People vs. Conrad Murray - Day 12

Today was day 12 of the People vs. Conrad Murray trial in relation to the death of Michael Jackson. Dr Nadar Kamangar, a sleep expert, resumes his testimony. Today’s session was very short and adjourned early.

Dr Nadar Kamangar

Dr Kamangar continued his testimony today under cross-examination. Michael Flanagan, one of Murray’s defence lawyers, questioned Dr Kamangar about a doctor’s role and responsibilities. Flanagan asked if it is a physician’s responsibility to find out why their patient is refusing certain treatments and asking for inappropriate treatments. Dr Kamangar stated he would make sure his patient received the right care and would not undertake treatments that are not in the patient’s best interest, even if they were asking for it. Kamangar stated it was an “extreme violation of care” that Murray did this with Jackson.

Flanagan then pointed out that doctors could perform a treatment, even thought it would be considered bad medicine, and it doesn’t mean that a bad outcome would occur. Kamangar said that this does not make it acceptable; it is still grossly negligent if a doctor were to work like this. Dr Kamangar also pointed out that Murray was administering very potent drugs without appropriate monitoring equipment. This was a recipe for disaster. Administering a cocktail of drugs in an inappropriate setting was a perfect storm for Michael’s demise. Dr Kamangar was also critical of Murray not having written any notes about the drugs he was administering or Jackson’s vital signs. Kamangar stated that this was a contributing factor in Michael’s death.

The defence then questioned Dr Kamangar about insomnia. Kamangar stated it was obvious MJ was suffering from insomnia. He also stated that Jackson’s dependency on other drugs and anxiety could have caused his insomnia. Flanagan put forward that if used in a clinical setting Propofol is an acceptable treatment for insomnia. Dr Kamangar stated he did not have enough information to answer but it is still incomprehensible to use Propofol in a home setting. The defence then mentioned a study conducted in Taiwan in 2010 where patients suffering from insomnia were successfully treated with Propofol. Dr Kamangar pointed out this study took place a year after Michael Jackson’s death and was conducted in a hospital.

Dr Kamangar then testified that Lorazepam has no role in treating insomnia. He takes this stand point as patients can become dependent on it therefore making an inappropriate treatment for sleep problems. Kamangar stated he would only prescribe oral Lorazepam for patients with anxiety, and only for short term use.

Dr Kamangar then went on to discuss Jackson’s drug dependency. He was critical about Murray not addressing Jackson’s addiction. As Murray mentioned in his police interview Michael would visit Dr Arnold Klein three times a week and would come back ‘wasted’ and had slurred speech. Kamangar states if your patient was in this state you should discuss this with them. Kamangar also states that if people had mentioned a change in Jackson’s behaviour or concern about Michael, Murray should have looked into it.  From previous testimonies we know that Frank DiLeo had asked Murray to get blood tests as he was concerned about if Jackson was taking drugs. Kenny Ortega also had voiced concern to Murray about Jackson’s wellbeing. Murray then told Ortega to mind his own business, Michael was fine. And in his own police interview Murray stated that MJ’s production team worried about Michael after he returned from visits to Dr Klein.

Dr Steven Schafer

The last person to testify was Dr. Steven Shafer, an anaesthesiologist and a leading Propofol expert. Dr Shafer had only just taken to the stand when the court was adjourned due to scheduling conflicts. Court was also postponed until Monday morning. Dr Shafer’s testimony will continue then.

News reports

In the press this week there have been some interesting stories about the case. One report suggests that Conrad Murray would not be on trial now if he had not himself requested to speak with police. We heard earlier this week from Detective Scott Smith that the first time the police heard about Propofol was from Murray himself. Prosecutors were not going to push for a case as they believed there was no way they could prove Murray administered Propofol to Jackson. But Murray himself admitted this and also that he had been doing it for two months solid.  This went on to prove that up until the 25^th June 2009 Murray had administered 5 gallons of Propofol to Jackson.

Detective Smith had testified that the police had no idea Murray had put a bag with Propofol bottles in MJ’s closet. When police informed Murray of this Smith stated Murray looked ‘shocked’. It seems Murray realised at that point the police didn’t know as much as he thought and he had now incriminated himself.

The police were also alerted when they realised parts of Murray’s interview were lies. This caused suspicion and lead to charges being filed.

The prosecution's argument is Murray acted recklessly and was negligent. By his own account to police Murray incriminated himself. Administering Propofol in a home setting is reckless.

Reduced sentence?

At this stage of the trial it is almost certain Conrad Murray will be found guilty. But media reports are suggesting that Murray may not spend much time in prison, if he spends any time at all. A new law was brought into effect in California on the 1^st October which states if someone commits a non-violent felony crime they cannot be sent to a State prison due to overcrowding. Instead they will be sent to a county jail. If found guilty Murray would be sent to a county jail because of this.

Currently Murray could face up to 4 years in prison. An LA County Sherriff told the media that Murray would probably only serve half of this sentence. This would make his sentence 2 years. But as there is a problem with overcrowding in county jail  non-violent prisoners with no previous criminal history will be eligible for house arrest. As Murray fits into this category he may end up spending whatever sentence he is given wearing an electronic tag but living at home.  The Sherriff did state that Murray would serve some time in prison as they would not allow him to be living under house arrest straight away.

I think it is very easy to get caught up in the verdict and forget the sentencing. It seems inevitable that Conrad Murray will be found guilty but his sentence is still something that is unsure. A possible four year sentence could be drastically reduced to an electronic ankle tag. It will be interesting to see what the outcome is.

To read more about these reports visit here.

Summery

I had previously mentioned in my post about the opening statements that I thought the jury may be hung due to what their stand point is regarding doctors giving unnecessary treatments to patients even though the patient has requested it. I found it interesting today that Michael Flanagan brought this point up. I am happy that Dr Kamangar stated that it does not matter what the patient requests, it is unethical for a doctor to perform treatments that are unnecessary and risky. Particularly when they are not in an appropriate environment. It does very much seem in the US there are two ways of thinking when you are a doctor. The doctors who are there to cure sick people, and the doctors who are there to make money. In this case it shows that Murray is in no way unique by performing unneeded procedures on patients. As we have heard with Jackson alone he had multiple doctors throughout the years prescribe him many different drugs and administer Propofol. Lest we forget this will be happening with many patients and doctors across the US. But it does bring hope that the whole of the medical care system is not corrupt when many of the doctors who have testified so far have condemned Murray’s actions and ethics.

I do find the defence’s arguments to be a bit scattered. First they suggest that other people were to blame for not reacting quick enough, then they suggest Michael administered the dose himself and now they talk about the liability of who is responsible if a patient has asked for a treatment. Instead of having one argument and sticking to it the defence seem to be flimsy and whenever the evidence stacks against them they change their argument. It does seem as if they know Murray is guilty of negligence and reckless behaviour but need to try to persuade the jury in any way that maybe he is less accountable due to other circumstances. As I mentioned before it does seem now that the trial is merely a formality. The defence know Murray will be found guilty but his sentence may be reduced if they can try and make other people or circumstances accountable.

The trial enters week four and resumes on Monday.

Sophie Dewing (@sophiedewing)

http://exploredreamdiscoverblog.blogspot.com/

People vs. Conrad Murray - Day 11

The trial has now entered day 11 of proceedings and the prosecution are getting towards the end of their witnesses.

Dr Alon Steinberg

The first person to testify today was Dr. Alon Steinberg, one of the leading cardiologists for the California Medical Board. Dr Steinberg made it clear that he was a cardiologist and not an anaesthesiologist. The key point Dr Steinberg made was that he found six separate deviations of standard of care from Conrad Murray in regard to Michael Jackson and each one showed “gross negligence”.

Dr Steinberg testified that he reviewed the case by reading the transcript of Murray’s interview with the LAPD so he could “judge Dr. Murray on his very own words." The main comments Dr Steinberg made were that Propofol should only be used in hospital and using it would require an anaesthesiologist. He said he had never heard of anyone using Propofol to treat insomnia. Steinberg stated it is gross negligence to use Propofol in this way. He also stated it was unethical. He went on to say that using Propofol in a home without proper medical equipment or staff is also gross misconduct. Because Murray did not have the correct essential medical items he was not prepared if complications were to arise. The equipment he did have, like the pulse oximeter, did not have an alarm so unless constantly monitored this device is useless. Dr Steinberg believes Murray should have had an assistant at all times.

Dr Steinberg then went on to discuss the events that took place on the 25^th June 2009. Steinberg stated that Murray should have called 911 immediately. Help could have arrived in 4 minutes. Crucially Dr Steinberg testified that if Murray had done this Michael Jackson would be alive today. Steinberg told the jury that "for every minute of delay there's less and less chance the patient will survive." It took Murray 20 minutes to call paramedics. During these 20 minutes Murray tried to save Michael’s life himself. The methods he used were inappropriate according to Dr Steinberg. Steinberg testified that when Murray noticed MJ was not breathing he started chest compressions. This was completely wrong because when people stop breathing their heart is still pumping. They do not need chest compressions. Instead Murray should have used an ambubag straight away and administered Flumazenil to try to reverse the affect of the Propofol and the other sedatives. The priority was to get oxygen into Michael and the fact that Murray performed CPR was 'inexcusable'. Murray also wasted time by calling Michael Amir instead of getting an ambulance. Dr Steinberg said Murray’s reaction and behaviour were “bizarre”. Dr Steinberg also stated that even if Jackson had self-administered the Propofol Murray had still failed to monitor him properly and this negligence still makes Murray accountable.

Dr Steinberg then went on to detail other errors Conrad Murray made. Murray did not make any notes. This is vital so the patient can continue to receive the right care in the future but also important for legal and insurance purposes. Records can also be checked to see if mistakes were made. The defence did try to argue that Murray did not need to write notes as he only had one patient. Dr Steinberg stated that Murray should have still been writing notes because when he arrived at UCLA he couldn’t remember what he had given Jackson so was unable to tell the doctors. This can make the difference between a patient living and dying.

A very interesting point Dr Steinberg made was that Conrad Murray was not board certified on June 25 2009 when MJ died. This is huge. This basically means that in California (at least, I am not sure about other states) Conrad Murray was not registered as a doctor.

Dr Steinberg went on to further criticise Murray for leaving Michael on his own as he states "it's like leaving a baby that's sleeping on your kitchen countertop,". Steinberg also said that according to the transcripts Murray gave Michael a drip of Propofol in addition to the 25mg he had already given him. The drip would have been needed to keep Michael under and to remain asleep.

Steinberg stated Murray's breeches in care "directly contributed to the untimely death of Michael Jackson."

A major development then occurred. Murray’s defence team announced they were no longer contending the Michael Jackson drank Propofol. They still will argue that Jackson gave himself the fatal dose but not orally. This is a crucial point in the trial and it will be interesting to see just how the defence will now alter their argument.

The defence also suggested that the two minute toilet break that Murray told of in his police interview wasn’t accurate. Murray’s statement is improbable and it had previously been testified that it would be difficult for someone who is sedated to suddenly sit up and then have the knowledge, skill and ability to administer Propofol themselves, particularly in a two minute timeframe. Previous phone call records and numerous testimonies from people who spoke to Murray that morning have already proven that in the hour leading up to Jackson’s death Conrad Murray was on the phone for 46 minutes. The police also never believed Murray only left for a two minute break. The admittance that Murray may have been out of the room for longer may play into the defence’s hands as it gives more time for Jackson to have self-administered Propofol. Although with testimonies from medical professionals who state this is still very unlikely it seems implausible that this is a strong enough argument to turn the case in Murray’s favour.

Dr. Nadar Kamangar

The final testimony of the day came from Dr Nadar Kamangar, a pulmonary and critical care doctor who specializes in sleep medicine. Dr Kamangar stated that he uses Propofol on a daily basis but it is a drug that can be extremely unpredictable especially when used with other sedatives. Kamangar testified that patients who have been administered Propofol need to be closely monitored as their condition can change rapidly. Dr Kamangar also stipulated the importance of using an automated pump when administering Propofol so the dosage can be regulated. This is vital as Propofol is so powerful.

Dr Kamangar then went on to discuss Conrad Murray directly. Dr Kamangar testified that he found "multiple extreme deviations" in Murray's standard of care calling his use of Propofol "inconceivable," "unethical," and "disturbing." Murray's use of Propofol outside of a highly monitored facility was "inconceivable." Kamangar stated Murray's treatment of Michael Jackson amounted to "gross negligence."

Dr Kamangar told the jury Murray should have never given Jackson any sedatives at all because he was dehydrated. This means his blood pressure was already low. Kamangar stated Murray’s CPR was poor and in violation of standard of care. Much like Dr Steinberg, Dr Kamangar believes Murray wasted time calling Michael Amir instead of 911 and not calling them right away was an "unconscionable deviation of care".

Kamangar also stated that by withholding information from the doctors at UCLA Murray broke the first rule of medicine – putting your patient first. Kamangar also believed it was unethical for Murray to ignore signs of Michael’s drug dependency.

Summery

Today was a turning point in the trial as the defence have admitted that Jackson did not drink Propofol. They still will argue that Jackson killed himself but the Propofol was not taken orally.

The past few days have also seen Conrad Murray come under very harsh criticism from many medical professionals. Multiple testimonies have stated that Propofol is inappropriate to use in a home setting and that many standards of care were not met. The key phrase seemed to have been ‘gross negligence’. Seeing as the prosecutions argument is that Murray was negligent and abandoned Jackson when he was administering a risky treatment, currently it is almost certain Murray will be found guilty. The witnesses to testify so far have solidified the prosecutions argument.

The trial continues tomorrow with Dr Kamangar finishing his testimony.

Sophie Dewing (@sophiedewing)

http://exploredreamdiscoverblog.blogspot.com/