People vs Conrad Murray - Day 22

The People vs. Conrad Murray trial has now entered day 22. Yesterday’s cross-examination of Dr White was a very long and complicated day, as many technical medical references were discussed. The judge is keen for today to be shorter and more concise as the jury were losing interest.

Today Conrad Murray’s final decision as to whether to testify will also be revealed.

Dr Paul White

The cross-examination of Dr White continued today.

Lorazepam

The prosecution wanted to talk about the levels of Lorazepam in Jackson’s stomach. Dr White stated that there really is no way to tell how many tablets Jackson took. (If this was the case as the defence are trying to push).

What we can tell is that the levels of Lorazepam were a lot higher than what Murray told the police.

Dr White’s testimony stated the tablets were taken around 8AM (this would be needed to give the levels of Lorazepam that were found MJ’s blood from the toxicology report). Jackson would have needed to have taken around 6 -7 tablets. Dr White also stated it was possible that the same levels could have been achieved if pills had been taken at around 4, 6 and 8AM.

If Jackson were to have taken tablets in the timeframe that Dr White suggested then Conrad Murray would have been in the room (according to his police interview). Dr Murray told police he only left the room for a two minute toilet break just before noon. 

Dr White also stated there were bottles of Lorazepam so it was a possibility that the Lorazepam had been administered via an IV.

Propofol infusion

Dr White told the court that he does not believe Dr Shafer’s scenario of a three hour Propofol infusion is possible as the levels of the drug found in the urine sample were too low. He also reiterated that the 25 mg that Murray told police he gave MJ would only give a minimal amount of sedation, which would induce a light sleepiness. It would last around 5 – 10 minutes.

Importantly Dr White stated that by the time Conrad Murray found Michael there is no possible way that Jackson could have been saved. This will help the defence as they can then state that any actions Murray took afterwards were irrelevant as the outcome would have still been the same.

Standards of care

When discussing standards of care Dr White was keen to differentiate between this and standards of practice. He stated that it is more important to follow standards of care than standards of practice. Dr White stated that in circumstances other than the usual it is not always possible to follow the guidelines.

Dr Conrad Murray

Once Dr White’s testimony was complete Judge Pastor asked Conrad Murray for his final decision to whether he would take the stand. Dr Murray told the court he had decided to not testify.

There was debate between Murray’s team as to whether he should tell the jury his version of events. Michael Flanagan was keen to have Murray tell his side of the story as he believed that otherwise the jury may believe this was a sign of guilt or that Murray is trying to hide something.

Ed Chernoff was keen for Murray to not take the stand as he believed Murray would not have been able to hold up against the prosecution’s questioning.

A big problem Murray would have had is that the evidence by the defence’s star witness, Dr White, was contradictory to what Murray had told police.

Dr Steven Shafer

Dr Shafer was then recalled to the stand on rebuttal. This means that the prosecution want to challenge some of the statements made by Dr White. They would use Dr Shafer’s expertise to do this.

Lorazepam

The prosecution wanted to ask Dr Shafer about Lorazepam. Dr White had testified that if Lorazepam had been taken intravenously then no traces at all would have been found in Jackson’s stomach. This means he must have orally digested some tablets of Lorazepam at some time. Dr Shafer told the court this was wrong. Drugs that are administered via an IV go into all tissues in the body, including the stomach. He also pointed out this has nothing to do with post mortem redistribution.

Shafer also told the court that Lorazepam pills that had been given by Dr Murray or that had been taken by Jackson himself look the same so there is no way to separate the two.

Lidocaine

Dr Shafer told the court that he had included Lidocaine in his scenarios because Lidocaine was present in the toxicology report.

Propofol infusion

Dr Shafer then discussed the key drug in the case; Propofol. He told the court that the main complication with Propofol is a failure to breathe. This is what caused Jackson to die. Shafer did state that Michael could have died at any time, not precisely at noon.

Dr Shafer stated it is fairly usual to administer Propofol using two IV lines but he would use an infusion pump. It had been discussed that Murray had used roller clamps but with these there is less control over the speed that the infusion that occurring.

Roller clamps are usually used for non-critical treatments using drugs such as antibiotics.

Simulations

Both Dr Shafer and Dr White had previously shown the court simulations of the scenarios they believe were possible, or impossible, to have killed Michael Jackson. Most of Dr White’s testimony was disproving the scenarios that Dr Shafer had put forward. Now was Dr Shafer’s chance to comment on Dr White’s scenario. Dr White’s scenario was based on a model completed last week by a doctor he had consulted. His expert’s model used two scenarios – two 25 ml doses of Propofol (the second administered by MJ, the defence’s argument) versus a 1000ml infusion (as Dr Shafer claimed).

The research and findings for this model were based on Simon’s 1988 article. From what I can understand this article discussed how the kidneys filter Propofol and how this can then be measured in urine samples. The results found that 0.3% of unchanged Propofol would be found in urine sample.

The issue Dr Shafer had with this is that it was unknown if the findings in this paper considered metabolites as well as the Propofol in its results. A comment on the article in 2002 stated that metabolites were included in the results. Due to advancements in technology the results could now be more precise. In the 2002 article they found 0.004% unchanged Propofol in eliminated urine. From the 550ml urine sample that was collected from Michael Jackson the reading showed 0.15 ug/ml of Propofol. When calculated a results of 82.5 ug/ml is reached.

This becomes relevant when Dr Shafer then spoke about the 2002 study which was a comment on the Simon’s article. The study used 5 patients undergoing major surgery who received a constant infusion of Propofol (as Shafer believes Murray used). Different levels of Propofol were administered to the patients from 1300 mg to 3300 mg. The focus of the study was to see the amount of unchanged Propofol was excreted in the urine of these patients. The results showed that 70.71 ug/ml of Propofol was excreted with a patient who received a 2000 mg dose of Propofol. This was close to the result that Jackson had. This also shows that it is more likely Jackson was given close to 2000 mg of Propofol.

Dr Shafer then stated that this completely rules out Dr White’s simulation.

Standards of care

Dr Shafer then spoke about standards of care. If a procedure is carried out in a home far greater precautions and vigilance would be needed. In a “remote location” you have no backups so you cannot afford to take any short cuts.

Cross-examination

Dr Shafer was then cross-examined by Flanagan. Flanagan questioned Dr Shafer about his report into Lidocaine. Flanagan stated that Shafer’s report was wrong. Dr Shafer then told Flanagan that this was not the case, telling Flanagan “you’ve misread my report.”

Flanagan then asked if Dr Shafer had rejected the Simon’s report findings. Dr Shafer replied that he had rejected the defence’s interpretation of it.

Judge Pastor

As Dr Shafer’s rebuttal ended the trial’s evidence section was finally complete. Judge Pastor told the jury “you've seen and heard all of the evidence in this case.” The jury will now be given the exhibit list ready for their deliberation.

The court is now in recess until Thursday. On Thursday the prosecution and defence will give their closing statements. This will be a summary of all the evidence they have produced and what they believe this proves.

Once this is complete the jury will then deliberate the verdict. This could be a very quick or a slow process depending on how split the jury is on the verdict.

Dr Murray could learn his fate at the end of this week or early next week.

Summary

After six weeks of evidence both the prosecution and defence have rested their cases. We have heard many weeks of a very strong case presented from the prosecution, so it was always going to be difficult for the defence to put forward a plausible theory that could disprove the prosecutions argument, especially with the evidence that was stacked against them. With the defence having very few witness testimonies and a sparse amount of expert witnesses this task was made even harder. The defence’s case was not helped when many of their witnesses were either seemingly pointless or their evidence supported the prosecution’s argument more.

I think from all the evidence that had been presented that it is certain that Conrad Murray is guilty of the charge of involuntary manslaughter. The only theory that the defence were holding onto was that Michael Jackson administered the fatal dose himself. Even if this was the case I still feel Murray would be guilty as he should not have left a patient unmonitored and with the ability to do this. It is also impossible to try to explain away Murray actions after he found Jackson not breathing. Every single expert witness that spoke about the delays in calling 911 and not informing medical staff of all the drugs he had administer said they could never justify Murray’s actions.

I also believe that Murray deciding to not take to the stand was the best decision for him. Although this does show to the jury that there must be something that is stopping Murray from testifying there is no way Murray could have taken the stand without proving he was guilty. I strongly believe the prosecution would have machine-gunned so many holes into his account that there would have been no way Murray defended himself in cross-examination. Also by testifying he would have had to admit that he lied to the police during his interview (if Murray stated that Jackson had killed himself as Dr White had testified). This then begs the question why lie to the police? Especially as Murray and his lawyers had called for the meeting and had two days to remember exactly what happened to the best of Murray’s abilities.

Dr White

Dr White’s testimony was very interesting, and certainly did shake up the trial. But during cross-examination he had to backtrack on many of his statements and seemed to not have all his facts or research totally straight. His main argument was that Dr Shafer’s three hour infusion scenario was wrong, but this had been the method that Murray been using in the 80 days up until three days before Jackson’s death. It is not as an implausible theory as Dr White might state.

Dr White’s theory that Jackson gave himself the fatal dose of Propofol is also a theory that is not based on the evidence that has been presented in court, rather on medical facts, models or articles. For example Dr White repeatedly commented on how Murray had given two 25 mg injections of Propofol. This was evidently not the case as the toxicology report states otherwise. Dr White also never addressed the fact that Murray did not leave the room for a two minute toilet break, in fact he was out of the room for 46 minutes. You cannot base your testimony without addressing and including the evidence in your findings.

Dr White also proved to not be an objective witness as he based part of his testimony on what he and Conrad Murray had discussed. This is admissible evidence and the judge did not allow this.

The closing statements will take place this Thursday. This is sure to be a day to watch.

Sophie Dewing

http://exploredreamdiscoverblog.blogspot.com/

People vs Conrad Murray - Day 21

The Conrad Murray trial has now entered day 21 and week 6 of proceedings.  Dr Paul White, the defence’s star witness, is due for cross-examination today.

Dr Paul White

Dr White is the final witness for the trial (unless Conrad Murray does decide to testify) and his testimony is key. Last week he told the court how he believed that Michael Jackson gave himself the fatal dose of drugs. Dr White dismissed Dr Shafer’s scenarios and showed the court his own scenarios around injecting Propofol and swallowing Lorazepam pills on his own accord.

Standard of care

The prosecution started their cross-examination by discussing standards of care. These are guidelines of how a patient should be medically treated. Dr White did agree that Dr Murray deviated away from standards of care in the 2 months he was hired by Michael Jackson before his death.  When discussing Murray’s care of Jackson Dr White based parts of his testimony on conversations he had with Dr Murray. This is not allowed at all in court. Judge Pastor had words with Dr White about this.

Dr White then spoke about the set up that Murray was using.  Dr White told the court that he had never heard of Propofol being administered in a bedroom before. He stated that if an infusion was to take place and not properly controlled you would need equipment present to monitor and to save the patient’s life if anything were to go wrong. Propofol can cause respiratory depression so Dr White stated he would have at least a bag and a mask present (to help with breathing). He also stated suction apparatus was desirable and that a pulse oximeter was essential. Dr White then told the court that during an infusion the patient needs to be monitored every 5 minutes. If this was minimal sedation in a hospital setting then it would be every 15 minutes.

Dr White told the court that airway obstruction and cardiovascular depression are the two most common risks with using Propofol, although it is very rare for these to occur. Dr White stated that it is very rare for a patient to experience apnoea but if Propofol is combined with an opioid or analgesic the risk is heightened. (Such as in this case.)

The prosecution then asked if Dr White disagreed with Dr Shafer’s testimony that Dr Murray’s treatment was an egregious and unconscionable deviation of standard of care. Dr White was very reluctant to answer this question. Eventually he did agree that is was a deviation of standard of care but it was a minor deviation.

Paid Witness

As previously mentioned during the trial Dr White had confirmed he was a paid witness. This was something the prosecution were keen to pick up on. Dr White told them so far he had been paid around $11,000 by the defence. He usually charges $3,500 a day to appear in court. He has been in the court so far for 12 days but does not believe the defence will have enough money to pay for all of his time.

This highlights two points. One, how objective can a witness be if they are paid by the defence and have regular conversations with the defendant which they then try to submit into court? And secondly, he has pointed out that the defence has very little money. I have previously written about the fact that Conrad Murray is virtually bankrupt so does not have the money to hire a first class team (such as the brilliant lawyers that the Michael Jackson Estate have been able to afford to hire). I think throughout this trial it is apparent that this lack of funds has meant a poor defence team, and in particular Ed Chernoff. I feel Chernoff has been very damaging for Murray’s case and it shows that money has a far bigger influence on the outcome of a trial than almost anything else.

But in saying that it is also a fact that the evidence against Murray has been very condemning. But if Murray had the money to hire excellent lawyers he may have more of a fighting chance. (Take for example the O.J Simpson trial. The world believed in Simpson’s guilty yet he had an incredible lawyer who managed to get a not guilty verdict. A good lawyer can make the case go anyway they want – but you need money to enable this.)

Appropriate medical care

The prosecution then questioned Dr White about the way he would respond if a patient were to stop breathing. Dr White stated that he has been in this situation before and he assisted the patient using a bag and mask and performed a tracheal intubation.

Dr White then told the court that as a doctor he has a solemn obligation to do no harm to a patient and you need to do your best to meet their health care needs. The prosecution asked if Dr White believed Conrad Murray had adhered to this in his treatment of Michael Jackson. Dr White stated that Murray was “providing a service to Michael Jackson that he had requested and insisted on”.  Dr White then told the court that medical care is more appropriate than being of service to a patient. A doctor always has the option to walk away if they are not happy or comfortable with what is being asked of them.

Dr White then stated that he would never administer inappropriate medical care to any patient. If they insisted he would walk away.  He later went on to say that is Michael Jackson had approached him with the same request he would have never accepted the job. No amount of money could persuade him to take it.

Monitoring

The questioning then moved onto monitoring patients. The prosecution asked why it is important to monitor patients. Dr White told them that it is very easy for a patient to move from one level of sedation to another. Dr White then stated that a standard of care would include monitoring the patient but this was an unusual case “as Dr Murray was trying to achieve a sleep state”.

Dr White was then asked if he would leave a patient unmonitored. He told the court that if he had administered a small dose for minimal sedation that last 15 – 30 minutes he would have no problem leaving the patient. The prosecution then highlighted that this would be in a hospital environment. Dr White stated that is the only place he had ever administered Propofol. Dr White also stated that if a patient also had benzodiazepines in their system he would monitor them for 30 minutes.

Dr White stated that having a pulse oximeter on the patient is using monitoring equipment. The prosecution then pushed the point that a pulse oximeter without an alarm is pointless. Dr White was very reluctant to answer this but eventually did agree this was correct.

Vitally Dr White stated he would not leave a patient unmonitored if he knew that the patient liked to push the syringe themselves. This is something that Jackson had requested from Murray and had performed with at least one other doctor before.

Responding to the situation

The questioning then moved onto Murray reaction to Jackson not breathing. Dr White stated he could not defend the fact that Murray did not call 911 right away. He then told the court that he believed that Murray probably did this because it was a “very stressful” situation. He also stated that it occurred in an “isolated part of the house” and that there were no working phones in the house. Walgren then pointed out that Dr Murray had a mobile phone in his hand on which he called Michael Amir Williams before phoning 911. Dr White agreed this was true and it would have been quicker to phone 911 instead.

Dr White then told the court that he does not believe that if Dr Murray had phoned 911 any sooner that it would have made any difference. Once the overdose had occurred there was no way to bring Jackson back to life. It is important to remember that when Murray first found Jackson there was a thready pulse. Therefore in my personal opinion if 911 had been called immediately there may have been an opportunity to try and save Jackson’s life. It is also important to remember that every other medical expert that has been asked about this stated that Jackson would be alive today if Murray had called 911 immediately.

 The prosecution then asked Dr White about Murray decision to withhold information from medical personnel about the drugs he had administered to Jackson. Dr White stated he believed Murray “overlooked” giving details about the Propofol he had administered but this was not done in a devious way.

Demonstration

A brief discussion about last week’s demonstration then took place. There was an issue about the apparatus used and if it had been modified. Dr White agreed that this was the case.

Walgren also asked if the IV equipment was small enough to have been removed from the scene without being obvious. Dr White stated that it did appear to be.

Dr White’s Report

Dr White was asked by the defence to write a report (he wrote a letter) that stated he theory on what happened. Initially Dr White stated that he believed Michael Jackson drank Propofol. Dr White stated he has now rejected this theory. He told the court that this report was prepared at short notice.

Dr White stated how he believed that Jackson had self-administered Propofol, whether it be oral or intravenously. Dr White had tried to research oral Propofol ingestion but found no such reports. He wanted to research the area as he “was just trying to cover all the possibilities”. In his original report Dr White did not mention Jackson taking Lorazepam pills.

Dr White states he never had any other theory than Michael Jackson killing himself. He took everything that Conrad Murray had told him to be the truth.

Dr Ornelis

Dr White then mentioned a model that he used to come up with his theory. As he does not have the maths or computer skills to create such a model he hired an expert, Dr Ornelis. Dr White met Dr Ornelis for the first time last week. Dr Shafer had provided a report in court for calculations using his own software. Dr White then used this report to test whether Dr Shafer’s account was possible.

Dr White asked Dr Ornelis to calculate how much Propofol appears in urine after a three hour infusion.

Walgren asked Dr White who thought of the theory that Michael consumed Lorazepam tablets at 10AM. Dr White states that no specific theory was put forward. He stated that Dr Ornelis had been following the trial and chose the timeframe herself.

Animal testing

Dr White then was asked about an animal study he had conducted. He stated after seeing Dr Shafer’s report in April he contacted a vet to conduct research on Propofol ingestion.  The test was conducted on beagles. No report was written up from this test. There was only an oral report from Michael Flanagan stating that the study produced negative results.

Dr White stated he was unaware of any tests that had been conducted on humans in regard to oral doses of Propofol. He did mention that Dr Ian Glenn, who is referred to as the “father of Propofol” had told him that oral consumption did not have an effect.

Self-administration

As mentioned Dr White believes that Michael Jackson self-administered the doses of drugs which killed him. Dr White told the court he could not be sure of the timeframe when the Lorazepam pills were taken. He stated that when Dr Murray was not paying attention Jackson took Lorazepam tablets. He was not sure of where Murray was at the time this occurred but he believed Murray was “somewhere in the vicinity”.  Dr White based his simulation on this. He believes it occurred around 7AM.

Dr White was then asked about the two minute toilet break that Murray had just before he found Michael not breathing. Dr White believes that Dr Murray had drawn up a syringe of Propofol and left this in the room somewhere. After observing Jackson for 25 minutes Murray felt it was safe to leave the room to make phone calls. Sometime during the 46 minutes that Murray was out of the room Jackson self-administered the fatal dose of Propofol.

Dr White believes that Jackson used a port on the IV tube to take the dose, although he states that Murray did not leave the syringe in the port. Dr White stated that Jackson had the ability to walk around the room and find the syringe. When the prosecution cast doubt on this claim, as Jackson was hooked up to an IV stand and was using a condom catheter, Dr White stated this is not the only theory but it is a possible theory. Dr White also stated he believed Jackson didn’t “realised the potential danger” of administering Propofol to himself.

The prosecution also brought up the point that it has been constantly referenced that the 25 mg dose of Propofol Murray administered would give light sedation. MJ had told Ms Lee that he wanted to be knocked out completely. Would Jackson have hired a doctor just to be slightly sedated? Dr White agreed that he would have wanted a deeper, restful sleep.

MAC Care

MAC care stands for Monitored Anaesthetic Care. Dr White had written an article about the use of Propofol in ambulatory care settings. The prosecution were keen to speak about this article as it is easy to trap an expert witness by their own works.

The prosecutions showed multiple quotes from Dr White’s article. The article discusses how standards for MAC are the same as for general anaesthetics and that the same level of care must be applied to patients no matter what venue they are in. It is stated that “during procedures patients are monitored to ensure safety and comfort”. It is important to note that MAC care does not involve off-label use of drugs.

In this section Dr White was very uncomfortable as his article shows that Dr Murray was not acting inappropriately. Dr White seemed very unhappy to have to answer questions that showed this.

A key part of the article for this trial was that it states “vigilant monitoring is required'. Dr White eventually had to agree with his own work and state this was true. Dr White stated monitoring is important because patients can rapidly progress through different levels of sedation.

Dr White went on to say that he has never practised in an office based setting so is not familiar with the requirements, although he did write about them in his article. All major US anaesthesia bodies give out information on the requirements of office based anaesthetic administrations. Mr White then had to read the guidelines out in court. It was clear Dr Murray did not follow these guidelines.

The prosecution then asked if similar guidelines would need to be followed in a bedroom setting. Dr White was very reluctant to answer. Dr White stated that “many of the requirements would be appropriate” but complex re-wording would be needed. But at the very least when administering Propofol in a home setting the minimum safety requirements must be followed.

The article also stated that every patient should receive care as if they were going to be receiving deep sedation, even if they are getting minimal sedation.

Dr White told the court that he could not say that a second person would need to be present when performing this treatment in a home. If the physician is qualified and paying attention Dr White would say only that physician needs to be present.

Simulation

Dr White then spoke about the simulation he has based his testimony on, created by Dr Ornelis. Dr Ornelis created a graph based on two scenarios, the scenario the defence are pushing and the scenario the prosecution are pushing. The test was to see how much unchanged Propofol is in urine sample after being filtered by the kidneys. Dr White asked Dr Ornelis to give an estimation of the result from two 25 mg doses of Propofol versus a 1000 mg infusion of Propofol.

The two urine samples from Jackson were compared. One was taken from the scene so would have been expelled prior to the Propofol overdose. The second sample was taken from the autopsy urine. Dr White stated that the Propofol levels in the scene urine were very low.

Dr White states that from the results of this modelling it looks more consistent with two 25 mg doses of Propofol rather than an infusion. This was also consistent with Murray’s police interview and the fact that there was no Propofol residue in the top part of the IV tubing.

Dr White was also asked about the heartbeat Dr Murray claims he saw. Dr White states this could mean that Jackson had a pulse or that Dr Murray was feeling his own pulse. Dr White told that court that in stressful situations doctors can be deceived into feeling their own pulse.

Dr White stated he was happy to testify using Dr Ornelis model as he trusts her integrity.

Re-direct by Flanagan

The prosecution then finished their cross-examination and a re-direct by Flanagan took place.

Flanagan started by asking Dr White how one should react when confronted with a patient not breathing. Dr White stated that you should start CPR straight away, in case the arrest had only just suddenly happened. He suggests CPR with an Ambubag be performed. Then 911 should be dial.

Flanagan then put forward the argument that nothing Dr Murray would have done could have saved MJ’s life. He also tried to establish that the Propofol’s effect would have elapsed so even if Murray had told the paramedics or hospital doctors about the Propofol it would have been irrelevant. Dr White agreed with this.

It was then stated that there is no specific antidote to Propofol and the only real treatment is to allow the drug to be redistributed and eliminated by the body.

Summary

Today was always going to be an explosive day as the prosecution were going to be able to grill the defence’s star witness. This certainly was the most confrontational day of the trial. Walgren machine gunned Dr White and left so many holes in his testimony it was unreal. Walgren showed how exceptionally skilled he is in cross-examination. Maybe Chernoff could learn a thing or two!

Walgren would often change topic suddenly to try to throw Dr White. And I thought it was very clever to use Dr White’s own words and works against him. It did very much seem that Dr White went in with an agenda and planned what he was going to say. But once Walgren used Dr White’s previous articles he had no choice but to backtrack on many of the statements he made in his testimony. It came across that Dr White was trying very hard to not incriminate Dr Murray but it was not possible to avoid answering Walgren’s questions. It was a wise choice for the prosecution to question in this manner as Dr White either has to show Conrad Murray made inappropriate choices or show that as a witness he is evasive.

I still find it odd that Dr White was a paid witness and that he was staying with Michael Flanagan during the trial. To me it seems he is too in the defence’s pocket to be objective. He was also scolded by Judge Pastor for constantly trying to use conversations he had had with Conrad Murray as evidence and as part of his testimony. This certainly is in no way acceptable. I read a quote from a lawyer who is covering the case and I think it surmises the relationship between Dr White and the defence team: “experts destroy their credibility when they stop being independent but start acting as advocates for the people who pay them.”

Yesterday it seemed the Dr White’s testimony shook the case up a bit. Today as Dr White had to change many of his statements and admit that Conrad Murray had multiple deviations of standard of care it seems that Dr White’s testimony was not strong enough to totally turn the case around.

Today Conrad Murray told the judge that he has not made a final decision as to whether he will testify or not. Judge Pastor told Murray he would ask him one final time for his decision tomorrow.

                                                                                                                                          

The trial continues on Tuesday.

Sophie Dewing

http://exploredreamdiscoverblog.blogspot.com/

People vs Conrad Murray - Day 20

The trial of Conrad Murray has now entered day 20. The final defence witness, Dr Paul White, continues his testimony. As he entered court Michael Flanagan, part of Murray’s defence team, stated this was "the most important day of the trial.”

Dr White

Dr White’s testimony today was full of technical medical descriptions and demonstrations relating to the effect of sedatives.  Dr White started off by discussing the ‘depth’ of sedation and the physiological effect this has on the patient. White explained there are 4 levels of sedation, from minimal sedation to general anaesthetic. At each different level of sedation different physiological changes occur. Dr White states that Michael Jackson would have been in a minimal amount of sedation from the 25 mg of Propofol that Dr Murray told police he had administered. Please note that the toxicology report found significantly higher levels of Propofol than this.

Not only were the levels of Propofol far higher than what Murray told police, the levels of Lorazepam were also greater. Dr White stated this could be due to traces of Lorazepam that Michael had ingested orally in the days beforehand that were still in his system.  The prosecution objected this as there was no evidence that Jackson had taken any Lorazepam orally.

Dr White then spoke about the simulations that Dr Shafer had shown in court, which were to show how he believed the levels of drugs in Jackson were achieved. Dr White tried to disprove all of Dr Shafer’s scenarios. Instead Dr White believes that Michael Jackson gave himself a fatal dose of Propofol.

Infusion

Dr Shafer’s main scenario was that Dr Murray infused Propofol into Michael Jackson via an IV drip. Dr White testified that he did not believe this theory, as no infusion set-up was found at Jackson’s house. Dr White told the court "I was somewhat perplexed at how a determination has been made that Dr Murray was infusing Propofol...it wasn't obvious to me."

White also stated that the levels of Propofol in Michael’s body were inconsistent with that of an infusion (based on the urine samples).

Dr White told the court he does not believe that Murray had put a bottle of Propofol into a saline bag, even though two witnesses have testified that they saw this. Dr White does not believe this to be true as no residue of Propofol was found in the saline bag or the upper part of the IV line. He also thought it would be unusual to create this set up as Propofol bottles have clips so they can be easily suspended from an IV rig. When speaking about the proposed set up Dr White stated "it's befuddling to me...why would you go to all the hassle?"

Lorazepam tablets

The other key drug that is being discussed in this case is Lorazepam. In Dr Shafer’s testimony he stated he believed that Dr Murray had given Michael Jackson at least nine 4 mg injections of Lorazepam through the morning of the 25^th June 2009. Dr White disagreed with this stating that these quantities were “enormous” and would certainly put anybody to sleep, if not kill them.

Dr White then said he believed it was more likely that Jackson took eight pills of Lorazepam throughout the morning (probably taking two or three at a time). He stated Jackson did this on his own accord after Murray had already given him Propofol.

This combination is what killed Jackson, according to Dr White.

White went on to discuss the traces of Lorazepam that were found in Jackson’s stomach. He stated that there were only small traces found as the drug had been quickly absorbed by the digestive system. Dr White then made an important point by stating if the Lorazepam had been given intravenously then there would have been no traces at all in Jackson’s stomach.

Michael Jackson killed himself

Dr White told the court there was no evidence that Conrad Murray had Michael Jackson on an IV drip to administer Propofol. According to the evidence he has seen Dr White believes Murray gave a small, non-fatal dose of Propofol. From the evidence recovered at the scene he believes this dose was given via injection.

Dr White testified that he believed that at around 11.30AM Michael Jackson somehow gave himself a fatal dose of Propofol. Combined with the Lorazepam that Murray had given Michael earlier this killed Jackson.

Dr White believes that this is the only theory that is supported by the interview Murray gave police and the evidence from Jackson’s house.

As a side note

Some other important points that were raised in today’s testimonies included that Murray had stated in his police interview that he had previously used an IV to administer Propofol to Jackson.

Flanagan also addressed the “elephant in the room” and asked Dr White whether he could justify administering Propofol to a patient and then leaving the room. White replied “absolutely not.”

The court adjourned early. Cross-examination of Dr White will begin on Monday.

Summery

This was probably the most important testimony of the whole trial and it certainly did shake the whole case up. Dr White gave detailed reasons for why he believes Dr Shafer’s scenarios to be wrong. It was also very important that Dr White stated that there was no evidence that Propofol was administered intravenously to Jackson. Neither the equipment, nor residue in the used equipment, was present. This will certainly give the jury something to think about.

Dr White was also the first witnesses to testify that he believed Michael gave himself the fatal dose; this is the statement the whole of the defence’s argument is based on.

It is interesting that for the whole case Murray was certainly culpable and it has come down to the wire for any testimonies to have any real sway. But the question is will the juries mind be changed by this testimony?

Lest we forget that the prosecution aim to state that Murray was negligent and did not react appropriately to the situation. Even if Jackson did administer the fatal shot himself Murray could still be held accountable for negligence as he had left Michael alone, and unmonitored, long enough for Jackson to do so. There were also a lot of inappropriate actions in the way that Murray responded. He did not call help immediately, he did not give all the information he had to medical staff and he lied in his police interview.

I

I think it was very clever for the defence to leave Dr White until last as his testimony will be the most fresh in their minds and this could lead them to be more influenced by this account.

“Mr Lorazepam”

Even on this most vital day the defence still showed how shoddy they were. Three times they got Dr White’s name wrong, who is their witness.

And also by a slip of tongue did the defence refer to Jackson as “Mr Lorazepam”. This is highly inappropriate and was something that Judge Pastor picked them up on.

Something I found insightful is that Dr White is a paid witness. I am sure this is something that the prosecution will want to discuss during cross-examination. The prosecution’s Propofol expert, Dr Shafer, received no monies for his testimony. Whether this will have any influence on Dr White’s testimony is to be seen.

The trial is now drawing to a close. On Monday Dr White will be cross-examined. The cross-examination will probably the most critical and dramatic day of the trial so far. As he is the last witness once his testimony is complete the prosecution and defence will then present their closing statements. It will then be up to the jury to deliberate the verdict. A verdict could be reached next week.

The trial continues on Monday.

Sophie Dewing

http://exploredreamdiscoverblog.blogspot.com/

People vs Conrad Murray - Day 19

Today we entered day 19 of the People vs. Conrad Murray trial. There are reportedly only two defence witnesses left to take to the stand.

Dr Robert Waldman

The first testimony of the day came from Dr Robert Waldman, an addiction specialist. One of the defence’s main arguments is that Michael Jackson was addicted to Demerol that had been administered by dermatologist Dr Arnold Klein.

Waldman stated that in the months leading up to Jackson’s death he had been regularly visiting Dr Arnold Klein for Botox and Restylane treatments. During these relatively painless treatments Jackson was receiving “unusually large” quantities of Demerol. It was revealed from Dr Klein’s medical records that in March 2009 Jackson was receiving 200mg of Demerol. By May 2009 it had increased to 300mg. The reports showed that in one sitting Michael received 375 mg; a typical dose would be 50 mg.

Waldman told the court that the amounts of Demerol that Dr Klein was administering to Jackson would have left him “sleepy, lethargic, possibly difficult to arouse, possibly unresponsive.”

A symptom of withdrawing from Demerol is insomnia. The defence believe that it was the withdrawing from this drug that caused Jackson to not be able to sleep and eventually lead to him administering Propofol to himself.

Dr Waldman stated he believes that Jackson had become dependent on the drug. Waldman told the court “I believe there’s evidence he was dependent on Demerol.” When asked if he believed Jackson was addicted Dr Waldman replied “possibly.” The difference between a dependency and an addiction is that a dependency is a physical need for a drug. An addiction is more serious as it involves destructive behaviours and continuing use of a substance despite bad consequences.

Waldman told the court that had had no expertise in dermatology, but had consulted doctors in the field.

Cross-examination

On cross-examination prosecution lawyer David Walgren implied that Dr Waldman’s conclusions were irrelevant and that the defence were seeking to confuse the jury by passing the blame on to someone else. Walgren asked “you understand there is no Demerol in the toxicology findings?” Waldman stated this was correct.

Walgren also questioned Waldman about how he concluded that Jackson was dependent and possibly addicted to Demerol. Waldman stated that he had not just looked at Dr Klein’s medical records, he had also formed his opinion based on “what’s known about his [Michael Jackson’s] public behavior.” Walgren then asked “would you diagnose Michael Jackson as addicted to Demerol based strictly on the documents in my hand?” Waldman stated “probably not.”

Waldman also acknowledged that he was not officially certified as an addiction specialist.

Dr Paul White

The second testimony of the day, and the final defence witness, Dr Paul White, a Propofol expert, then took to the stand.

Dr White tried to dismiss the prosecutions claims that Murray was reckless by combining a number of sedatives when treating Michael Jackson. White stated "in anaesthesiology, it's what we do every day… We're polypharmacists. We combine drugs to achieve better effect, with less medication."

Dr White also told the court that it would be unusual for Jackson to have been able to have died from the dose that Murray gave him. Murray told the police that he had administered 25 mg of Propofol to Jackson. White stated that this was a relatively small dose.

The court was then adjourned for the day.

Summery

It is certain that Dr White’s testimony is going to shake the case up. It will be interesting to hear if the prosecution pick up on the point that Dr White thinks the dose Dr Murray stated he administered, 25 mg, was too small to kill him. The toxicology reports prove that Murray had lied to the police as far higher doses of Propofol were found in Jackson’s body. If White is basing his testimony on what Murray told police it seems his testimony will be filled with inaccuracies. It will be interesting to see what Dr White believes the toxicology report findings prove.

I thought it was highly surprising that Dr Waldman was not actually an addiction specialist. I also thought that it was not right that his decision was informed by here say about Jackson’s public persona. In a court only fact really matters and opinions that are not supported by evidence or fact are completely irrelevant and invalid.

It seems the witnesses that the defence have called so far have either been irrelevant to the case, such as the former patients, or under qualified to be experts on their subjects such as Dr Waldman and Michael Henson from Pacific Toxicology. The only witness that seems to have any relevance is Dr White, whose testimony is not only key to the defence’s argument but also to the case.

It does seem unfortunate that the ultimate decider of how the case goes is in the testimonies of the two key witnesses, the Propofol experts Dr Shafer and Dr White, who are holding their own battle as they were former colleagues and are now rivals.

In a court of law I always feel that witnesses should be as balanced and unbiased as they can, particularly expert witnesses. It seems very few of the witnesses in this trial have been. Combined this with an incompetent defence team I do not feel this is a fair trial, either to Dr Murray or to Michael Jackson.

The trial continues tomorrow with the most important, and final testimony, from Dr White.

Sophie Dewing

http://exploredreamdiscoverblog.blogspot.com/