen added it would not cause respiratory or cardiac collapse. 

Dr Nguyen was then questioned about Propofol. She stated as a cardiologist she is licensed to use Propofol. Although Dr Nguyen is licensed to administer Propofol she would only ever do it with a crash cart present and with the correct personnel in the correct areas of a hospital. She has never used Propofol without an anaesthesiologist.

Dr Nguyen then repeatedly and strongly stated that Propofol must only been administered in a hospital but always only in the ICU or the procedure room, a 'designated place with designated personnel'. A crash cart must always be available.  

Dr Nguyen states that she does not use Propofol outside of a hospital and had never heard of Propofol being used in a bedroom of a home. She explicitly expressed once more that when Propofol is used in a hospital it is only ever used in certain rooms with certain personnel.  

Dr Nguyen also stated that unlike Lorazepam Propofol will cause respiratory and cardiac arrest. Lorazepam can stop breathing but will not cause respiratory or cardiac collapse.

Dr Nguyen asked if Conrad Murray used anything to reverse effects of Lorazepam in Michael. Murray stated no. The defence then asked what would have been needed to reverse the effects. Dr Nguyen explained that an IV of 0.2mg of the drug Flumazenil would be the antidote to an overdose of Propofol. But the Flumazenil needs to be used in seconds. The result will be a delay the depression of the brain and respiratory collapse and possibly stop the need for intubation, or at least give time for intubation to take place. This highlighted the need for a crash cart and lifesaving medical equipment to be near when using Propofol. Something Murray did not have access to. 

The final section with Dr Nguyen discussed the effect Propofol has on people. Dr Nguyen states that an IV of Propofol would make someone sleep very quickly. The defence then stated that Propofol would not make someone's speech slurred. Instead they would sleep. It seems this was a tactic to pass blame. In the opening statements the defence claimed that Dr Arnold Klein, Michael Jackson's dermatologist, was responsible for getting Michael addicted to drugs. 

Dr Nguyen's testimony was very interesting and gave a very clear insight into the way the two drugs that are key in this case work. It also reiterated the need for Propofol to only be administered by a qualified anaesthesiologist, in a clinical setting and with the correct lifesaving equipment present. 

Dr Joanne Praschard

The fourth testimony was from Dr Joanne Praschard, a physician based in Texas. Dr Praschard treated a patient of Conrad Murray. The patient was taking medicine that was a concern to the anaesthesiologist. Dr Praschard needed to speak to Murray to see if she could take the patient off the drug to have the operation. Dr Prashard had some difficulty contacting Murray but eventually spoke on 25th June. Murray stated the patient needed to continue with the drug. Dr Praschard did note that Murray knew exactly what patient she was discussing and recalled the treatment even without notes in front of him. Dr Praschard was impressed with this as she states doctors see so many patients it is often difficult to remember details from memory. 

Dr Prashard's testimony seemed to play more into the defence’s hands which is unusual for a prosecution witness. But Dr Prashard did also state that it is vital a doctor write all treatments and drugs on a patient’s medical charts so that others afterwards can then give correct treatments. This was to highlight that Murray did not ever write any medical notes for the treatments he gave Jackson over the duration of time that he worked with Jackson or give vital information to paramedics or the UCLA trauma doctors.

Phonecalls

The prosecution then called two women that Murray spoke to on the morning of the 25th June 2009. The first woman to testify was from Antoinette Gille, a volunteer at one of Murray's medical practices. The second was Bridgette Morgan, a woman Murray met in a nightclub in Las Vegas. Although neither of these phone calls took place during the time that Michael Jackson got into trouble it shows that Murray was distracted in his duties during that day. As has been stated by Dr Nguyen and Bob Johnson, from the pulse oximeter company, the procedure Murray was performing on Jackson needed constant monitoring. Leaving the room repeatedly to make phone calls shows his lack of focus and plays into the prosecutions argument that Murray neglected Michael, which then led to his death. 

Tomorrow the girlfriend of Murray, who was apparently on the phone when Michael got into medical difficulty, is set to testify. 

Sophie Dewing (@sophiedewing)

http://exploredreamdiscoverblog.blogspot.com/