Murray Trial _ All daily trial Summaries - No discussion November 7/ Verdict announced

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September 23, 2011 Jury Selection Report

84 jury candidates were brought in for selection process. 10 jury candidates were quickly dismissed because they said they could no longer serve on such a long case. The personality and life of Michael Jackson dominated much of the jury questioning.

Conrad Murray’s defense team asked potential jurors:
- Do you believe Michael Jackson is less capable of making decisions that somebody else his age?
- If Michael Jackson was "childlike...not capable of making decisions?"
- Does anybody think that Michael Jackson should be held to a different standard of responsibility?
- Does anybody believe that Dr. Murray is partially responsible for Michael Jackson ‘s death?

Prosecution asked if the jurors could convict Murray if they found Michael Jackson had contributed to his own death. Jurors were given a hypothetical situation where a reckless driver runs a red light and kills a pedestrian who was “also not being safe as he could be and steps out in front of a car.” “You could say the driver is not 100% responsible, but he did play a substantial role,” DA Walgren said. “Could you find him guilty?” he asked to the jurors.

12 Jurors selected consists of 7 men and 5 women. 6 of the jurors are White, 5 of the jurors are Hispanic and 1 is African American. 5 alternate jurors (3 women, 2 men) were also selected.

Below are basic information about the 12 jurors.

Juror #127 Mexican-American female, 54, property manager, has a daughter who was an alcohol and drug user 5 years ago, thinks famous people are treated differently in court. She loved MJ's music as a girl.

Juror #145 White male, 45, partner in management consulting firm, wife is pediatric nurse at a hospital, served twice on a jury, watched "This is It".

Juror #61 White female, 57, unemployed, worked in past for Red Cross, followed the OJ trial, her younger brother uses drugs, served 5 times on a jury.

Juror #70 White male, 54, college professor of animation and art, created characters for motion pictures at Disney, followed OJ trial, convicted of DUI, thinks celebs are not treated the same by police and can bend rules. MJ fan.

Juror #44 Cuban/Mexican-White, family members with alcohol addiction, served on a civil jury, fan of MJ, especially Thriller.

Juror #49 White female, 43, head of communications for international marketing firm, served as juror in child sexual abuse case, does not think cops are more lenient with celebs.

Juror #100 white female, 48, paralegal for 30 years, watched Casey Anthony trial, brother is an EMT, people of wealth and fame treated differently in court system.

Juror #52 Mexican male, 51, USPS letter carrier, wife is back-office medical assistant, fan of MJ.

Juror #99 Hispanic male, 42, school bus driver, father was addicted to alcohol, father-in-law died from alcohol abuse, served on a jury, MJ fan.

Juror #38 Hispanic female, 36, customer service rep, watched Casey Anthony trial , former employer is a doctor, father was an absent alcoholic, served on a DUI jury, MJ fan.

Jury #128 African American male, 54, technical director for TV, has cousin is a judge and another cousin who's a lawyer, his dad died of alcoholism, juror on 3 cases, loved the Jackson 5 as a kid, now likes Jay Z.

Juror #108 White male 32, book seller, juror in civil trial, trained actor, MJ fan.

 

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Murray Trial Day 1 - September 27 , 2011

Hearing started approximately 30 minutes late. Judge Pastor explained the reason as traffic and problem with the elevators. Trial started with Judge Pastor explaining jurors the process, breaks , taking notes and what is an opening statement.

Prosecution Opening Statement

DA Walgren started his opening statement. He used a presentation to accompany the points he’s making. In the presentation he showed a picture of Michael lying in a gurney - most probably taken at the hospital after revival attempts.

DA Walgren “Evidence will show that Michael Jackson literally put his life in the hands of Conrad Murray. Michael Jackson trusted his life to medical skills of Conrad Murray. That misplaced trust was a too high of a price to pay.” DA Walgren states that Dr. Murray’s actions led to MJ’s death.

DA Walgren explains what Michael was doing in months before his death. Walgren mentions that Michael was getting ready for his comeback tour TII, mentions rehearsals and that Michael was living in 100 N Carolwood with his children.

Walgren mentions that Michael and Dr. Murray met in 2006 in Vegas and maintained contact. At the time Michael Jackson died, Dr. Conrad Murray was not board-certified in any medical specialty. In March 2009 Michael asked Dr. Murray to accompany him on tour. Murray agreed and requested to be paid $5 Million a year. They offered him $150,000 a month. Murray's duties included to perform general medical care, emergency medical care. He would have received $150,000 , airfare to UK and housing. He would have been hired as an independent contractor. At the time Michael died the contract was not signed by Michael or AEG.

DA Walgren explains Propofol to the jurors. Walgren tells that it's not a sleep agent , it's anesthesia. Walgren goes over good and bad qualities of Propofol and tells the dangers. DA Walgren mentions Murray lied to pharmacists Tim Lopez and told him that he had a clinic and patients in California. Walgren starts listing Murray's Propofol orders and how they were sent to Murray's girlfriend Nicole Alvarez's house.

DA Walgren plays a part of an audio Murray recorded on is iPhone on May 10. Walgren mentions that Murray was recording Michael who was under influence of a unknown drug. Walgren states that this shows that the Murray knew the effect of his treatment on Michael, yet continued to order Propofol.

<iframe width="480" height="360" src="http://www.youtube.com/embed/7XJFoH2MwLY" frameborder="0" allowfullscreen></iframe>

The recording said:

&#8220;We have to be phenomenal. When people leave this show, when people leave my show, I want them to say, &#8220;I&#8217;ve never seen anything like this in my life.

"Go. Go. I&#8217;ve never seen nothing like this. Go. It&#8217;s amazing. He&#8217;s the greatest entertainer in the world. I&#8217;m taking that money, a million children, children&#8217;s hospital, the biggest in the world, Michael Jackson&#8217;s Children&#8217;s Hospital.&#8221;

Between April 6, 2009, and the time of Michael Jackson's death on June 25, Dr. Conrad Murray ordered enough propofol to give Jackson 1,937 milligrams a day, prosecutor David Walgren told jurors in his opening statement.

June 19, 2009. Michael was not in good shape. He had chills, he was rambling and trembling. Kenny Ortega put a blanket on him, massaged his feet, fed him chicken and then made him go home early.

June 20, 2009. There was a meeting about Michael's health. DA Walgren says that Dr. Murray scolded Kenny Ortega. " I'm the doctor not you. You direct the show leave MJ's health to me."

June 23, June 24, 2009. Michael had good rehearsals. He's fine, strong and optimistic.

June 25, 2009. Michael comes home around 1 AM. DA Walgren shows pictures of the house, layout, inside the rooms.

DA Walgren shows a list of Murray's phone calls and emails. Walgren mentions the 11:51 phone call with Sade Anding and tells that 5 minutes into the phone call that Sade Anding heard a commotion and Murray stopped talking to her. DA Walgren says for 11:56 - 11:57 AM ""This is likely the time Conrad Murray first noticed Michael Jackson's lifeless body".

Walgren says that Dr. Murray called Michael Amir Williams (MAW) at 12:12PM. MAW returned Murray's call at 12:13 PM. Dr. Murray told him to come to house, he didn't ask him to call 911. MAW called Alberto Alvarez and told him to go into the house. When Alberto came into the room Murray told him to collect the vials and saline bag on the IV. 911 was called at 12:20 PM.

Paramedics arrived at 12:26 PM, they tried their best but Michael was gone. Paramedics asked Murray what he gave to Michael. Murray said Lorazepam and he didn't mention Propofol. Paramedics was on call with UCLA and UCLA wanted to announce Michael death on the scene. Murray wanted Michael to be transferred to UCLA. When they arrived UCLA doctors asked Murray what Michael was taking and what he gave to Michael. Murray told the doctors that Michael was taking Valium and Flomax and he gave Michael Lorazepam. Again Murray does not mention Propofol to the doctors. Michael is announced dead at 2:26 PM at UCLA.

2 days after Michael's death LAPD interviews Murray. At that time the tox results wasn't back and there was no visible trauma so the detectives did not know the reason of Michael's death. This is the first time that Murray mentions Propofol and tells his version of the events.

According to Murray all the drugs he gave to Michael did not work. At 10 AM Michael tells Murray that he would cancel the rehearsal and he wouldn't need to get up at 12:00PM. After that Murray decided to give Michael Propofol. Murray claims he gave Michael 25 mg of Propofol. When Michael was lying in bed with all the drugs in his system Murray emails the insurance broker saying that Michael is fine.

Walgreen discusses issue of standard of care. DA Walgren explains gross negligence to the jurors and gives examples of Murray's actions that account to gross negligence. These are
- No written standard of care / risks / consent form
- Not calling 911 (especially when calling 911 is basic common sense)
- Employee / employer relationship and Murray not working for the best interest of Michael but working for $150,000. He did not use sound medical judgement.
- Deceived paramedics by not disclosing Propofol
- Deceived emergency room doctors by not disclosing Propofol

Murray had legal duty of care to do no harm to Michael Jackson. Murray with his eyes on $150K agreed to provide him massive aounts of propofol with complete disregard to all medical standards. Murray abandoned Michael on June 25. Filled with drugs, no monitoring equipment, no resuscitation equipment, left him all alone. It's clear that Murray abandoned Michael when he needed help.

Pictures shown during the Prosecution Opening Statement

Saline Bag and Propofol bottle that Murray asked Alvarez to collect

syringe

urine jug

IV stand

Bed

 

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Murray Defense Opening Statement

- Chernoff argues that Michael was frustrated and desperate to sleep and took 8 2 mg Lorazepam pills without Murray&#8217;s knowledge. It was an act that caused his own death.

- Chernoff believes that scientific evidence will show that Michael administered Propofol when Murray left the room and with the Lorazepam in his body it created the perfect storm and killed him instantly. He couldn&#8217;t even close his eyes.

- When Murray found Michael, there was no way to bring him back.

- 2 questions
o How did Michael get to this (desperate) point?
o What happened when Dr. Murray was out of the room?

- TII would be creating history. It would be a world tour and movies. Michael would earn a lot of money. It was dependent on Michael doing TII shows but he was never able to do this shows. He had a problem that would not be resolved by any determination or talent. He knew he needed help and he went looking for help in Spring 2009.

- Summer 08 initial negotiations of TII. October 08 meeting. Michael cried at that meeting said he was tired of being a vagabond. January 09 signing the contract. Michael was afraid he wouldn't sell the tickets. It sold quickly. Increase the shows to 50 on 2 conditions: 1 - house for him and his children and 2- Guinness world book of records would be there to record. 50 year old man 50 shows in one arena over 1 million people. This was it for him. He named the tour himself.

- Murray is not a celebrity doctor. He has 2 practices, he performs angioplasty surgeries. Those require anesthesia. He saves lives. They will bring patients of Murray to testify. Chernoff states that Murray is not greedy and provides service for free.

- One of MJ's bodyguards knew Murray; he was called to the hotels to look after his children were sick. They would become friends first. Michael would tell him about his childhood, dreams etc. From 2006 to 2008 Murray treated Michael for things like toe fungus, broken foot, checked his heart, his liver. Michael told Murray twice he had anxiety and problems with sleeping. Murray prescribed him sleep medicine but it wasn't effective for Michael.

- Michael didn't have insomnia. Michael Jackson had an absolute and through inability to sleep, not for minutes, hours. It was for days.

- June 27 meeting with the police. Defense only selected the location. 9 of the other witnesses also had lawyers. Detective Smith had already spoken to everyone before he spoke to Murray. There was no limitations in regards to questions or time. He answered every question. In that interview Murray said he said to the detectives he didn't know what killed Michael Jackson and he wanted to know as well.

- In this interview Dr. Murray told detectives about Michael's sleep problems. Michael Jackson told Murray he had inability to sleep and he could only sleep on Propofol and he always slept on Propofol when he was touring. Michael Jackson explained how to give Propofol. Murray told detectives he agreed to give Michael propofol to help him sleep. He said that he was concerned that Michael would use Propofol without him.

- Murray provided Michael Propofol for 2 months. For 2 months Michael slept, woke up and went to work. Chernoff states that Michael Jackson dies when Murray stopped giving Michael Propofol.

- Murray told detectives his goal was to find a way for Michael to sleep normally. He says that he said to Michael he can't continue using Propofol, what would happen once his tour over and let him try other sedatives - something else to sleep.

- Midazolam and Lorazepam was ordered as well as Murray hoped to switch Michael to those sedatives.

- The day Michael died was 3rd day of wean process from Propofol. On that day the goal was not to give Michael any Propofol, Murray refused to give Propofol and gave Michael Midazolam and Lorazepam.

- 10 AM Michael started to begging for Propofol. Murray was confused and couldn't understand why Michael wasn't able to sleep as he slept last night. Murray checked under the covers to make sure the medicine he was giving was reaching to Michael's system.

- Michael compartmentalized his life. Different people in his life didn't know much about other parts of his life. Murray didn't know what Michael did during the day.

- Klein dermatologist. Michael would visit Klein 3-4 times a week. From medical records he would get Botox etc, and he would receive a shot of Demerol ranging from 100 mg to 300 mg. Sometimes 1000 mg of a week.

- They would present a witness about addiction. This witness will say that Klein addicted Michael to Demerol and one effect of Demerol addiction or withdrawal is inability to sleep.

- Murray didn't know about Demerol.

- Michael received a shot of Demerol on 16th june, attended a rehearsal same day. Attended a rehearsal on June 17th. Missed the June 18th rehearsal and was sick on June 19. Defense expert will explain that he believes this to be Demerol withdrawal.

- Michael told the result for his insomnia was he was always thinking, creating.

- Murray told investigators that he knew Michael had to be up at 12 PM and that's why he only gave 25 mg Propofol to Michael around 10 AM. He knew that Michael had Midazolam and Lorazepam in his system. Michael told Murray he needed sleep and he need to do his rehearsal or they would cancel his show. There had been 3 meetings so Murray knew he needed to sleep.

- Chernoff states that scientific information will show that by the time Murray left the room, there was no Propofol in Michael Jackson's system.

- Chernoff mentions defense witness Paul White , "father of Propofol". Explains Propofol. Chernoff says that their witness will tell that there was no risk with the amount of Propofol that Murray gave to Michael. White would tell that what Murray gave to Michael could not kill him.

- Chernoff says that there was no drip so the question becomes how did Michael Jackson get more Propofol. Defense says that they believe Michael gave himself that Propofol.

- Chernoff says the defense tested Lorazepam levels in Michael's stomach and it was 4 times higher than the levels in his blood. Chernoff say that he believes this could only happen if Michael was swallowing Lorazepam.

- Defense believes that Michael wanted to sleep and frustrated that he couldn't sleep and his doctor refusing to give him Propofol he swallowed Lorazepam (up to 8 pills) while Murray was outside the room. Murray geva him Propofol unknowingly and then when he's out of the room Michael gave himself another dose of Porpofol.

- Chernoff states that the events are tragic, but Murray is not guilty and they would ask for an acquittal.


Kenny Ortega testimony

- Ortega states he has been a director since the 1980s, a choreographer since the 1970s. He first met MJ in 1990, MJ called him to work on the Dangerous tour. He was a co-creator and director of production, as well as the History tour. For History tour, he supervised choreography, MJ did most of it. Ortega stated he was also responsible for costuming and lighting and the same for the This Is It tour. MJ and Ortega had been in touch for the last few years before MJ died. AEG told Ortega that MJ wanted Ortega for the This Is It tour, then MJ told Ortega himself. Ortega stressed that MJ was excited for This Is It, and that MJ said this is the time to do it.

- Ortega started working in the middle of April '09 on This Is It. MJ was heavily involved.

-Ortega states that Michael had several reasons for wanting to tour now. First, Michael's children had taken in interest in his music and his performances, Michael felt the kids would now appreciate live performances. Second, he wanted to do a tour for his fans. Michael was allowing his fans to choose the songs which would be performed on This Is It. Third, Michael felt that his environmental songs, such as Heal the World and Earth Song, were just as important or more important now that when they were written and performed.

- Preparation for This is It started as Center Stages In Burbank. Ortega, MJ and Travis Payne were conceptualizing the tour. Ortega states at this point, he was meeting with MJ 3 to 4 times a week.

- Rehearsals began at the Forum in LA in the beginning of June, '09. Michael's children did not attend rehearsals because he wanted them to focus on school. The rehearsals lasted 5-7 hours, from late afternoon until evening. There was stating, tech work, lighting and musical rehearsals done by MJ.

-Ortega states he met Murray in April or May of '09. MJ introduced Ortega to Murray at his home on Carolwood Drive. Murray came to rehearsal rarely; never at Center Stages, once at the Forum and never at Staples.

-MJ was not showing up for rehearsals in the middle of June, the last week at the Forum. Ortega was told it was a scheduling problem, and that there was a "continued absence".

- Friday, June 19, while still at the Forum, Ortega says MJ "wasn't right, wasn't well". He was chilled, appeared "lost and a little incoherent". Ortega states he gave MJ some food, wrapped him in blankets and gave him a heater. Michael, according to Ortega, asked him if he could sit and watch the performance, with Travis Payne filling in for MJ. Ortega agreed. Ortega emphasizes that he'd never seen MJ like that, and that he suggested Michael go home.

-Ortega is asked about an email that was sent to Randy Phillips at AEG Live on June 21, 09. In the email, Ortega reiterates that Michael was ill, chilled and was sent home. Ortega also states that MJ will need psychological help and lots of nurturing.

Text of the email

Randy

I will do whatever I can to be of help with this situation. If you need me to come to the house, just give me a call in the morning. My concern is now that we've brought the doctor into the fold and have played the tough love, now or never card is that the artist may be unable to rise to the occasion due to real emotional stuff. He appeared quite weak and fatigued this evening. He had a terrible case of the chills, was trembling, rambling and obsessing. Everything in me says he should be psychologically evaluated. If we have any chance at all to get him back in the light. It's going to take a strong therapist to help him through this as well as immediate physical nurturing. I was told by our chereographer that during the artists costume fitting with his designer tonight they noticed he's lost more weight. As far as i can tell there is no one taking care responsibility (caring for) for him on a daily basis. Where was his assistant tonight? Tonight I was feeding him, wrapping him in blankets to warm his chills, massaging his feet to calm him and calling his doctor. There were four security guards outside his door, but no one offering him a cup of hot tea. Finally it's important for everyone to know , I believe that he really wants this. I twould shatter him, Break his heart if we pulled the plug. He's terribly frightened it's all going to go away. He asked me repeatedly tonight if i was going to leave him. H e was practically begging for my confidence. It broke my heart. H e was like a lost boy. There still may be a chance he can rise to the occasion if we get him the help he needs

Sincerely,
Kenny

- Ortega states that there was a meeting on 6/19, with the heads of AEG, Randy Phillips and Gongaware. Ortega heard that Phillips and Gongaware told MJ that if he didn't start showing up to rehearsals, the This Is It tour would be cancelled.

-On 6/20/09, Ortega is asked to go to MJ's house for a meeting with Randy Phillips, Frank Dileo, Conrad Murray and MJ. The topic is that Murray is upset that Ortega home. Murray tells Ortega that he should stop being an amateur doctor, and leave that to Murray. Ortega clarifies that he did not make the decision to send Michael home on the rehearsal date 6/19, it was a mutual decision between Ortega and MJ. Ortega states that Murray's demeanor is stern.

-Ortega states there were no rehearsals on 6/21 or 6/22. On 6/23, This Is It performance is shown, The Way You Make Me Feel, MJ wearing a red and a blue shirt. On 6/24, MJ is fully involved, a full participant. Earth Song on This Is It was done on 6/24, the very last rehearsal that Michael did before he died. MJ is wearing a black jacket and black sweats. Ortega states that the last time he saw MJ, he told him he loved him, and MJ said I love you more.

-Ortega tells the prosecutor that MJ had plans for This Is It beyond the London tour. He planned on touring to the US. He also planned on making movies; a full length Thriller and the Legs Diamond story, which Smooth Criminal is based on.

-Ortega states on 6/25 that the illusion part of This is It was supposed to happen that day. MJ was supposed to stand on a bed, flames were supposed to shoot up and MJ was disappear. He would reappear on a cherry picker above the crowd.

-On cross examination, Ortega denies that he told Karen Faye that he "read Michael the riot act" or "don't placate him".

Paul Gongaware Testimony

- Gongaware is the co-CEO of AEG. AEG was the producer and promoter of TII.

- Gongaware states that he was also involved with Michael&#8217;s Dangerous and History tours.

- They contracted 31 shows because Michael wanted to do 10 more shows than Prince.

- They put 10 show tickets on sale just to engage how strong the sales are going to be. It was sold out instantly. Then they put the rest of the shows on sale and increased the concert number to 50.

- Michael said that he would do 50 shows.

- All 50 shows were sold out and even after that there were 250,000 people still in que for tickets. They could have sold out another 50 shows.


- DA Brazil asks Paul Gongaware to go over Michael&#8217;s performance schedule for the upcoming weeks. July 5 rehearsals / 8 shows, August 10 shows / no rehearsal, September 9 shows/no rehearsal, October / November/ December no show / no rehearsal, January 3 rehearsals/10 shows, February 10 shows/no rehearsals, March 3 shows/no rehearsals.\

- DA Brazil asks Gongaware about a production meeting at Carolwood house. Gongaware says Michael came a little late because he was at Dr. Klein. He seemed little off and little slow than usual. His speech was slurred. Yet he participated to the meeting.


- Gongaware said that in May Michael told him to hire a personal physician, Dr. Murray, in May. Gongaware called Murray. Murray told him that he had 4 practices that he needed to close and lay off people and asked $5 Million a year to do it. Gongaware told him it would never happen and ended the negotiations. Gongaware believed they could get a more reasonable priced doctor in London. Michael said they needed to look after "the machine" (his body) and wanted Murray.

- Gongaware received a call from Michael Amir Williams who said that Michael wanted him to hire Dr. Murray. Gongaware heard on the background Michael saying &#8220;offer him 150&#8221;. He called Dr. Murray again and said that he was authorized to offer him $150,000 a month. Murray accepted.


- Gongaware asked Murray how will this work as he wasn&#8217;t licensed in UK. Murray told him not to worry and he&#8217;ll take care of the license. Employment contract was being drafted.

- Another early June meeting in Carolwood with Ortega, Dileo, Phillips, Gongaware, Murray and Michael. The meeting happened because Kenny Ortega believed that Michael wasn&#8217;t at the stage he needed to be and they might not be ready for the show.


- Gongaware said that the tone in the meeting was great and that Michael wasn&#8217;t defensive on the contrary he was engaged. They discussed what they can do to give Michael everything he needs to get to where he needs to be such as health and eating habits.

Testimony will continue

 

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Re: Murray Trial - Daily Summaries Thread - Update September 27 DAY 1

Murray Trial Day 2 - September 28 , 2011

Morning Session

Resuming with Paul Gongaware (PG) on the stand. Ms. Brazil is continuing cross examination.

The recapped schedule for tours. From Jul to Sept there were 27 shows then a break from Oct-Dec. Then there were 23 shows between Jan-Mar. (8 shows in July, 10 in August, 9 in Sept, 10 in Jan, 10 in Feb., and 3 in Mar.)

After the tour ended in March there were plans to add additional shows but PG stressed these were only plans.

Early June there was a meeting to discuss MJ's health and stamina attended by MJ, CM, PG, Frank Dileo, Randy Phillips. It was a positive meeting. PG was also aware of the June 20 meeting but did not attend.

PG saw CM at rehearsals at Forum rehearsal after the early June meeting. PG did not see Murray at other meetings.

PG saw MJ rehearse on June 24th and 25th and thought MJ was strong, excited, full of energy, and engaged.

Defense cross examination

Defense go over PG's history with MJ. PG says he was tour manager of Dangerous and did not see MJ very much. In History tour for the first leg he worked with the promoter and in the second leg he was tour executive. PG talked and interacted with MJ in the second half of History. PG worked on TII from the start.

Defense brings back the day Michael came from Dr. Klein. PG says he saw a slower speech pattern and a little slur in his speech. PG says he was on the look out for any drug usage by Michael.

PG says his relationship with Michael was business relationship but friendly. If PG needed to get in touch with MJ, he would see him at rehearsals if MJ was there. Or, if needed, he would go through Michael Amir.

Meeting in early June was pushed by Kenny Ortega who was concerned that MJ was missing rehearsals.
PG did not know how many practices CM had, the value of his practices, or what kind of doctor CM was.
When he turned down $5 mil, Cm did not try to negotiate another price. That was the end oof their correspondence until MJ prompted PG to contact Murray and offer CM $150,000/mo.


PG did not know Murray was a cardiologist. He did not read the final contract and did not know how long Murray was to receive $150,000. He did not see the completed contract between Murray and AEG. PG was not involved and did not know about the contract between AEG and Murray.

Defense tried to bring up lawsuit against PG and AEG that is by Katherine and he was shot down.

Brazil recross

PG did not know Conrad Murray (CM) gave MJ nightly doses of propofol. CM did not seem surprised that PG was contacting him about his services. He didn't have to explain in depth why he was calling.

PG says a personal doctor for tour is normal but the $5 million was high in his opinion.

Defense recross

PG made a phone call to another doctor to get an idea about acceptable payment.

MJ said "they needed to take care of the machine." There were no further conversations about any medical needs of MJ.


Kathy Jorrie Testimony

Examination of Kathy Jorrie (KJ) is a lawyer with Luce, Forward, Hamilton, Scripps and is in charge of their LA office.

She was contracted by AEG to draft a contract for services involving CM and MJ. She began drafting contract in May-June timeframe after being contacted by Tim Wooley (TM) of AEG. TM sent her basic information. KJ sent first draft of the contract to TM on June 15th. TM forwarded the contract to CM and KJ received phone call from CM about the contract draft.

The start date of Murray's contract was when all three parties signed the contract. The contract was not valid until this was done.

Initally CM contract had a end date of September 2009. CM called KJ asking to change the end date to March 2010. Kathy queried CM as to whether he asked MJ about getting paid during the hiatus of Oct-Dec and all of the way til Mar 2010. CM said he did and MJ was willing to pay for his services during hiatus and till March 2010.

Final contract was signed by CM and sent back to KJ on June 24th, 2009.

KJ spoke to CM twice about changes to contract. CM requested certain changes, one was for the start of his payment to be retroactive to May, 2009.

KJ said CM did not want his name on the contract but instead wanted the name of his company, GSA Holdings. KJ said she could add the company to the contract but needed to have his name on it as well.
Another change was for a medical professional to be available in London. KJ asked CM why this was needed. CM said it was for if Murray was unavailable or needed to rest, that someone would be there.
There was a right to terminate the contract immediately if MJ no longer wanted CM. Also, if the tour was cancelled. Murray wanted a provision that said if a termination for any of those reasons occurred past the payment date of the 15th of the month, CM would not have to return the payment for that month.

KJ had a conversation on Jun 18th with CM about medical equipment needed to be included as a provision in the contract. KJ wanted to know why he needed this equipment including a CPR machine. CM said when MJ was performing at the O2 arena he was going to be performing extraordinary things. Also considering his age, CM wanted the machine. KJ asked wouldn't this be at the arena? CM told her he didn't want to take any chances. KJ was worried MJ might have a heart problem or was unhealthy. CM assured her he was healthy. CM told KJ three times that MJ was in perfect health.

They also discussed where CM was licensed to practice medicine. Murray told Kathy he was licensed to practice in CA, TX, NV, Hawaii.

June 23 conversation: CM had some revisions he wanted. He asked the term to be changed from September 2009 to March 2010. Start date was changed to May 1. Contract said "services requested by the producer" CM asked it to be changed to "artist". KJ asked CM to help with medical records of MJ to submit to insurer for concert cancellation insurance. Insurer company asked for 5 year of medical history. CM asked KJ to send what is required to MJ's house.He said that he had only been the physician of MJ for 3 years and since MJ was in such good health, the file would be very tiny. KJ later provided CM insurer company's information so that he can contact directly.

CM repeatedly told her MJ was healthy, in excellent condition, he was great.

Prosecution presented contract that Murray sent to KJ on June 24th. The only signature on it was CM.
Above where MJ was supposed to sign reads:
"The undersigned hereby confirms that he has requested Producer to engage Dr. Murray on the terms set forth herein on behalf of and at the expense of the undersigned."

The contract was between Murray, AEG Live, GCA Holdings with the consent of Michael.

Defense cross examination

Contract was not signed and no payment was made to CM - at least by AEG. CM had to provide liability insurance and medical malpractice insurance.

CM told KJ he would need the equipment in London. First time KJ talked to CM was on the 18th. When she received the information from Tim Wooley, the CPR machine was already on the list of machines CM needed.

Kathy: "Murray said he needed the CPR machine for MJ at the venue. He did not indicate home use."

KJ was not aware of the hours CM would be providing services to MJ. She assumed they would be during the day. She had no hint that the services would be at night.

Records were not provided to KJ. But she requested that medical reords be sent to the broker trying to secure the insurance (Bob Taylor).

According to the contract CM was not prohibited from doing other things at all.

Contract was terminable at the discretion of MJ. CM was not guarateed the next month of employment.


Michael Amir Williams Testimony

Personal assistant of MJ. Had been employed by MJ in mid 2007. Before this he had been brought on to archive and organize MJ's films and DVDs.

MAW did anything MJ needed and considered himself a friend of MJ's. MAW was a liason between MJ and security and major staff. MAW would come to Carrolwood and call to make sure MJ didn't need anything. If not, he would go to the security trailer.

According to MAW only MJ and his three children lived at Carrolwood on a continuous basis.

Walgren then shows several pictures depicting the layout and some interior/ exterior photos of Carolwood.

Security routine: An advance vehicle, MJ in principal vehicle with driver and MAW and a security detail following them.

Fans outside the house. If any security ever did anything against his fans, they would be gone according to MAW. MAW mentions MJ stopping, talking to fans, getting gifts, pictures to sign.

MAW said he was a fan first so tried to sneak to see of MJ performing. But MJ usually had him doing things for him/ running errands.

It was a rule across the board that no one would go upstairs unless they were asked specifically which was very rare. MAW said that MJ liked his privacy.

MAW met Murray for the first time in 2008 in Las Vegas. He saw Murray visiting MJ's house in Las Vegas in 2007. MAW would call Murray in 2008 at Michael's request to treat the children and him.

Amir said that in Apr/May/Jun it was common to see Murray's BMW parked there after rehearsals and still there in the morning. During this time MJ asked MAW to sometimes call CM even though he had a cell phone.

MAW said they left for rehearsals late afternoon and did not return after it was dark although the time varied. MAW said that it was not uncommon for him to call Murray ahead of time to make sure he was at home.

MAW said they were late on the 24th going to the Staples Center. They left around 5 or 6pm give or take an hour or two. MJ was in good spirits ans was adamant about getting there on time. Amir said that he thought the rehearsal on the 24th was great. "MJ told me he only gave 30/40% at rehearsals. But I thought it was great."

MAW lived in downtown LA and left Carolwood to go home after making sure that MJ was in the home. Security was 24 hrs around home. They would either be checking gates, doing perimeter checks but were stationed in the trailer.

At 12:13pm, MAW received a phonecall from CM. MAW was not able to answer this since he was in the shower trying to get dressed. When he came out and saw the phone, he had a message. The message said to call CM right away. He then called CM back. CM didn't ask him to call 911. CM told him to "Get here right away and send someone up" and that Michael had a bad reaction.

A still photo of the phone (MAW's phone) was labeled People's 12 and the video of the voicemail was marked as People's 13. A transcript of the video message was labeled as People's 14.

"Call me right away. Please call me right away. Thank you."

Walgren goes over MAW's phone calls on the 25th.

At 12:15 MAW calls CM back and CM tells him that MJ had had a bad reaction and asks him to get someone up to the room. Amir said Murray did not ask me to call 911 initially.

After he got off of the phone with CM, MAW called Faheem Muhammad (FM) at 12:16 and told him to go upstairs. FM told MAW that he was not on the property to run an errand to go to the bank. MAW told him to hurry and get back home.

There were then 3 calls between Amir and Alvarez that were not being connected so he then contacted Derrick Cleveland (another security). He did not get him. Later he was able to talk with Alvarez. He told Alvarez to go to the house and told him to run. Nanny opened the door. Alvarez asked MAW for permission to go into the house and go upstairs. Alvarez hanged up the phone after a little while. MAW made multiple phonecalls.

Amir: "It took maybe 30/40 minutes to get from my home to Carrolwood. When he got there medics were bringing gurney down."

MJ's kids were in the car to follow the ambulance to the hospital. MAW thinks CM looked frantic. CM ride with the ambulance. People were following them to the hospital. MAW shielded the children with their jackets and took them inside the hospital to a private room with their nanny. They placed a security on the door. MAW waited outside the room they were working on Michael. Slowly people such as his manager and family came to the hospital. Later they learned that MJ dead.

After Michael was announced dead, Murray asked him if he or someone else could take him back to the house so he could get some cream of MJ's that he was sure MJ would not want the world to see. MAW said "let me check". He spoke about this with Faheem Muhammed (FM). He told FM he was goig to tell CM that the police had his keys.

He then spoke to CM again who asked to be taken to go get something to eat. MAW refused.

MAW went to FM and told them to call the security and tell them to lock down the house and do not let anyone go in or out.

MAW did not see CM after that talk about food. MAW gave CM's contact information to the police. After MJ was announced dead MAW and the other bodyguards loaded the cars and drove to fool the media so that the Jackson family can leave without being followed. On the ride MAW received a phone call asking them to come back to Carolwood. They spoke to the police at Carolwood.

Oxygen tanks was normal. Security would pick oxygen tanks and bring to the house.

Defense cross examination

Defense asks if the first time MAW mentioned the cream to the detectives was in August 2009. MAW says yes.

MAW denies planning a lie with FM. He says he just told FM what he would say to CM and FM said "do whatever you need to do".

MAW says there was a lot of police officers both at UCLA and Carolwood. Police asked him about the timeline of the day. MAW says that his initial talk with police wasn't in detail.

MAW says he spoke to Michael several times a day. Defense goes back MAW first seeing Murray in 2007. MAW says that he just saw Murray to go to the house. MAW says he never learned or know how MJ and Murray met.

Defense mentions the phone calls between MAW and CM. Defense asks if sounded like an emergency. MAW: "When I hear someone has a bad reaction, I don't think anything fatal - me personally. I wasn't asked to call 911. He told me what to do and I did it what doctor told me to do - get someone up there quickly"

2 security on the property 24/7. House has gates and those gates are monitored. Family only allowed by Michael's request.

[Afternoon session will be posted later]

 

[ivy]

Re: Murray Trial - Daily Summaries Thread - Update September 28 Day 2 Morning Session

Murray Trial Day 2 - September 28, 2011

Afternoon session

Michael Amir Williams (MAW) - Cross examination by Ed Chernoff continued

Frankly, a lot of what Ed Chernoff asked MAW was tedious and irrelevant, so for this part of the testimony, only relevant material will be posted.

MAW states that he left at either midnight or 1 a.m. on 6/25/09 after dropping MJ off from rehearsal. Chernoff asks if it was unusual for MAW to be at the Carolwood home at 12 pm during the week, MAW states no. Chernoff then states that Murray said "Get security up here" (meaning upstairs), MAW states that no, Murray said "Get someone up here." MAW states called Alberto Alvarez, Faheem Muhammad and a guy named Derek, all security for MJ.

Chernoff and MAW then go through pointing to specific doors at the Carolwood home.

Chernoff asks MAW, if Murray had told MAW to call 911, would MAW have done so. MAW answers yes. Chernoff then asks if MAW would have gotten a voicemail from Murray telling him to call 911, would he have done so. MAW answers yes, and then he would have called Murray. This goes on for over a minute. Chernoff continues to ask whether it was usual or unusual for Murray to call and tell MAW to get someone up there. This continues for several seconds.

Chernoff moves back to whether it was usual for MAW to be at the Carolwood residence at 12 pm on a daily basis. Chernoff states that MAW called Faheem Muhammad first, Alberto Alvarez later. MAW has known Faheem Muhammad for ten years, and Alberto Alvarez for five years. Alvarez was brought in to work for MJ in 2008.

Chernoff asks about a security company called Security Measures. MAW states that they were hired in 2008, MAW was "instrumental" in helping to connect Security Measures and MJ.

After MJ died, MAW states that he got into a blue Escalade, along with Alberto Alvarez and Faheem Muhammad. The three of them planned to be a decoy, to distract from other cars that were trying to leave UCLA.

Chernoff asked MAW where he was when MAW talked to police in August 2009, 2 months after MJ died. Chernoff basically asks if Alvarez and Muhammad were with MAW at the same time and place as MAW when giving their statements to police. MAW says he could not recall. MAW also states that he could not recall if he talked to either Alvarez and Muhammad about MJ and his death in the two months that transpired after MJ's death.

MAW states that the meeting with the police was postponed because the police postponed it. Chernoff states, "Well, that's interesting but what I want to know is did you speak..." At this point, Judge Pastor states, "Editorial comments are not appropriate for either parties..." (Essentially, Judge Pastor admonishes Chernoff for the comment.

Chernoff asks if MAW took the video of the voicemail of Conrad Murray telling MAW for help on 6/25. Chernoff asks if MAW had help making the video, MAW states yes and his wife helped him. Chernoff asks MAW if he received voicemails from others on 6/25, MAW states yes, that he received many on that date. Chernoff asks if he received voicemails from Alberto Alvarez or Faheem Muhammad, and MAW states he cannot remember.

At the time of death, MAW had worked for approximately two years, he stated. As MJ's personal assistant, MAW stated that he did whatever MJ asked him to do, for the most part. MAW stated that MJ had his own cell phone, but if someone needed to get in touch with MJ they would call MAW.

Chernoff asks MAW if he picked up prescriptions for MJ, MAW states yes. MAW also states that he accompanied MJ to Dr. Arnold Klein's office. Chernoff asks MAW if he heard the audio tape of MJ (the one where he is clearly drugged). Chernoff asks if MAW felt that when MJ left Klein's office, if MJ's speech was slower. MAW says yes, but not to the extreme of the tape he heard.

Chernoff asks if MJ kept his medical conditions separate from MAW, MAW states yes. Chernoff asks if MAW ever called Dr. David Adams for MJ, MAW states the name sounds familiar, but he cannot say for sure. Chernoff asks if MAW can remember calling Adams in Las Vegas, MAW says he's not sure.

Chernoff asks how long MAW stayed at the Carolwood house. MAW states a few hours, he talked to police and waited for MJ's family to arrive. Chernoff states that the entire security team had been replaced, and MAW states yes. Chernoff asks if it surprised MAW, MAW stated no. MAW states he called either Frank Dileo or Randy Phillips to make sure it was okay that the new security team was there.

Redirect from Prosecutor David Walgren

Walgren asks MAW about MJ's slow speech when leaving Dr. Klein's office. MAW states that it was not unusual, but it was not every time either.

Walgren asks MAW about the recording Murray made of MJ in a 'very intoxicated state". MAw states he heard of it on the news because it was everywhere. Walgren asks if MAW had ever heard of MJ in that state, MAW states "Never, never in that extreme." Walgren asks if it was shocking to MAW. MAW states, "Yeah it was kinda sad."

Recross by Defense Ed Chernoff

Chernoff asks if MAW has ever called Cherilyn Lee for MJ, MAW states yes. Chernoff asks if MAW had ever called Cherilyn Lee because MJ was sick, MAW states that Faheem Muhammad called Lee one time because MJ was not feeling well

Faheem Muhammad (FM) Testimony

Prosecutor Walgren Direct

In June 2009, FM states he worked as a security chief for MJ, for approximately 10 months. As chief of security, he made sure MJ's house and children were protected, and daily routine was safe and planned out. FM states he was stationed in the trailer outside of the Carolwood home. FM states that he would deal with Michael Amir Williams, not MJ directly. FM states that he initially was hired as a driver, but then promoted to chief of security.

FM states that he saw Murray daily and stayed overnight every day at the Carolwood home. FM states he did not know the details as to why Murray was staying the night. FM states that he saw oxygen tanks in the trailer, Murray brought the tanks to the back door, and security would bring them inside the trailer.

On 6/24, FM drove MJ to Staples to his last rehearsal, leaving at approximately 7 p.m. Michael Amir Williams accompanied both FM and MJ to Staples. FM states that there was an underground parking lot, and that Alberto Alvarez would meet them, and take them on a golf cart to MJ's dressing room. FM states that his duty was to set up security at specific doors, but that he was also able to observe some of the rehearsal. FM stated that MJ's rehearsal was excellent and high energy. FM states that he, MJ and Michael Amir Williams left at approximately midnight. FM states that MJ stopped outside Staples to greet fans, and in front of the Carolwood home. FM states that they arrive approximately 1 a.m. FM states that security would normally take gifts that fans gave MJ and leave them at the bottom of the stairs. MJ would then say goodnight and go upstairs. FM stated they had a security meeting, and then went home.

On 6/25, FM states that he arrives at Carolwood at approximately 11:45 a.m. FM states that he left the property to go to the bank. FM states that he then got a phone call from Michael Amir Williams, stating that MJ had a bad reaction and to go upstairs. FM stated he was not at home, but that he would go back and he did.

FM states that he arrived back at the house, types in the PIN for the gate, and enters the house. FM called Michael Amir Williams, asks if he can enter the house and go upstairs. FM states the he did go upstairs. FM entered the room that MJ was in, he states.

Walgren asks FM when he came into the room MJ was in, what did he see? FM states that he saw Alberto Alvarez pacing the floor, he saw MJ's feet on the side of the bed, as FM moved closer, he could see MJ's body and Murray to the side of MJ. FM states that he saw MJ at the far side of the bed, his feet were on the floor. FM states that Dr. Murray was to the right of MJ on the far side of the bed.

FM states that he asked Alberto Alvarez how it was going, Alvarez states it's not looking good. FM states that he moved closer to the far side of the bed, Murray appeared to administering CPR, Murray was nervous, sweaty. FM states that he then saw MJ's face and his full body. FM states that MJ's eyes were open, mouth slightly open, and when asked, FM states that MJ appeared to be dead. FM states that he saw no medical equipment attached to MJ.

FM states he then realized that both Paris and Prince were inside the room slightly. FM states that Prince was "slowly crying" and Paris was "balled up on the floor, crying". FM got nanny and moved them to downstairs. Then FM went back upstairs.

CM asked if they knew CPR, Alvarez went to help CM with CPR. After FM went back upstairs asked Alvaraz if 911 was called. Alvarez said yes. FM went down again to get the cars ready. Paramedics arrived, FM escorted them up to the room. FM was mainly in the room while paramedics working. FM left the room twice to put the children in the car and talk to the security saying that they'll be leaving soon and get ready for paparazzi.

FM said he saw an IV stand in the room, he did not realize any other medical equipment.

They followed paramedics to UCLA. When they arrived paparazzi was at UCLA. They took their jackets to shield MJ's body so that paparazzi cannot take pictures. They also escorted the children inside. FM talked to UCLA security about family arriving and not let in people trying to sneak in. FM helped UCLA security to let Jackson family in and keep other people out.

MAW talked to FM about CM wanting to go home to get a cream. FM says that they agreed that CM should not be let into the house. FM states that MAW came up with the story to say that police took their keys.

FM states that at UCLA Murray wanted to leave because he was hungry. FM stated that there was a cafeteria at the hospital.

FM states he remembers seeing an IV stand in the room where MJ died. FM states he does not remember if there is tubing attached to the IV, but he clearly remembers the IV stand in the room.

FM states that after he spoke to Dr. Murray, FM went to the room where his children were. FM believes that at that time, the children were getting ready to see MJ's body. FM eventually left UCLA with Michael Amir Williams, Alberto Alvarez, and he's not sure, but maybe Isaac, a guard from Carolwood. FM says he was not sure where they were going, but that the police called and asked all of the security to come to Carolwood. FM states that they did talk to the police at Carolwood on 6/25.

FM states that he talked to the police again in August, 2009.

Defense Cross Examination - by Chernoff

FM states his wife picked him up from the Carolwood home. FM states that Murray asked if he would take him to Carolwood and to get him something to eat, FM states he said no. When FM left Carolwood, Murray's car was still at the residence.

FM states he watched Murray walk away from UCLA. FM states he does not know what time he left the hospital.

FM states that the first time that he mentioned that Murray wanted to get something to eat and leave UCLA, was in August, 2009. FM states that he made his statement to the police in his attorney's office. Chernoff repeated asks if Alberto Alvarez or Michael Amir Williams were there, or if FM saw them before or after he talked to detectives. FM states he did see Alberto Alvarez at the attorney's office.

FM states he knew Michael Amir Willaims for 10 years, in a social capacity.

FM states his normal shift approximately at 11 a.m. and leave at 7 p.m., but if MJ was leaving, he would stay and accompany him. FM states he took MJ to see Dr. Klein. FM states that MJ often left Klein's office tipsy, and at times, Klein's staff would have to accompany MJ downstairs and to the car.

FM states that MJ once said to him, "You must think I'm crazy for going to Dr. Klein's office so much." FM states that he didn't see MJ one way or the other, and MJ states that he was going to Klein's office because his doctors told him that he had to go to a doctor for a skin disease.

FM states that at Carolwood in the month prior to MJ's death, he never saw another doctor come there.

FM states that he knows who Cherilyn Lee, and that she was hired for the kids. FM states that he knew Lee professionally and that she was hired. FM states that he called Cherilyn Lee for MJ. Michael Amir Williams told FM that one of MJ's hands was hot, and one of his feet was cold, and to call Cherilyn Lee. FM states that he thinks he left a voicemail, but ultimately talked to her, but cannot recall the conversation.

Chenoff asks if FM told the police that CM was helping MJ to sleep. FM said yes it was rumored. Chernoff asked if everyone knew, FM says he can't say what other people knew. FM says the security didn't discuss it among themselves.

FM says the house didn't have any land line phones.

On 25th FM came to Carolwood around 11 AM and left to go the bank after 12PM. FM said that he can come and go and do tasks. FM says there was a security camera recording the gate. FM is not sure about a security camera recording the door of the house.

June 27, LAPD asked FM to help them to take surveillance tapes from the gates. FM helped a technician from LAPD. FM cannot remember what was downloaded.

Defense again asks how many times FM went up and down the stairs. FM repeats 4 times going up and down the stairs again. FM calls the scene shocking, seeing Michael. FM says he doesn't recall what was on IV and does not recall any other medical equipment.

Defense again asks about the security leaving the hospital. FM said they received a call asking them to come back to Carolwood to talk to police officers. They were outside the front door talking to the detectives.

Chernoff looks for pictures to show, and shows pictures of the bodyguards talking to the detectives. FM yawns and nods to the jury while waiting the defense to find the picture. Chernoff spends several minutes asking FM identify the people on the pictures.

FM said that after Carolwood he took the detective Abdul to Hayvenhurst so that he can talk to the nanny.

Prosecution Walgren redirect

FM when talked to detectives on August 31, 2009 he was alone in the room with the detectives and his lawyer. Alvarez and MAW was not with her.

Nurse Lee is a nutritionist and that's all she does.

 

[ivy]

Re: Murray Trial - Daily Summaries Thread - Update September 28 Day 2 Full Summary

Murray Trial Day 3 - September 29, 2011

Morning Session

Alberto Alvarez (AA) Testimony

Prosecutor Walgren direct examination

Month of June. AA says that he worked for MJ in Carolwood. AA was director of logistics, he was part of the advance team. He made sure everything was okay before MJ arrived to a venue.

AA worked for MJ on / off since 2004. AA was called to work for MJ December 2008 / January 2009. AA said it was a good full time job with a good salary.

Security would be in the trailer outside he house, they will only go inside when requested. Two different security : Property security and personal security. Personal security were MAW, FM, AA, Isaac and Derek.

AA saw CM first after January 2009 in Carolwood. April/ May/ June AA saw CM 5-6 times a week. AA knew that CM was staying the night. AA was aware about the oxygen tanks. AA from time to time saw CM bringing empty oxygen tanks and take full ones.

June 24th. After 5 PM they took MJ to rehearsals. AA made sure everything was in order in MJ green room (dressing room) such as arranging the room temperature, checked the venue for security. MJ came around 6:30 - 7:00PM. AA met MJ with golf cart and took him to his dressing room. MJ was very happy and in good spirits. AA was behind the stage. AA sometimes peeked to see his performance. AA believed his performance was good. After the rehearsal they did the same routine. MJ was still happy and in good spirits. They came to Carolwood. CM's car was already parked. MJ came home, they helped with the gifts. MJ said "goodnight".

After they unloaded the gifts, they secured the front door and went to the security trailer for debriefing. After they went to home and house security stayed.

June 25th AA came to Carolwood at 10:15AM. He sat down in the trailer and waited for any specific instructions. He was in the security trailer around 12:15 PM.

Phone records. 4 phone calls between MAW and AA, those were attempts to reach each another. Another call from MAW to AA, they finally spoke. MAW asked where was AA, told him to get up and go to the front of the house without much commotion. MAW asked him if he was walking AA said yes, MAW told him to run. AA came to the front door and tried to open it but it was locked. Nanny came and unlocked the door. From the glass door AA saw nanny Rosalind ,Paris, Kai Chase and CM on the second floor. CM had both hands on the rail and was looking down.

AA told MAW he was in the house. MAW told him to run up the stairs. Prince was upstairs walking opposite direction of AA.

Walgren shows pictures and layout of the house and asks AA to identify where CM was and identify the rooms.

AA said he only went upstairs 2 times in 6 months he worked for MJ to let MJ's hairdresser.

CM said to him "Alberto come quick", AA realized the situation was serious. AA hung up the phone call to MAW. AA followed CM into the room.

AA saw CM giving chest comprehensions to MJ. MJ was in the bed. AA saw MJ lying on his back, his hands extended out to his sides with palms up, his eyes and mouth was open. His face was slightly towards the left. CM was using one hand (his left hand) giving MJ chest comprehensions.

CM said to him they need to get him to a hospital. AA was walking towards the bed and reaching for his phone in his pocket. Prince and Paris followed him into the room, they were behind him. Paris screamed out "Daddy". Paris was crying. CM said "don't let them see their dad like this". AA ushered the children out the door and told them that everything will be okay and not to worry.

When returned AA asked CM what happened. CM said "he had a bad reaction". AA was at the foot of the bed.

AA saw some sort of a plastic device on his penis to collect urine. AA now knows that it was a condom catheter. AA did not see any monitoring equipment, no ventilation equipment. AA only saw a clear plastic tubing for Oxygen attached to MJ's nose. AA saw an IV stand.

CM got some vials from the night stand and asked AA to put them in a bag. AA held out the bag and CM dropped the vials. CM told AA to place that plastic grocery bag to the brown bag. Then CM told AA to get the bag in the IV stand and put it in the blue bag. AA says there was a bottle in the saline bag.

Walgren: "Why were you following these instructions?" AA " I believed CM had MJ's best intentions at mind, I didn't question his authority. I thought we were getting ready to go to the hospital".

IV stand has 2 hooks. One hook had a saline bag, CM didn't ask AA to remove that one. AA was only asked to remove the saline bag with the bottle. AA saw milky white substance at the bottom of the saline bag.

Walgren shows the saline bag pictures to AA. The bad has a cut, AA says he didn't see the cut on june 25th. Walgren shows the cut to the jurors. Walgren then shows empty 100ml Propofol bottle. Walgren replaces the bottle in the saline bag through the slit shows it to AA and the jurors.

Mid morning break

AA says all these events happened very quickly. AA says he was obeying CM's instructions.

911 call is played in court. Alberto visibly upset and looks like about to cry when listening to the call.

AA and CM moved MJ from bed to the floor. AA saw a clear plastic tube coming from the bag on the IV coming to MJ's leg. CM removed it when they moved MJ. CM took pulse oximeter from a bag and clipped it to MJ's finger.

AA says a few days to a week before June 25th, CM asked the securities for AAA batteries. AA saw CM holding the device, AA had asked him what it was and CM said it was like a heart monitor.

FM arrived to the room. AA said "It's not looking good". CM asked if anyone knew CPR. AA and FM looked to each other. AA went to assist CM doing CPR. AA started doing chest comprehensions with two hands. AA knew CPR before that day, he learned it when he was a swimmer. CM was giving mouth to mouth. CM said "this is the first time I do mouth to mouth. but I have to because he's my friend". AA continued chest comprehensions. Paramedics arrived soon after and took over. AA says there was no indication that MJ was alive.

Paramedics moved MJ from the side of the bed to the foot of the bed. AA went downstars twice; to check on the childern and to meet MAW. When paramedics were bringing MJ down, AA was trying to distract MJ's kids so they wouldn't see their father like that.

At UCLA AA begged to paparrazzi to leave them alone saying it was a private moment, shielded MJ when going in, waited in the hospital. CM came to AA to thank for help, AA said "we did our best". At that moment AA didn't suspect that CM did anything wrong. CM first said he was hungry and asked if someone could take him home. AA didn't answer, CM then asked it to MAW. AA last saw CM outside the emergency room saying "I wanted him to make it".

AA and other security drove off after the announcement and MJ was taken to the coroners. They went to Carolwood, police was there. They stayed outside of the house while talking to the detectives. AA was asked to bring children's dog Kenya to Hayvenhurst.

20-30 times media approached to AA to give interviews and was offered money. Media have offerred him $200,000 to $500,000, AA said no. AA says this event was negative for his life. He went from a full time great wage job to bad financial position. AA says he's totally wiped financially. AA said he had been honest with the police to best of his ability.

Defense cross examination by Chernoff

AA draw the IV bad picture after the preliminary hearing. Defense shows another drawing done for the police. AA doesn't remember drawing it. Defense questions AA never mentioned the pointy nub before. Chernoff says that the IV bag doesn't have any white substance in it today.

Chernoff asks if he could be confused about the timeline of events. AA says no. Chernoff asks if it was possible if CM asked AA to collect the vials after the 911 call after the paramedics came and before they went to hospital. AA says no.

Defense going over AA's phonecalls and how AA went into the house. AA understood something was wrong by that time but he didn't knew if it was related to MJ. Defense goes over what AA did when he entered to the house. AA basically repeats his previous testimony. AA says he was shocked when he entered the room. Chernoff is writing AA's timeline on a easel. Jurors has a problem with reading it. Defense continues with the events, at one moment they refer back to AA's testimony from preliminary hearing. Chernoff is asking about the 911 call and putting the vials in a bag. Most of the questions are about if he yet called the 911 and how CM put the vials in the bag. Basically defense is going over AA's timeline of events.

Lunch Break

 

[ivy]

Re: Murray Trial - Daily Summaries Thread - Update September 29 Day 3 Morning Summary

Murray Trial Day 3

Afternoon session

Defense cross examination continued

Still discussing AA's version of events and timeline. Chernoff writing the timeline on a piece of paper.

Chernoff questions how AA held the IV bag and got it from the stand. AA says he got it bu holding it from the top of it. AA first mentioned taking off the IV bag in August, 2009 at his second meeting with the police. He was also fingerprinted at that time.

Chernoff again asks if AA could be mistaken about his timeline. AA said no.

AA: (looking at 911 transcript) Indicated when he placed MJ on floor according to transcript. OP says, let's get him to the floor-AA acted on that order. AA says that they got MJ on the floor while he was talking with 911 operator. AA says he put his phone on his shoulder. Chernoff plays the 911 call and AA identifies the point they got MJ on floor.

AA: Clarifies pic he drew. He clarified that there was a box with a wire sticking out of it, NOT a needle.

Chernoff mentions media offers. AA says there have been media offers before he talked to the police August, 2009. Chernoff says AA didn't mention most of the things he said in August interview in June interview.

Chernoff plays a video of AA at hospital. AA was waiting outside the room where MJ's body was placed after he was announced dead. Chernoff mentions there was a lot of police around and asks AA if he mentioned them about collecting the vials. AA says no. AA was interviewed by the police in the hospital.

sidebar

Bodyguards went to Carolwood , talked with the detectives. Chernoff shows pictures taken outside the house with detectives asking AA to identify people in the pictures. Again Chernoff asks if AA told the detectives about the vials then. AA says no.

Chernoff mentions saline bag and asks if that was connected to MJ. AA says yes. Chernoff asks if it was connected to anything else, AA says no.

AA sees a report on CNN about evidence and saw detectives coming out of the house with a baby blue bag. AA heard on the news about Propofol and heard it being white. AA says that he realized that he handled those items and believed he needed to talk to the detectives. AA believed he needed to report it to the police.

Chernoff asks about AA's work. AA says he's unable to get a continious job. AA's work history with MJ. In 2004 worked for MJ for 6 months. 2007 in Las Vegas worked for MJ for a few months. 2008 Las Vegas 2-3 months. After MJ's death AA worked with Jackson family. AA would call to check on the children. Katherine's assistant mentioned AA could become a secruity for Jacksons. This talks happened Nov 2009. AA worked for the Jacksons for a few months in 2010. Chernoff tries to ask AA what other celebrities he worked for.

Objection. Sidebar.

Chernoff asks AA about his relationship with CM and if they were friends. Chernoff tries to ask questions about why would CM would conspire with AA to hide evidence. Objection. Sustained.

Walgren redirect

Walgren goes over the timeline Chernoff wrote, asks AA if most of the events happened simultaneous continious events. Walgren asks questions very rapidly. Judge Pastor asks Walgren to slow down and jokes that "I see steam coming out"

Chernoff recross

Chernoff asks if AA did these events quickly. AA says he acted quickly and he's "very efficient". Laughter heard in the courtroom.

Kai Chase (KC) Testimony

Brazil direct

KC professional chef. March 2009 was working for MJ. Her duties was to prepare food for MJ and his children. KC learned what they liked and didn't like. KC did the shopping. KC says she enjoyed working for MJ and kis kids. KC wears professional chef uniform - chef jacket and bistro apron. Her apron had 2 pockets. KC said she kept track of time because she needed to follow the food cooking and had to get food on the table on time. KC says she had her cellphone in her apron pocket and kept track of time.

KC worked 6 days a week for MJ. KC came at 8 AM and prepared breakfast for the kids. Then prepared breakfast and juice for MJ for breakfast. MJ ate Granola, juices and vegatarian omelets. Healthy foods was very important for MJ and his kids. KC saw MJ eating with his kids. "It appeared to me that MJ had a close, loving relationship with his children and appeared to be happy around them."

mid afternoon break.

June 24. Arrived around 8:30AM. Prepared breakfast for children. Prepared MJ his beet juice which had beets, celery, apple, carrots. KC would see CM in the mornings. He would come to the kitchen. He would sometimes come to leave or sometimes would come to get MJ's juice. CM said MJ will be down shortly and MJ would like to have lunch with his children. CM then went to other part of the house.

KC saw MJ on June 24. They talked. MJ asked about the lunch , he smiled. KC says MJ was happy because he was going to have a lunch with his children. KC prepared the same Ahi Tuna salad so that MJ could take it to rehearsal. KC prepared Tuscan White Bean soup for MJ for dinner. KC also prepared food for CM as well. KC made dinner for children. KC left at 10 PM on June 24.

June 25. Arrived between 8:00-8:30AM. Prepared breakfast for children. The soup KC prepared the previous day was still in the refrigerator. KC started to prepare MJ's breakfast. She prepared him Granola with Almond Milk. MJ's children would notify KC when MJ would eat his food. 9:45 AM KC leaves to go to market. She cames back around 10:30. Everything seemed the same as she left when she returned. Children were playing, music was playing. KC started preparing lunch.

MJ always had lunch at 12:30PM. There was no difference on June 25th. KC was preparing Spinach cobb salad with organic turkey breast for lunch. KC had already prepared fresh juice for MJ. CM didn't come to pick up the juice that day.

CM came down to the kitchen from the stairs between 12:05 and 12:10. CM looked frantic. KC says CM was nervous, frantic and he was shouting. CM shouted "get help, get security, get Prince". KC stopped what she was doing and run to get Prince from the den. KC said to Prince "Hurry. Dr. Murray needs you. There might be something wrong with your father". Prince and KC went back to kitchen. Prince went to CM. KC went back to work.

Brazil asks if CM asked her to call 911. KC says no. Brazil asks KC why she decided to get Prince. KC says Prince was in her sight and CM seemed frantic and disturbed. KC wanted to get help as soon as possible and Prince was the closest. Security is outside. Prince was closer to her.

KC returned to work. KC saw housekeeper crying at he foyer of the house. KC approached to them and asked them what was wrong, they said something might be wrong with MJ. MJ's kids were crying and screaming. They held hands and prayed in a circle. KC then saw security and paramedics running up the stairs. KC, housekeeper and the children stayed in the foyer. Soon security asked KC and the housekeeper to leave the house and KC left.

KC says her heart is still broken. She is devastated. KC met with detectives a few days later. Several media contacted KC asking about what happened that day. After KC gave statements to the police, KC gave interviews to several media sources. Brazil asks if she was paid any money by US media, KC says no. KC mentions interviews she has done with the foreign media. One interview was with German media about food. She was paid $1,000 for it. KC also met with a French documentary, she was paid $1,000. She took part in 5 more interviews. She was paid in total $7,000 for all the interviews.

Brazil asked if KC ever planned to get rich from her experiences with MJ. KC says no.

Defense cross Flanagan

Defense asks if KC was at house Sunday May 10th. KC says no. KC says MJ will come down for breakfast 2 times a week around 8:30 - 9:00 AM. Other days breakfast was taken up to his room.

When KC come in the morning the gate was closed. She press a buzzer, tells who she is and one of the security guys will come to meet her. She can't recall which security let her in on the 25th. When she comes to the house , she had to knock the kitchen door to be let in. Children or housekeeper would let her in. On June 25th MJ's kids let her in.

KC says she only had MAW's phone numbers. KC says there was no land line in the house and she didn't have any phone numbers for AA, FM, Nanny or MJ.

Defense asks KC how far it was from the kitchen to the security trailer. KC explains the distance.

CM came down frantic. CM yelled "go get help, go get security, go get Prince". KC thought it was emergency but did not know what kind of emergency it was. KC went into the den to get Prince. KC said " Prince Dr. Murray needs you. There might be something wrong with your father." Prince went with CM. KC went back to work.

Flanagan asks how old was Prince. KC says 12 years old at that time. Flanagan asks why she did not get the security. She said Prince was right in front of her. She thought there was a human being she can get immediately. She says she didn't want to take the time to go out and go to the security and get them. She didn't know if the security was there or left. She didn't want to take the chance.

Flanagan goes over says that KC saw a frantic CM and thought there was something wrong with MJ. KC says yes. Flanagan asks "He was asking for help, he was asking for security. Did you think a 12 year old child is going to be able to assist this doctor with a problem with Michael?". KC "I did what I was told and I went to get Prince". Flanagan asks if she ever saw CM again, KC says no. Flanagan asks if KC ever told CM that she would not get the security, KC says no.

 

[ivy]

Re: Murray Trial _ All daily trial Summaries - No discussion September 29th / Day 3

Murray Trial Day 4 September 30 2011

Morning session

Bob Johnson Testimony

Walgren Direct

Employed by Nonin Medical, designs noninvasive medical equipment such as pulse oximeters. Johnson states he is the Director of Regulatory Affairs Clinical Research and Quality Assurance. Johnson states his responsibilities are to get product approval with the FDA and Worldwide Health Ministries. Johnson states that the clinical research entails both animal and human research. Johnson states again that Nonin Medical designs pulse oximeters.

When prompted, Johnson states that pulse oximeters detects both pulse rate and red blood cells that have oxygen attached to them, basically determined oxygen saturation and a pulse rate, called SPO2. Johnson states that Nonin probably makes ten or models of pulse oximeters.

Walgren asks if Johnson if familiar with model 9500, Johnson states yes. Johnson describes the "onyx 9500" is a fingertip oximeter, which displays both heart rate and SPO2. Johnson is asked to identify a pulse oximeter that was in MJ's bedroom at the time of death, he does. Johnson is asked to identify two numbers on the oximeter, Johnson explains that the "92" is the heart rate, and the top number is the percentage of red blood cells that have oxygen attached.

Walgren then asks if the Nonin 9500 oximeter has an audible alarm, Johnson states no. Johnson also states that this particular model is used for spot checking. A doctor would use this if a patient were to come into their office to have their heart rate and pulse checked. Johnson then states that this model is not used for continual monitoring and that it is specifically label not to be used continually.

Walgren then asks Johnson if Nonin makes oximeters that have an audible alarm, Johnson states yes. Walgren asks how much this particular model of oximeter costs, Johnson states $275 retail value. Walgren asks if Nonin makes a model of oximeter 2500A, Johnson states yes. Johnson states that the 2500A displays the same functions as the 9500, but also has visual and audible alarms. Johnson states that the alarm at its loudest, can be heard outside. Johnson states that the retail value of the 2500A model is $750. Walgren asks if Nonin makes a 9600 tabletop pulse oximeter, Johnson states yes. Johnson states that the readings are the same, heart rate, then moves to retail value, $1250 in 2009. Johnson also states that Nonin makes pulse oximeters that display capnography, which is the C02 coming from a person's breath. Walgren asks Johnson if all of these models are available to lease, Johnson states that yes they are. When asked how much one of the most expensive models costs to lease, Johnson states about $40 a month.

Defense Cross

When asked if the model 9500 (the one found in the room MJ died in) is accurate, Johnson states yes. Johnson is asked if someone to monitor a patient for 15 minutes, would that model of oximeter be adequate, Johnsons states perhaps. Johnson is then asked if the pulse oximeter detects change, Johnson states yes. Johnson is asked if someone were there with a patient, under the influence of propofol for five or ten minutes, would there be a constant change in the pulse oximeter, Johnson states no. Johnson states that it is very difficult to constantly monitor the numbers, so it is not recommended for continuous monitoring. When asked what Johnson means by continuous monitoring, he states something other than a spot check or to take vital signs. Defense asks if it would be safe in monitoring every five minutes, Johnson states yes. Defense asks if it would be safe continuously for fifteen minutes, Johnson says only if the doctor is constantly monitoring the screen.

Johnson states that it takes about five or ten seconds to get an accurate reading on the oximeter. Defense states that after the five to ten seconds, does the reading change, Johnson states yes. Defense then states that it can be used for constant monitoring, Johnson once again states that it cannot.

Walgren Redirect

Walgren asks if the difference between the audible versus the nonaudible pulse oximeter models is a big difference, Johnson states that it is a huge difference. Walgren states that it's the difference between life and death, Johnson states yes. Walgren states that if in another room, the inaudible oximeter is useless, Johnson states yes.

Flanagan (Defense) Recross

Defense once again asks if a doctor is constantly monitoring, is the pulse oximeter useless, Johnson states no.

Robert Russell Testimony

Deborah Brazil, Prosecution Direct

Russell states that he had a heart attack in 2009 in Las Vegas. Russell stated that he met Dr. Murray in the emergency room in the hospital. Russell Murray reviewed what had happened, and ultimately inserted stents to the heart to repair it. Russell states that this was the first time he had ever met Murray.

Russell states he went into the emergency room, and then went into a surgical room, where Murray and an anesthesiologist performed heart surgery. Russell states that he was awakened during the surgery, because he had been give too much medicine for his blood pressure, by the hospital staff. Russell states that after he was awakened, Murray said "here's your heart (on a screen), stay awake", and that Russell did not want to see it. Russell states that Murray installed three stents in his heart. Russell states that he wanted to leave the hospital that night, but that Murray was stern with him, told him he was minutes from death, and that if Russell left the hospital, he was a dead man. Russell was released from the hospital on approximately March 12, 2009.

Russell states that he went to a follow-up visit on March 16, 2009, and that Murray advised him that he needed to have a second procedure to insert more stents into his heart. Russell states that Murray told him that because of the problems with the first surgery, Murray told Russell that he was unable to put all the stents in his heart, therefore Russell needed another surgery to finish inserting the stents. Russell states that he felt Murray treated him very well. Russell states that Murray told him that he had an opportunity to go to the UK, and take care of one person as a physician, but did not tell him who the one person was. Russell states that he made an appointment for the second surgery, and that he had the surgery in April of 2009. Russell states that the procedure was the same as the first, but that it was an outpatient surgery. Russell states that an anesthesiologist was present in addition to Murray and other medical personnel. Russell states that he went home the same day and had scheduled meetings for follow up care. Russell states that he went to the follow up visit, Murray told Russell that he had made a decision to take care of the one patient and that patient was Michael Jackson. Russell states that he has not told his staff, and that he was going to tell them after Russell and his wife. Russell states that Murray inferred that he had had an ongoing professional relationship with Michael Jackson. Russell states that he was very happy for Murray, and that Murray seemed highly excited and pleased that he would be working for Michael Jackson. Russell states that Murray advised that Russell needed further therapy for his heart and that it was important to his recovery.

Russell states that the therapy for his heart began mid-April 2009 on a daily basis. Russell states that Murray is only there occasionally. Russell states that Murray advised him that he would not be there. Russell states that he asked the staff, and Murray called him at home to answer them. Russell states that he completed the therapy in early June, and had a follow-up visit on June 15 to get the results of therapy to see how Russell's heart was doing. Russell states that this visit was very important to him, but Murray did not keep the appointment. Russell states that he was notified by mail that Murray after June 15, mailed out to all patients, that Murray would be leaving his practices temporarily in order to take "a once in a lifetime opportunity". The letter stated that Murray would manage the practice, and would find a suitable replacement. Russell states that he was not surprised.

Russell states he had a second follow-up visit on June 22, because Murray cancelled the appointment. Russell states that the June 22 appointment was also cancelled and was frustrated. Russell states that he felt he was dependent on Murray, because he had no referral, rescheduling and that Murray had all his medical records. On June 25, 2009, Russell calls Murray's office early in the morning. Russell states that he had formed a relationship with Murray's staff members because during the therapy, he had seen the staff members more than he saw Murray. Russell stated that he expressed his frustration to the staff members, he felt desperate, he threatened legal action, and that he felt abandoned. Russell received a voicemail later that morning from Murray on June 25, 2009.

The voicemail played is Conrad Murray stating that Russell's therapy went very well. Russell states that he felt grateful that he took the time to call him. Russell felt that the statement was odd, because Murray stated that the heart was repaired, when months earlier Murray said it could never be fully repaired. Russell also stated it was odd that Murray had stated he was going on sabbatical, when all along Russell knew that Murray was going to take care of MJ.

Russell stated that although at first he felt Murray's care was excellent, he also felt that he was abandoned.

Chernoff Defense Cross

Chernoff establishes that Russell and Chernoff have never met. Russell states that the medical care he received was unlike any he had never had before. Russell stated that Murray was adamant about how serious Russell's condition had been, and that Murray saved his life.

Russell states that Murray knew his wife. Russell states that his heart attack was on March 9, 2009, and that now, his heart is in good shape, according to his new cardiologist. Russell stated that his new cardiologist stated that the stents had been inserted properly.

Paramedic Richard Senneff (RS) Testimony

Brazil Direct

RS is a paramedic at Los Angeles Fire Department. RS explains his training and experience and certification.

June 25th, RS was working at fire station 71. They received a call to go to Carolwood. "Cardiac arrest. CPR in progress. 50 year old male. Patient not breathing" They went to Carolwood. RS was the team leader and the radio man and he gather information and write records. Senneff rode in Ambulance 71 with Paramedic Blount. Fire Engine 71 followed them with engineer, fire fighter, fire captain and additional paramedic.

Brazil goes over People's Exhibit 43 and what's written on it.

Print out information

Line 1 : Engine 71 Rescue Ambulance 71
Line 2: Address 100 Carolwood
Line 3: Incident number 5-12 Cardiac Arrest 12:21 call time 50 year old man
Line 4 : code cardiac arrest not breathing at all
Line 5: the phone number call came from
Line 6 : dispatch time the time they got the call at station 12:22
Line 7 : 911 call from a cell phone , caller is still on the phone with the dispatcher
Line 8 : Where the call is originated and transferred

At the end there's a patient identification sticker at the UCLA assigned to MJ when he was brought in.

Mid morning break

They arrived at 12:26. Rescue ambulance entered the residence, fire truck stayed on the street. RS got his equipment the starter kit and followed the security guards up the stairs and in the bedroom. RS saw CM, MJ and a security guard in the room.

RS describes the patient. MJ was wearing pajama bottoms and a top. The top was open. Surgical cap on his head. He appeared to be thin.

RS describes CM. CM was leaned over MJ and was holding his torso and was moving MJ from bed to the floor.

RS also saw a security person helping to move MJ to the floor.

According to RS, CM was frantic.

When entered the room RS asked if there was an advanced DNR (Do Not Resuscitate) order. No one answered initially. RS repeated the question CM said no. RS saw an IV stand with a saline bag hanging and saw an oxygen tank. RS was trying to gather information to understand what was happening. RS asked three times if there was an underlying health problem. CM finally said nothing. According to RS this didn't make sense as there was a physician at the house and a IV stand.

RS asked how long the patient been down. CM said "just happened right I called you". RS says that ambulance got there very quickly and if they were called right when the event happened, they had a good chance of reviving MJ and starting his heart.

12:26 is the time RS was in the room and making observations. RS states that they were in the room within 5 minutes. RS says that a firefighter and himself moved MJ from side of the bed to the foot of the bed because there was not enough space to work on the side of the bed. RS was still trying to gather information from CM. Firefighter Herron was doing CPR. Paramedic Blount was starting ventilation. Paramedic Goodwin was hooking up the EKG. Fire Captain was helping with anything needed. RS was busy and didn't look to see the patient was MJ. He later learned that it was MJ.

EKG showed flatline/ asystole.

MJ had an IV on his leg. RS checked to see if it was working and then gave MJ atropine and epinephrine - those are drugs used to start the heart. RS saw no change in MJ's condition after administering the started drugs. RS asked CM if MJ was taking any medicines and was he given any medicines. RS had to ask that question multiple times. RS told CM that he's seeing an underweight patient, with an IV stand and medication vials on the nightstand. At that point CM said MJ wasn't taking anything and CM only gave MJ a little bit of lorazepam for sleep. CM said he was treating MJ for dehydration and exhaustion.

By this time MJ was hooked on the machines and had received one round of starter drugs. Blount incubated MJ quickly to give air directly to his lungs. RS was monitoring MJ's situation. RS was also communicating with UCLA Base Situation reporting to them. RS told the age, the situation, how long he was down, what they did. RS was talking to the radio nurse and radio nurse was communicating with the doctors.

When RS looked to the MJ, he didn't believe that MJ was "just down". RS observed that MJ's skin was cool to the touch; MJ's eyes were open, dilated and dry; EKG was flatline, and capnography reading was low.

They gave MJ a second round of starter drugs through left jugular vein (left neck). Paramedic Goodwin tried to find a vein in MJ's arms to locate a vein 5 times to start an IV but he was unsuccessful. RS says it's significantly difficult to locate a vein when the blood is not circulating for a while.

After RS first contacted UCLA and told them what they administered the first round of starter drugs, UCLA asked them if they wanted to continue or stop. RS said they wanted to continue. After the second round, RS talked to UCLA again. UCLA was ready to announce MJ dead.

Brazil asked what happened to the IV on MJ's leg. RS says CM pulled the IV from MJ's leg and that's why paramedics needed to find another vein and finally found jugular vein.

CM says he felt a pulse at right femoral (right groin). RS looked to heart monitor and he saw a flat line with CPR (lines were only moving due to CPR). RS told his crew to stop CPR to check for pulse. The heart monitor was a clear flat-line, it means that the heart wasn't functional and there could not be a pulse. RS and another paramedic checked for pulse, they did not felt a pulse.

People's 43 exhibit again. They are going over handwritten notes.

call time 12:21, glucose levels, EPI 3.5 mg at 12:40, Allergy : florazen, another EPI and atropine. 12:57 the time UCLA wanted to call MJ death. Box on the right hand side : Hydration and lorazepam what CM told RS. Second bicarb - another starter drug given to MJ. RS says the time is wrong. He wrote 14:00 but it was actually at 13:00 PM

RS's call to UCLA is played. CM assumes control.

CM asked paramedics to do a central line. RS says they don't have any training or equipment to perform it. CM asked paramedics to administer magnesium, RS says they didn't have it. Brazil asks if CM provided them the materials to perform these tasks. RS says no.

People's exhibit 46

902-M. The document contains comprehensive information about the care provided. Starter drugs provided from 12:27 to 12:50. Readings are also written in the document. Medication information and RS's own notes are written.

They gave MJ sodium bicarb before transportation. All of the paramedics and firefighters took MJ downstairs on a backboard. Some of them were carrying the backboard and the others were still performing resuscitation efforts. When downstairs MJ was put on a gurney with wheels. RS turned back to go upstairs to get their equipment.

RS sees CM with a bag in his hand picking up items from the floor near the nightstand.

Blue ambu bag on the floor. RS says it's not paramedics.

RS collects the items, go down the stairs and go to the ambulance. CM was still inside the room. CM joined them later. RS was sitting close to MJ's head in the ambulance and was observing MJ. There was no changes. MJ was given another round of starter drugs on the ambulance. No change. RS saw CM on his cell phone. RS says he never saw any sign of life at MJ and there was no change in MJ's situation for the 42 minutes he was with him. They arrived UCLA at 13:13 PM.

Brazil lists monitoring equipment and asks RS if he saw them in the bedroom. RS says "No" to them all. Brazil asks if CM ever mention Propofol to RS, RS says No. RS says CM was alone in the bedroom for a while after he left the room with their equipment.

Defense cross by Nareg Gourjian

RS says they got the call 12:22 and left at 12:22. Gourjian mentions the call was placed at 12:20 and transferred from Beverly Hills. RS was not aware of it.

Gourjian reminds of RS's preliminary hearing description of MJ: pale, underweight, so thin that you can see his ribs. Gourjian asks if MJ looked real sick to him. RS says he looked like he had a chronic health problem.

Gourjian asks if it was the physical characteristics of someone that has been a drug addict for a long time. RS says he cannot say that and he has seen drug addicts that are overweight and underweight. Rs says he just thought it was a chronic illness.

Gourjian asks about MJ being on the bed. RS says MJ was in the process of being moved, his feet on the ground and his upper torso still on the bed. IV tubing on his left calf.

Defense asks if RS asked CM if MJ was on recreational drugs. RS says it's a common question that he asks but he doesn't remember if he asked it or not. Defense asks RS about Lorazepam. RS says he's not that knowledgeable about it.

Defense asks about CM not answering the questions right away could be because he was busy. RS says there was a lot of things going on and he was busy.

Defense is going over what each paramedic doing. RS repeats what he previously said. Gourjian mentions Paramedic Herron doing CPR and Paramedic Blount managing ventilation. And if CM asking for help as well it acceptable. RS answers yes you wouldn't want to do it alone. Defense reminds American Health Association (AHA) guidelines which says people should work collaboratively.

Lunch break

 

[ivy]

Murray Trial Day 4 September 30 2011

Afternoon Session

Defense cross by Nareg Gourjian continued

Defense asks if the CPR should be performed where the patient is found. RS says that&#8217;s wrong. Defense reads from American Heart Association (AHA) guidelines. RS agrees with it. Defense asks if MJ had IV connected to him. RS says yes. RS says he didn&#8217;t see anything else connected to him. Defense asks if things connected will be a factor when moving a patient, RS answers yes. Defense asks if the chest comprehensions are adequate, would be irrelevant if the patient was on a bed or floor. RS says correct.

Defense asks questions the pulse CM felt at MJ&#8217;s femoral artery. RS says he didn't suspect what CM said. Defense reminds of RS&#8217;s preliminary hearing in which he said that it&#8217;s common to get femoral pulse from CPR. Defense asked would it be likely that CM actually felt that pulse. RS answers yes.

Defense asked why RS didn&#8217;t pronounce MJ dead as UCLA said. RS said he preferred to go to the hospital as it was a VIP patient and as he was told it was a recent arrest. CM took the control and he needed to ride in the ambulance with them. After getting MJ down to the ambulance, RS went back to the room to pick the medical equipment left behind. CM was also picking up items in plain sight. Defense asks if it's normal practice to pick up medical items, RS says yes. Defense asks if CM could have been picking up his glasses and wallet. RS says he didn't see anything and the bed was blocking his view. RS goes back to the ambulance. CM came to the ambulance in a minute or so. Defense asks about the phone call CM did at ambulance, asks RS if he heard anything. RS said he didn't hear anything. Defense asks if CM was trying to help the paramedics with anything they needed when they were at Carolwood. RS says correct.

Defense asks is fractured ribs is a show of good CPR. RS says it is common occurrence. RS wasn&#8217;t aware that MJ sustained fractured ribs. Defense asks if RS is familiar with Propofol, RS says no.

MJ was a combination of P.E.A (Pulseless Electrical Activity) and asystole (flat lined). Defense asks if there are certain protocols to follow if someone is P.E.A. They wouldn't shock (defibrillate) a person with P.E.A. They would give CPR and give atropine and EPI and sodium bicarbonate. Defense asks if they knew MJ was given Propofol, they wouldn't be able to anything different. Objection. Sustained.

Brazil redirect

Brazil asks if there was any confusion and chaos when RS&#8217;s team attempted to save MJ&#8217;s life like the defense claimed. RS says it was not the case.

Brazil asks if RS knows the IV tubing had been replaced, removed or placed again prior to his arrival. RS says no.

RS says that it&#8217;s accurate that they believed the femoral pulse that CM felt to be due to comprehensions and not a real pulse.

RS says by the look of CM's face he was surprised to see him come back in the room. RS says it was "deer in the headlight" kinda look. RS says CM had a trash bag in his hand.

Defense recross

Defense asks RS's time of estimate for the cardiac arrest. RS says it is hard to speculate. Gourjian reminds of RS's preliminary testimony which said "at least 20-25 minutes before we arrived there". Gourjian asks if the time of arrest could have been 12:01 -12:05PM.

Defense again asks if CM could have been getting his wallet. Objection. sustained. Defense asks if CM asked RS to close his eyes or step outside the room. RS says no.

Brazil re re direct

Brazil reminds of the preliminary hearing and asks if it's correct that RS said the arrest could be anywhere from 20 minutes to 1 hour ago. RS says correct.

Defense re re cross

Defense asks if CM stopped doing what he was doing when RS walked into the room. RS says no CM continued to do what he was doing.

Martin Blount (MB) Testimony

Brazil direct

LA Firefighter paramedic. Worked for 20 years. Became a paramedic in 1999. Trained by UCLA doctors and nurses. Every 2 years they are required to take 48 hours of trainment. Works at firestation 71.

MB drived the rescue ambulance. RS was sitting next to him. He came to Carolwood and parked the ambulance and went into the house. Fire truck accompanied them and parked outside the street. Fire Captain Mills, Paramedic Goodwin and Herron was on the fire truck.

MB saw a man lying on bed. He was on the bed fully. MB saw 2 rescue personnel getting MJ to the floor. CM was sweating profousely, he was aggitated. CM said "He needs help could you help him please".

MB has the designated role as a driver. His job is initial treatment and assessment of the patient. RS is responsible for communications and obtain information.

MB immediately recognized it was MJ when he came in the room. MB went to the head of the patient and started basic life support. MB's job was to provide air to MJ.

Steps:
Tongue suppressor so the tongue would not go back of the throat and wouldn't block the airway.
Head tilt back - to make airway open and unconstrusted
Ambu bag - artificial air. More efficient than mouth to mouth. Tied it to an oxgyen tank that he brought.
It took him a minute or so do these all

Then he did advance life support which is endotracheal tube - 100% of the air is going into the lungs. It's better than ambu bag. He did did it in 45 seconds.

According to Blount, MJ wasn't breathing, he wasn't moving, his eyes was fixed and dilated. MB felt that MJ was dead.

MB observed an an oxygen tank and saw a long tube and nasal cannula attached to it. Nasal Cannula was on MJ. MB also saw an IV on MJ's leg and saw an IV bag on IV stand. He did not see any monitoring equipment in the room or on Michael.

While MB was doing his tasks, MB was able to see the heart monitor. He saw no movement. He believed MJ was flat lined.

RS's duty was to gather medical information. MB heard RS asked about the medications MJ took. MB heard CM said no. For previous medical condition CM said no. CM said he was a healty 50 year old man. CM said he was providing normal saline. CM said MJ was rehearsing for 16 hours and was dehydrated. MB heard RS asking if MJ was taking recreational drugs. CM said no.

Brazil asks about stater drugs. Atropine and EPI. Paramedic Goodwin made multiple attempts to find a vein in the arms but he was unssuccessful. RS found a jugular vein on the neck to administer another round of starter drugs.

MB saw 3 open vials of lidocaine on the floor when he was helping MJ. Lidocaine is a heart drug. Paramedics do not carry lidocaine and did not administer it. CM did not mention of giving MJ any lidocaine. MB did not hear CM mentioning Propofol.

MB says he did not hear anyone saying they felt a pulse. Brazil reminds him of his preliminary testimony. MB then remembers that CM said he felt a pulse on MJ's groin area. They stopped the comprehensions to check it (comprehensions can create artificial pulse). When they checked, no one else felt any pulse.

RS was communicating with UCLA base center. MB heard UCLA was ready to announce him dead. MB never saw any signs of life and did not believe MJ was alive. CM took over the control of the patient. MJ was put on a backboard and paramedics took him down to transfer him to UCLA. Before they were taking MJ down, MB saw CM taking Lidocaine vials from the floor and put them in a black bag. MB never saw those lidocaine bottles again.

MB rode with MJ to UCLA. He was sitting towards his head. They administered another started drugs to MJ on the ride. There was no change to MJ's situation on the ride. MB saw and heard CM on the phone. MB heard CM say "It's about Michael and it doesn't look good" on the phone. MB doesn't know who CM was speaking to on the phone.

MB saw MJ had condom catheter. It allows urine to be collected in a bag. It's typically used when someone not able to get up and go to the restroom.

RS asked how long the patient was down. MB heard CM say "he's been down about 1 minute". MB felt MJ's skin,when he was on the bed he was warm. On the floor MJ felt cold to the touch. MB looking at MJ's condition believed he was longer than one minute.

mid afternoon break

Defense cross by Gourjian

MB parked the ambulance, got his equipment went upstairs to the bedroom. MB says MJ was still on the bed. MJ looked pale and thin.

Gourjian shows MB a picture and asks what the black thing on the bed is.

MB doesn't know what it is.

Gourjian asks what are recreational drugs? MB gives examples such as heroin, cocaine. CM answered that question as no. MB says he didn't hear CM mentioning lorazepam to RS.

Defense asks if MB heard CM said "he has been down about a minute prior calling for help". MB says he didn't hear that , he only heard "about 1 minute".

Gourjian goes over the AHA guidelines :comprehension first, airway next, breathing last. MB mentions in 2009 the rules was airway first but now the rules have changed. Gourjian asks is asking for assistance during CPR is normal, MB says yes.

Gourjian asks about Lidocaine bottles. Lidocaine wasn't hidden, they were out in the open and in plain sight.

Defense asks if MJ was P.E.A. MB says MJ was never P.E.A., he was flat-line the whole time.

Dr. Richelle Cooper (RC) Testimony

Walgren direct

UCLA Board Certified Emergency Physician. Explains her medical background, training, education in detail.

RC explains what is a base station: Nurses with specialized training. They answer radio calls from paramedics, help paramedics, consult with doctors to provide further information to the paramedics.

June 25th RC was consulting with the paramedics through base station nurse. Nurse called RC after receiving the call from the paramedics after the resuciation effort were unsuccessful. RC knew the patient was incubated and received starter drugs but still asystole for 40 minutes. LA protocol say if rescuaiation efforts are unsuccessful for 20 min person can be announced dead. After receiving the information RC authorized paramedics pronounce MJ dead at 12:57.

Nurse called RC back said there was a physician on scene requesting paramedics provide another medication. It was sodium bicarbonate. RC said if that was a physician with an active licence they can administer it but the physician need to take over the control and the patient needs to be transported to the local hospital.

When MJ came to the hospital, the care became RC's responsibility. RC knew patient was on the way so she was waiting for the ambulance.

She assigned a team of 14 people. It included :
- Richelle Cooper and 4 residents
- at least 2 emergency technicians,
- a respitory therapist,
- a scribe nurse to record information and make calls to get consult,
- 2 circulating nurses,
- a pharmacist,
- a social worker to contact/assist family members, gather information from physicians and
- a charge nurse who assigns other staff as it's needed.

Additional doctors were consulted and came as needed. Administrative people came down after a while as it was MJ.

RC's main goal is to manage MJ's care. While paramedics was transferring MJ to the trauma bay. RC was speaking CM and asked what happened. CM told MJ was working very long hours, CM believed MJ was dehyrated, CM gave him IV and gave MJ 2mg lorazepam , later gave another 2 mg lorazepam and saw MJ go into cardiac arrest. CM reported MJ had not been ill. RC asked about medications MJ has been given. RC was told MJ was given 2 doses of 2 mg lorazepam through IV.

Walgren asks "Did CM tell any other medicines other than lorazepam?" RC says "No".

CM said witnessed the arrest. What does it mean? RC says it's an observed arrest and the critical event happens when you are with the patient. It's when the patients heart and breathing stops. It means you are on site and saw it happen.

RC asked for MJ's routine regular medications. She was told Valium and Flomax. Valium - anti anxiety medicine. Flomax is given for prostate or kidney stone. CM did not mention any other medicines.

RC asked past medical history , if he had a heart problem, blood clot or drug use. CM said no to all. RC asked if he saw any seizures and if MJ had complained about chest pain, CM said no.

RC did not see any physical trauma.

RC says MJ was clinically dead, he didn't have a pulse. There was signs of a dying heart (heart might still send some signals), pupils were dilated. Despite this they made attempts to revive MJ. They confirmed the breathing tube was in correct place and they were breathing for the patient. They checked for pulse, there was no pulse. They started CPR and tried to resuscitate MJ. They used an ultasound to examine the heart.

Walgren shows pictures of trauma bay and asks RC to go over all of the medical items in the trauma bay. RC identifies items one by one.

Court adjourned till monday

 

[ivy]

Re: Murray Trial _ All daily trial Summaries - No discussion September 30th / Day 4

Murray Trial Day 5 October 3, 2011

Morning Session

Dr. Richelle Cooper Resumption of Direct by David Walgren

Cooper states that CM indicated he had given MJ 4 miligrams of lorazepam, with no mention of propofol. Cooper states that there were over 14 people in the room where MJ was at UCLA, but that she had the final say over everything that happened in the room. Cooper states that she was aware that paramedics have given "starter drugs" at the Carolwood home and also during transport to UCLA. Cooper states that at UCLA, epinephrine, sodium bicarbonate, vasopressin were all given to try to restart MJ's heart. Dopamine was given in a drip. Cooper states that chest compressions were given from time of arrival.

Cooper states MJ arrived at 1:13 pm and was death was called 2:26, chest compressions were given continuously throughout. Cooper states MJ had an endotracheal tube, and a respiratory therapist was squeezing an ambu- bag to pump oxygen into MJ's lungs throughout. Cooper also states that MJ was hooked to monitors throughout. Cooper states that during this hour and thirteen minutes, from the time MJ arrived at UCLA, until the time of death was called, she never felt a pulse. Cooper states that when compressions were going on, they could feel a pulse. But, that a spontaneous pulse (when there are no chest compressions going on) was not found by her. Cooper states at 13:21 (military time for 1:21) one of the staff reported a pulse, but when Cooper consulted the monitor it was not consistent with a pulse.

Cooper states that she made the decision at 2:26 pm to call the time of death, even though she called time of death at the Carolwood home at 12:57 pm. Cooper states that from 12:57 pm to 2:26 pm there had been no notable change in MJ's condition. Cooper states that she noticed a condom catheter on MJ's body. Cooper states that condom catheters are used to collect urine when unconscious. Cooper states that the condom catheter was unusual for a 50 year old male who was reportedly healthy.

Cooper states that she did not request Murray to sign a death certificate, because MJ was her patient.

Cooper states she did not have a reason for MJ's death and therefore MJ's case would be a coroner's case. Cooper states that there was a social work team to help with the family even before the time of MJ's death was called. Cooper states that the social work team is standard care for UCLA, not initiated by Conrad Murray. Cooper states that she was notified that MJ's children were aware that their father was dead. Cooper states that she saw the children, that they were scared and that they were fairly hysterical, and taken care of by someone referred to as their nurse.

Defense Cross

Cooper states she does not know exactly time of death for MJ, she bases it on what the paramedics told her, and called time of death at 12:57 pm. Cooper states based on the information she had, she believed MJ to be dead at 12:57 pm. Cooper states that she could override Murray's request to continue to try to revive Murray, but she allowed Murray to make that call. Cooper states that her assessment when MJ arrived, he was clinically dead and that any revival would be futile. Cooper stated that Murray claimed there was a pulse, so she continued efforts to save MJ.

Cooper states she was never an anesthesiologist, but she has used propofol, at UCLA you need to have privileges. Cooper states she always practices medicine in a hospital emergency room setting. Cooper states that in her use of propofol, she uses amounts that are based by case. Cooper states that she chooses a dose that will make a patient comfortable, so that the patient does not feel pain. Cooper states she never used propofol as a pre-med student. Cooper states that if 25 mg of propofol was slowly infused in 3-5 minutes, on a patient at 135 pounds, and he received no other medications, she believes if she achieved sedation, he would wake up in seven to ten minutes. Cooper does not believe that the propofol would be completely metabolized in seven minutes. Cooper states that 25 mg is very small, and would not be sufficient to sedate a patient.

Cooper states that Murray stated he witnessed MJ's cardiac arrest. Cooper states that she never asked what time the lorazepam was given to MJ. Cooper states that she previously testified that Murray stated he witnessed MJ's cardiac arrest. Cooper states that the half life of benzodiazepines varies greatly.

Cooper has been to courses in procedural sedation, she has administered procedural sedation, and reviews articles on procedural sedation. Cooper states that on a healthy patient, she would start sedation at a mg per kg dose, and in MJ's case that would be 60 mg, it would keep them asleep for about 10 minutes.
Cooper states that if Murray had told her that he had given 25 mg of propofol at 10:40, it would have not changed how she treated MJ as a patient. Cooper states that MJ died long before he became her patient.

Cooper states that Murray stated that he thought MJ was dehydrated, had given him lorazepam, and had witnessed MJ's cardiac arrest. Cooper states that Murray told her MJ took Flomax which is typically taken for a urinary problem.

Cooper states that while it is normal to take a rectal temperature, but Cooper cannot recall if it was done. Cooper states that rectal temperature would not tell her time of death. Cooper states that there is a protocol for LA county paramedics, with 20 minutes of revival procedures, after 20 minutes with no change, it's time to call time of death. Cooper states that this is the first time that paramedics have ever asked her to continue revival procedure after she tells them to call the time of death.

Cooper states that she does not recall Murray being frantic, but to be honest, she does not pay that much attention to someone other than the patient. Cooper does not recall much about Murray's demeanor, except that Murray was respectful in that he was not allowed to do procedures in the emergency room. Cooper states that Murray and a Dr. Cruz had a conversation, which she did not hear, but then the aortic pump was inserted. Cooper states that there was no urine present in the condom catheter or the collection bag. Cooper states that had there been urine, Cooper would have sent it to the lab to be analyzed.

Walgren Redirect

Cooper states that she assumed that Conrad Murray was not lying to her. Cooper states that Murray told her that MJ was working hard, was dehydrated and he had given him lorazepam. Cooper states that all physicians do not have propofol privileges. Cooper states that they have equipment set up within a room and outside a room for issues arising in a patient who has received propofol. Cooper states that there is always an attending physician present, plus other physicians when administering propofol or another anesthetic agent.

Defense Cross

Cooper states that when administering propofol, it should go in as a slow infusion through a bolus. Cooper states that a direct injection of propofol would cause apnea, although she has never seen a direct injection done. Cooper states that continual propofol usage is rare.

Walgren Redirect

Cooper states that she is prepared as a an emergency physician to intubate patients or attend to patient's airway during procedural sedation.

Defense Recross

Cooper states she has never had a patient stop breathing during a procedural sedation. Cooper states that if there is a problem, the first thing to do is to stimulate the patient, meaning wake the patient up and that that is almost always sufficient. Cooper states that if a doctor was to administer 60 mgs to 60 kg patient, the doctor would be able to see insufficient breathing right away, that it could be determined by seeing, but that capnography would be able to detect a breathing problem first.

mid morning break

Edward Dixon Testimony

Brazil Direct

Dixon states he works for AT & T as a senior support engineer since 1997. Dixon states that he is familiar with preparations of cell phone records and has testified previously in cases regarding cell phone records. Dixon states he has reviewed Murray's cell phone records. Dixon states that Murray's cell phone account status was active in June, 2009.

Dixon states that on June 25, 2009, calls were made:
- 9:23 am Call placed to Murray's phone lasting 22 minutes
-10:14 am Call placed to Murray's phone lasting 2 minutes
-11:07 am Call placed to Murray's phone lasting 1 minute
-11:18 am Call placed from Murray's phone lasting 32 minutes
-11:49 am Call placed to Murray's phone lasting 3 minutes
- 11:51 am Call placed from Murray's phone lasting 11 minutes
- 12:12 pm Call placed from Murray's phone lasting 1 minute
-12:15 pm Call placed to Murray's phone lasting 1 minute
- 3:38 pm Call placed from Murray's phone lasting 2 minutes
- 4:31 pm Call placed from Murray's phone lasting 1 minute
-4:32 pm Same as above
-5:02 pm Same as above

Dixon states that cell phone contains data as well as calls. Dixon states that data activity occurred on Murray's cell phone on June 25, 2009:
- 1:04 am, 2:04 am, 3:04 am, 4:04 am, 5:04 am and 6:04 am, Dixon states that this is pull notification, and that information is pulled to the phone.
-8:54 am - 5:02 pm Data activity

Gourjian Defense cross

Dixon states the records do not identify who is using the phone. Dixon states that there is no way to identify what is said in a text message sent from any AT&T phone (referring to data activity). Dixon states that he does not know, as of today, who own the cell phones that Murray called on June 25, 2009. Essentially, Dixon states that he can tell if calls went to voicemail or they were answered only if they made from or to AT&T phones.

Dixon states that regarding data usage, the data is set automatically, in this case, it was set at 1:04 am, 2:04 am, 3:04 am, 4:04 am, 5:04 am and 6:04 am.

11:07 am, phone call to Murray's call, Dixon states that he cannot tell whether the call was answered or it went to voicemail. Dixon then looks to his records, looking specifically at the duration of the call, and states it is identified as an incoming call, length is 1 minute, but he still cannot tell if it went to voicemail or answered.

Brazil Redirect

Brazil corrects that 3:38 pm call is wrong, it is 3:58 pm.

Jeff Strohom Testimony

Brazil Direct

Strohm states that he is a custodian of records for Sprint/Nextel, and is responsible testifying for courts who require it. Strohm states that the subscriber for the number that Brazil asks, is Conrad Murray. Strohm states that calls were made from or to Murray's phone on 6/25/09:
- 7:01 am Call made to Murray lasting 25 seconds
- 8:25 am Call made from Murray lasting 0 seconds (text message)
- 8:39 am Call made from Murray lasting 53 seconds
- 10:20 am Call made to Murray lasting 111 seconds
- 10:34 am Call made from Murray lasting 8 1/2 minutes
- 11:26 am Call made to Murray lasting 7 seconds
- 1:08 pm Call made from Murray lasting 2 minutes

Gourjian Defense Cross

Strohm states that the 11:26 am call cannot tell whether the phone was answered or not, but that the call is not a voicemail.

Dr. Thao Nyguen Testimony

Dr. Nguyen states she works at UCLA as a cardiologist/scientist. Nguyen 20% of her time spent as a cardiologist, 80% of her time she researches. Nguyen states that in June, 2009, she was a cardiology fellow. Cooper states her responsibilities included taking care of patients that were critically ill in CCU at UCLA, managing patients and supervising her was Dr. Daniel Cruz.

Cooper states she was called into the emergency room at UCLA to help with the patient MJ. Cooper states she received a page that the ER needed help with a VIP patient, named Michael Jackson. Nguyen states that Dr. Cooper was treating MJ when she arrived at the emergency room. Nguyen states that Murray introduced himself to her as MJ's private physician. Nguyen asked Murray what happened, and Murray replied that MJ was very tired, he was preparing for a concert tour. Nguyen states that she asked Murray if there were any drugs given, Murray stated 4 mg of Ativan (another name for lorazepam). Nguyen asked if any other medications were given, Murray stated no other medications given.

Nguyen states that she asked what time the Ativan was given, Murray stated he did not know. Nguyen states that Murray told him he found MJ not breathing, Nguyen asked what time was that, Murray stated he did not know. Nguyen states that she then asked Murray what time was 911 called, Murray stated he did not know, he had no concept of time because he did not have a watch. Nguyen states she asked for an estimate from Murray from the time he found him not breathing to the time he called 911, Murray was not able.

Nguyen states that Murray never mentioned propofol to her. Nguyen states that after receiving from Murray, she consulted Dr. Cruz. Murray told them that he found a pulse, but Dr. Nguyen nor Dr. Cruz found a pulse. Murray asked both Nguyen and Cruz to continue to try to revive MJ, to not give up easily. Nguyen states that the next thing to do to try to revive MJ is to use a balloon pump for MJ's heart. Nguyen states that she feared they were running too late, that time was not on MJ's side.

Lunch break

 

[ivy]

Re: Murray Trial _ All daily trial Summaries - No discussion September 30th / Day 4

Murray Trial Day 5 October 3 2011

Afternoon Session

Thao Nguyen (TN)Testimony

Walgren Direct continued

What is a balloon pump? It is inserted into aorta to help heart. She was doubtful that it would help. It looked like time wasn't on MJ's side and he looked lifeless. She went forward with the balloon pump to show good faith. TN and Dr. Cruz (attenting cardiologist) could not felt a pulse but CM told them he felt a pulse and asked them not to give up easily on MJ and try to save his life. TN and Dr. Cruz moved forward with balloon pump even though they thought it was futile. Dr. Cruz decided and authorizated the ballon pump. It was quite smoothly placed but the attempt was futile.

Before they did the balloon pump placement, they made an agreement with CM that this would be the last attempt to save MJ and if it didn't work they would stop the efforts.

Dr. Nguyen: "We wanted Mr. Jackson to depart with dignity and respect, so we decided to end our efforts. "

Shortly after the balloon pump MJ was pronounced dead.

CM did not mention propofol during all these balloon pump efforts.

Defense Flanagan cross

TN was called a minute before 1:35. TN remembers the time because she looked to her pager. TN was on the 7th floor in the rounding room of cardiac care. She talked to Dr. Cooper when she came into the trauma bay and Dr. Cooper pointed and introduced her to CM saying that CM is the physican for MJ.

TN knew the patient was MJ because page she received was a code for "VIP named Michael Jackson".

TN talked and asked CM first because he was the primary source . She always goes to the source and then talks to ucla attending doctor (Dr. cooper).

CM said to TN that MJ was having hard time sleeping, MJ was tired because of preparation/ rehearsal for the concert tour and MJ asked for sleeping aid. CM told TN that he gave MJ "Ativan 4 mg IV" .

CM didn't tell her that he gave it in 2 seperate doses. CM didn't mention Valium or Flomax and said no when she asked if there was any other sedatives and narcotics involved. CM did not recall the time when gave Ativan to MJ. CM didnot remember the time of the arrest. CM did not recall when he called EMS.

TN had some concerns: 1)time was not on their side 2) IV for insomnia for outpatient setting is quite uncommon. The dosage wasn't too high but there was a lifeless patient.

4mg of Ativan by IV would put a person to sleep. TN would start with 1 mg by a mouth. IV would be stronger than by mouth usage. She wouldn't use Ativan in outpatient setting and even inpatient setting because they are better drugs that are non-sedatives and non-narcotics.

Recommended dosage for Ativan is 2 -4 mg by mouth for an adult. 2 mg Ativan by IV would put a patient to sleep pretty quick in 5-7 minutes depending on the patient. If a person is used the drug before it can take them longer to sleep. Ativan half time is 12 +- 5 hours. TN says the amount of sleep would depend on the patient and the conditions. She says that normally people would be able to sleep through the night with that dose.

Defense asks about the second dose of 2mg Ativan and if it would put the person to sleep. TN says yes if the person has not developed higher tolerance , if they had a high tolerance they would need higher dosage. TN also mentions that the even though a person's tolerance to drug could increase, their body's tolereance level to toxicty wouldn't increase.

Defense asks 20 mg Ativan IV, TN says that it's a really high dose. Defense asks if it would kill a person. TN says that Ativan affects the brain and will make the brain sleepy (depress the consciousness) and it would not tell the diaphragm to breath.

Defense talks about half life of Ativan. Defense asks if Ativan would be expected in to be present in blood at 12:00PM if 2mg is given at 2 AM and 5 AM.

Defense asks if they would watch the patient if they gave them Ativan. TN says that multiple people watch them until they would gain total consciousness.

Slurry speech is mentioned and TN says that it would be an affect of Ativan. TN has used Propofol. She says that they don't hear slurred speech in Propofol.

CM sounded desperate and looked devastated. CM said "Do not give up easily, please save his life".

There was no pulse but TN didn't know how long he didn't have pulse. TN believed when she was called to come down, CPR was partially successful. All TN knows when she came down MJ appeared lifeless and TN and Dr. Cruz could not find a pulse. There was typically no reason to use a balloon pump.

TN says as CM was there and he was trained and knew how to take pulse so TN gave CM the benefit of the doubt and believed when he said he felt a pulse.

Defense asks when they did the balloon pump. She says that they got the equipment in 5-7 minutes and did the balloon pump immediately after they got the equipment.

Defense again goes over the agreement they did with CM to do balloon pump and stop if it doesn't work. TN repeats multiple times of her previous explanations.

TN says she asked CM if he gave anthing to reverse the effect of atrivan. Later TN explains the drug Flumazenil. 0.2 mg to prevent the further depression of the brain. To reverse the effect of Ativan it should be given immediately like in seconds. Defense questions about window of opportunity. TN says seconds to minutes (2-3 minutes). TN says you can 100% reverse Ativan but if you wait too long then you would zero chance to reverse it. It must be given as soon as you find the patient. TN says that antidote should be to be at hand when giving Ativan to a patient. TN says the next step will be to incubate the patient and to be put on a ventilator to breathe.

Defense asks is she would expect 4 mg Ativan need Flumazenil. TN says she would not typically expect any complications in a person that is accustomed to the drug and tolerant to it. TN adds that anything can happen and they always use it at a monitored environment with oxygen on board.

Walgren redirect

TN use propofol at the hospital but uses an anesthesiologist in procedures. TN says at least 3 people will be in the room - cardiologist,anesthesiologist and a nurse. TN says Propofol will be administered in a hospital setting and furthermore only in an ICU or procedure room. TN also mentions that it would be administered in a designated place, with designated personnel and necessary equipment. TN says that crash cart should be available. TN says she wouldn't administer Propofol without the necessary equipment.

TN mentions Propofol can cause negative effects and that it doesn't have an antidote so that they should be prepared for the worst when giving Propofol before they even start administering it. TN mentions it's a must.

Flanagan recross

Defense asks if Propofol can be used for other reasons than procedures. Defense asks if TN knows conscious sedation. Defense mentions that TN only used Propofol during a procedure so divided the responsibility with anesthesiologist and asks if there's no procedure could she give it alone (be in charge of giving Propofol). TN replies " I don't use Propofol when there's no procedure being done". Flanagan says that's because she never practiced outside a hospital. TN says she does work outside a hospital setting and she would never use Propofol in an outpatient setting.

Defense asks how much Propofol she would give to someone MJ's size. TN says that it would depend the conditions and if other sedatives were used.

Flanagan states Propofol being commonly used outside hospital setting. TN disagrees , Flanagan asks if TN knows Propofol being given at a dentist offices and gastroenterologist, TN says she was not aware of it and never asked what they gave and wasn't interested. TN says that she was only concerned with what is given to her.

Walgren redirect

Walgren asks TN if she has ever heard Propofol being used in someone's home in a private residence, she says that's a first.

Dr. Joanne Prashad (JP) Testimony

Brazil Direct

JP Internal medicine physician for 9 years at a Houston Hospital.

JP was called to evaluate a patient for a surgery to see if the patient can undergo surgery. JP generally sees the patient, takes their medical history, does a physical exam and she would review medical charts. The patient had a recent surgery done by CM, CM had placed a stent to an artery on his leg to keep a blood vessel open. Patient was taking medications (Plavix) which was a concern for the surgeon and the anesthologist.
Patient had an open wound on the leg that went to the bone. If they do the surgery the wound would additional bleed. The concern was that if the patient could continue to take Plavix or not.

The stent was put into 4.5 months ago. JP saw that he was taking plavix medicine , generally it's taken for 6 months. She needed to learn if the medicine could be stopped. JP wanted to ask CM what was his opinion about this patient and if she can tell the patient to stop the plavix and have the surgery.

Brazil questions about medical chart and asks if they are important. JP says they are important because they can get the accurate medical information from them. Patient generally don't know the details of the medications and previous procedures.

Shee called CM's office and was given a phone number it was a answering service. She called the office again and was given a second phone number. JP called the second number and explains her reason for calling and she asked if this patient needs to continue to take Plavix or if they can stop it and the patient can have the surgery. CM was clear, he said the patient need to continue the medicine for 6 months and postpone the surgery until that the time period was over. CM properly told the medicine dosage and his treatment plan.

She was surpised that she called out of the blue and he was able to give an answer. Generally doctors would say they need to review the chart and call back. CM was clear about the treatment and about the need for the medication.

10:20 AM . It was a brief call. CM provided the information she needed. She decided to postpone the procedure based on the information she got from CM.

Defense Chernoff cross

Defense mentions that a lot of the times doctors doens't remember the patient but CM did, he knew the treatment, he knew the medication. Chernoff asks if she was impressed with CM, she says she was impressed.

Mid Afternoon Break

Antoinette Gill Testimony

She's from Las Vegas, Nevada. She has known Murray for over 10 years. She was referred to him by a client of hers. She is a patient of CM.

Mid June she received a letter from CM's office. It said that CM was going on to a sabbatical. She called CM's cell phone on June 25th at 8:45AM . She had a short normal conversation. She was seeking referral for another physician she didn't receive it.

No Defense Cross

Consuelo Ng (CN) testimony

CN met CM 2003 -2004 when CM was treating her grandmother. CN says CM helped to cure her grandmother. She volunteered to work at CM's Las Vegas office and she was working as a caregiver at a group home. She's not a nurse.

She consistently volunteered in CM's Las Vegas office 5 days a week. She worked at the front and back of the office. She did filing, answered phones and took vitals of the patients.

She knows Robert Russell who used the ECP room. 3 other girls Carol, Sarah, Leah worked at CM's office. Carol mostly handles the front office - checking in patient, scheduling appointments , answering the phones, authorizations from insurance and verification and filing of insurances. Leah works at back of the office also answer calls and help the front if needed. Sarah does the same. None of them are registered nurse. They are not licensed vocational nurses. All of them did whatever needd in the office. CM also has an assistant administrator Stacy who worked from San Diego. Stacy order supplies, process payroll.

CM will be in Houston for a week and next week he will be in Las Vegas. Las Vegas office will be open when CM was in Houston . When CM is in Houston they would provide ECP threaphy and an Echo tech would come and do echocardiogram (echo).

ECP threaphy : They would wrap lower extremities, they put the patient on a Blood Pressure cuff, check oxygen level, hook up the patient on machine. They would check the oxygen level with a machine that they put it on the finger.

When CM was not in office he would call the office daily to check. When CM was in Houston they would see patients in a partial day basis. CM did not perform procedures in his office. His procedures will be on Friday at the hospital.

June 2009 - she did not know CM was in California. CM would call in to say to rechedule some patients.
Brazil mentions the June 15 letter sent to CM's patients telling that the CM would leave his practice for a period of time. CM told his staff that he was the personal physician of MJ before the June 15 letter. They would continue working for CM, another physician would come and would take over but it wasn't set up.
June 25, she was working in the office with Carol, Leah and Sarah. CM called the office, she did not speak to him. 11:18 AM 32 minute call. She did not speak to him, someone else from the office could have talked to CM. It was his normal habit to call the office when he was away.

They went to lunch, they weren't seeing patients that day. When they got back from lunch, they got a call from their biller. That how they found up something happened to MJ.

Defence cross Chernoff

Defense asks if she was supbeonad to testify. She says yes.

Defense goes over CM's schedule. Mondays and wednesdays he sees patients in the afternoon, mornings makes rounds in the hospital. Tuesdays see patients mornings, make rounds in the afternoons. Fridays he does procedures at the hospital.

Defense again goes over if CM would call the office and what they would do in the office when CM was away. She repeats the previous answers.

Defense asked why she volunteered to work in CM's office. She says because she wanted to learn and experience how it is working as a medical assistant was. she saw how CM treated her grandmother.

Chernoff question : Did CM had a tendency to become friends with his patients? Yes. Patients had an attachment to CM? Yes they did.

She stopped working CM because of what happened , CM shut down his practice due to what happened with MJ Objection. Sustained.

CM talked everyone at the same time and told that he was going on sabbatical to go on tour with MJ. They were excited "because it was MJ and everyone knows MJ". CM told them he would be back by the end of year.

Bridgette Morgan testimony

Brazil Direct

She met CM in 2003 in a social setting. She maintained a relationship / friendship with CM. CM told her that he was MJ's personal physician.

She called CM on June 25th. 11:26 AM. CM didn't answer the phone.

Defense cross

She lives in LA since 1998.

Brazil redirect

She met CM in Las Vegas.

 

[ivy]

Re: Murray Trial _ All daily trial Summaries - No discussion October 3rd / Day 5

Murray Trial Day 6 October 4 , 2011

Morning Session

Stacey Ruggels (SR) Testimony

Brazil Direct

SR has worked for CM since 1997. June 25. 10:34 AM phone call. She talked to CM for 8.5 minutes. 11:07AM she called CM back. She spoke to him again.

Chenoff Cross

Defense asks what the conversation was about. SR says she called CM to let CM know that she had sent the email. It was brief call.

Defense asks if she helped CM to open an office in Houston in 2005. CM wanted to open an office for his father's memory. Her duty was to look for places to open office. They opened the office in July 10, 2006.

After the Houston office opened he would go every other week - one week Houston one week in Las Vegas.

Type of patients in Houston office are people that are on fixed income and cannot afford to see physicians. Houston was a high volume office, CM saw a lot of patients. CM did not profit from the Houston office, there was very minimal income coming from that office.

SR learned CM was going to work for MJ April 2009. She was involved with trying get another cardiologist for CM's place.

Brazil Redirect

Brazil asks how many offices Murray had as of June 2009. CM only had 2 offices in Las Vegas and Houston.

Michelle Bella Testimony

Brazil Direct

Bella met CM in February 2008. She met CM in a Las Vegas club that she was working. CM gave her his phone number. She called CM. CM called her as well. CM sent her text messages and she had sent him text messages.

June 25th CM sent her a text message. June 16th she received a voice mail from CM.

Brazil wants to play the June 16 voice mail. Objection. Side Bar.

Brazil asks if CM told her if he was MJ's doctor. She says yes. CM also mentioned working for MJ on the voice mail. On the voice mail did CM said he hoped to meet with her in the club? She says yes but the answer is stricken.

No defense recross

Sade Anding (SA) Testimony

Brazil Direct

She lives in Houston Texas and worked as a waitress. CM gave her his phone number when they met Feb 2009. After that first meeting and phonecall they spent time together and communicted by calling each other. They exchanged text messages as well. They maintained regular contact and got to know each other better.

June 25. CM called her. She was in Houston. The call was 11:51 AM. CM said "Hello it's CM. How are you doing?" She asked "how he was doing?" and said "I haven't talked to you in a while". SA had seen CM in May in Houston and went to dinner. CM said "Well.." and paused. SA said "let me tell you about my day". CM didn't respond. She realized that CM was no longer saying anything on the phone. SA says she realized 5 to 6 minutes into the phone call CM wasn't saying anything back to her. SA said "Hello Hello" she didn't hear anything. SA pressed the phone to her ear and heard mumbling of voices. It was like the phone was in CM's pocket. She also heard coughing.

She did not recognize who the mumling voice was. She said "hello hello are you there hello" several times. She didn't receive any response from CM. SA hang up the phone can tried to call back and text multiple times but there was no replies.
SA later learned that MJ was dead.

Brazil tries to ask about the next phonecall she had with CM after MJ was dead. Objection. Sidebar.

July 23, 2009. SA's father told her that LAPD detectives was in Houston and wanted to speak with her. SA called CM and talked to him. She told that LAPD detectives wanted to talk to her. CM said "why they are calling you? I'm sorry they are contacting you. I'm going to give you my lawyer's number. Make sure that when you speak to LAPD to have my lawyer present".

Defense Chernoff Cross

Chernoff goes over June 25th phonecall. Chernoff asks if the voices she heard could be CM. SA answers yes. Defense asks how long she was on the phone before she hang up after she realized CM wasn't responding. SA says 3 to 4 minutes.

Nicole Alvarez (NA) Testimony

Brazil Direct

NA met CM at 2005 in a club at Las Vegas. They exchanged phone numbers and kept in contact. A few months later their relationship became something beyond friendship. She was in a relationship with CM in 2009 and gave birth to a son in March 2009. She had been living in her apartment for 3-4 years.

CM told her that he was MJ's personal physician in 2008. NA says that she was interested and excited about hearing that CM was MJ's doctor. NA says that she didn't ask questions as she respected CM's profession.

NA says that she met MJ around 2008. She was introduced by CM. CM arranged the meeting as a surprise to NA. She was speechless when she met MJ. She met MJ at his home. At the time she met MJ, he was the only patient of CM's that she met. NA says after MJ's death she met some of CM's patient in Houston.

NA says she accompanied CM to MJ's residence 2-3 times. MJ wanted to see her son. She went to MJ's residence after March 2009.

NA knew that CM had practices Las Vegas and Houston. NA says CM didn't mention having a medical practice in California.

NA says that she still lives with CM. CM in 2009 was living in her residence and was paying her rent of $2500 and provided financial support.
NA says she's an actress. Brazil asks where NA was working in May and June 2009. NA says she was maintaining her instrument (herself), going on casting calls, auditioning and refining her craft.

April 2009. CM was living with NA but not on full time basis. CM was maintaining his practices and knew that CM was MJ's personal physician. CM would leave at night time to go to MJ. NA knew that CM was working for MJ, she didn't know at what capacity.

CM's routine. CM would leave around 9 PM and return in the morning sometimes it would be early morning (6-7 AM) and later he started to come around 8-9-10 AM. CM would go very frequently with a few off days.

May 2009. CM's activities would be similar to the April 2009. NA at times called CM while he was working MJ , she says the calls were brief.
June 2009 CM's schedule was similar. NA knew that MJ getting ready for his concert tour. NA didn't ask CM about the show and rehearsals because she thought she would see the show as she would be accompanying CM to London. She learned they would be going to London in March 2009.

NA wasn't aware of the negotiation details but she knew that they were arranging places for them to live. NA says that she don't recall reveiving CM's contract through fax. Brazil reminds her about her preliminary hearing in which she said she saw the AEG contract. NA says she never read the details. Brazil goes over the preliminary hearing testimony and readsthat NA received a fax and looked to the contract and she looked and knew that CM would be paid $150,000. NA says as of now she doesn't recall that moment. NA says that if she said that's what happened then it's true.

NA didn't know when they were going to London. NA knew that they would be gone until November.

mid morning break

Direct continued

April, May, June CM was living with NA's apartment and was providing care to MJ. At the same time packages addressed to CM were being delivering to her house. CM would tell her that he's expecting packages. CM didn't tell her what was in the packages. NA says she didn't know what the packages contained. NA says she didn't open the packages. NA signed for the packages. CM also received mail at her address. Some packages was left at her door and sometimes they were left in the common area. NA would make sure that CM knew that he had a package.

Brazil enters Fedex receipts into evidence dated April 8th, April 29th, May 1st, May 13th, May 15th, June 11 and June 16th.

June 25th. 1:08 PM. CM called NA's home number. CM told her he was on the way to the hospital with MJ. CM didn't want her to be alarmed. She received phonecalls from CM in the late afternoon. CM came to her house in the late afternoon.

No defense cross

Tim Lopez (TL) Testimony

Brazil Direct


Tim Lopez owner and pharmacist of Applied Pharmacy. Applied pharmacy is a specialized pharmacy that made compounds.

TL received a phone call from CM at November 2008. CM told that he had patient having Vitiligo and needed Benoquine. TL needed to look to the raw materials to see if he can make the Benoquine. TL told CM he would look into it and let him know. During their office move TL lost CM's information and didn't call him back.

March 2009. TL received a phonecall from CM. CM asked why TL didn't call him back. TL told him that they were in the middle of the move and lost his phone number. TL got his contact information again and promised that he would keep in touch.

TL looked for the compounds to create Benoquine. CM asked what strentgh TL could make the cream, he said he can make the standard 20% strength. TL said they can make 40 of 30gr tubes. CM placed an order. CM was also told about preordering and he needed to pay up front. CM said he had many African American patients that suffer from Vitiligo and this was a trial basis to see how the medicine worked. CM told he had multiple clinics and would use the cream overseas as well. CM would have come to TL's office to pick it up and pay with a company check for $1,200

CM provided TL with his medical office in Las Vegas and he told him his DEA licence number and his medical license number. TL verified CM's medical license and DEA number.

TL says as the cream was asked for a "trial basis" and under doctor control he didn't need to know the patient's name. TL says he would need to know the name of the patient once they are prescribed the cream for home use.

When CM came to pick up the cream, he discussed if the cream could be delievered to his office. TL said they could. TL also said they needed to have credit card on account for future orders. CM gave him his credit card number.

April 2009. CM called TL and said he was happy with the cream. CM asked if the pharmacy was able to order other stuff for his offices. CM asked him to find pricing and availability of normal saline IV bags and Propofol.

TL says he didn't sell Propofol before CM asked him about him. CM wanted 100ml and 20ml sizes. TL found out the pricing information for Propofol. CM placed an order on April 6th on the phone. 10 bottles of 100ml Propofol and 25 bottles of 20ml Propofol.

The first shipment was sent to CM's Vegas office. CM removed some items and asked if the rest can be shipped to his office in LA.

April 28 order. 40 bottles of 100ml Propofol and 25 bottles of 20ml Propofol.

Lunch Break

 

[ivy]

Re: Murray Trial _ All daily trial Summaries - No discussion October 4th / Day 6 Morning Testimony

Murray Trial Day 3 October 4, 2011

Afternoon Session

Brazil Direct Continued

April 30. CM inquired about availability of Lorazepam and Midazolam in injectible form. Lorazepam is also available in a pill format. 10 vials of 10ml Lorazepam, 20 vials of 2ml Midazolam.

First 2 weeks of May. TL discussed several items with CM. CM had a concern with the base of Benoquin, wanted it to be less greasy. TL said he could do several formulas. CM also asked if it could be done in a larger packaging size. CM wanted packaging to look better.

CM wanted energy formulations for boost. CM didn't want any narcotics or prescription drugs , he wanted natural products. CM said this was for wakefulness and energy. TL said he would look into it.

CM said his patients were complaining about injection site pain. CM wanted a topical anesthetic that only had lidocaine cream in it. TL did a mix for him that had 2% Lidocaine. Such creams are rub onto the skin before injecting a needle.

May 12 receipt. 40 vials of 100ml Propofol. 25 vials of 20ml Propofol. 20 vials of 2ml Midazolam. 10 vials of 0.5 ml Flumazenil . Lidocaine cream 30 gr.

May 14. TL talked with CM about Lidocaine cream. CM wasn't getting the desired responde with thr 4% cream and wanted him to increase the strenght to 4 %. CM asked about the energy formulation. TL suggested several items to CM and agreed to do more research on it. TL also said that he would change the base of the Benoquin cream and would send CM 3 samples and CM would determine which one he liked better. CM asked TL about Hydroquinone cream (used for Vitiligo) and CM was interested in receiving a sample.

TL was driving to LA airport that weekend. Rather than charging CM delivery fees, TL offerred to drive the items to CM's office in LA. CM said there was no need for it and he can just ship them as he always does.

May 14 order. Lidocaine cream 4%.

June 1. TL had another talk about energy formulations. CM requested TL send some samples so that he can try them. TL shipped these items with June 10 order.

June 10. 25 vials 30ml Lidocaine . 40 vials of 100ml Propofol . 50 vials of 20ml Propofol. Hydroquinone 60 gr 20 tubes. Benoquin 60 gr 20 tubes.

June 15. CM said he was happy with the energy formulation. 10 vials 10ml Lorazepam , 20 vials 2 ml Midazolam . Saline IV 1000ml 12 bags.
CM never told him tha he was the doctor for MJ. CM never mentioned any name of his patients.

June 23 -24. TL talked with CM on the phone. There was a lot of background noise and he couldn't understand what CM said. TL said he would call him back. TL didn't call CM. On June 25 he learned that MJ died.

Brazil asks total number of Propofol bottles. 255 bottles of Propofol. 20 vials of Lorazepam. 60 vials of Midazolam.

Gourjian cross

TL put in the DEA number in their system. There was no red flags. CM was authorized to make these orders.

Benoquin is not controlled substance. Propofol is not controlled substance.

Gourjian asks if there's a regulation that says he could only ship to clinics and/or hospitals. TL says he doesn't know any regulations.

Gourjian tries to ask what TL's delivery person said about CM (all positive and nice things). It's is sustained as it's hearsay.

Gourjian asks if the medicines are for an office use, they won't disclose the patient names when ordering. TL says yes as they wouldn't know who the patient will be. Gourjian asks if this will also apply to high profile patients.

Brazil redirect

Talks about confidentiality. Asks if a physican tells the patient's identity if TL would keep it private. TL says yes.

Court ends early due to some scheduling issues

 

[ivy]

Re: Murray Trial _ All daily trial Summaries - No discussion October 4th / Day 6 Full Testimony

Murray Trial Day 7 October 5, 2011

Sally Hirschberg (SH) Testimony

Prosecutor Walgren Direct

SH states that she is employed with SeaCoast Medical, a medical and pharmaceutical distributor and they sell medical supplies. SH states she is an account rep and she has been employed there for 10 years. SH states that they have an account record of medical order records held by Conrad Murray.

SH states that she holds records for a Conrad Murray on Flamingo Road in Las Vegas. SH states that records reflect a Consuelo Ng, was the account rep that SH worked with who represented Murray. SH states that Murray's account was created in December 2006, and that the address was always the address in Las Vegas. SH states that an order was placed 12/16/08, and then there is a lull in activity until 4/14/09. SH states that prior to 4/09, even though there was no activity, there were phone conversations between she and Connie Ng, with Murray requesting an infusion IV set. SH states that 3/25/09, Murray via Ng requested a case of Safe Site infusion IV sets. SH states that on 3/26/09, the account had a credit card declined, so the infusion set was not shipped. SH states that on 3/31/09, nothing yet had been resolved as far as payment. SH states that with regard to the infusion sets, 24 come in a case.

SH states that on 4/13/09, she spoke to Ng, Ng asked her to send the infusion sets to a residential address in CA, but SH did not agree, it brought up a red flag in her opinion. SH states that on 4/14/09, the invoice shows that the products ordered were a case of sodium chloride solution, a blood pressure cuff, some parts for the blood pressure cuff, components for infusion sets, a tubing device, 20 gauge 1 inch 3 cc syringe needles, IV catheters 25 gauge (50 in a box), transparent dressing a type of bandage, set of syringes 30 cc (40 in pkg), IV catheters, ultrasound equipment, electrode gauze (would attach to EKG machine), alcohol prep pads, gauze sponge, drape sheet (fabric cover that would drape over patient), saline bags (48), sodium chloride bags, and that the order was processed to a credit card belonging to Conrad Murray. SH states that latex gloves, IV components for infusion sets, XL administration sets, exam paper for the bed, exam gloves were also ordered.

SH states that on 4/16/09, lidocaine 1% 25 of them were shipped. SH states that on 4/21/09, blood pressure cuff and components, medex injection adapters, IV catheters were ordered and shipped on 4/24/09 as well the pump IV set. SH states that on 5/12/09, her records reflect that 25 1% 30 lidocaine, more medex T connectors, a child's blood pressure cuff, tape, tourniquets, more medex catheters, blood pressure cuff for adult, shipped on 5/12/09. SH states that the blood pressure cuff is packaged inside a plastic bag and then in a white box, manufactured by Starline. SH states that alcohol pads, 10 cc syringes (100 in a box), saline bags, 10 cc syringes 22 gauge (100 in a box), hypodermic needles (50 in a box) were ordered.

SH states that on 5/19/09, Murray's order is more infusion connectors, blood pressure device for a child, IV catheters (50 in a box), urine pads, external catheter medium for urine collection, urine collection bags were ordered.

SH states that on June 1, 2009, an ambu-bag, and an airway kit was ordered. SH states that this is the first time an ambu-bag was ever ordered, and that the airway kit price is $2.02 per kit. When asked SH states that the airway kit has six in a package.

SH states that on 6/15/09, she talked to Ng about urine bags, that Ng wanted a small urine bag, and SH told her she was not aware that small urine bags were made. SH states that she later talked to Ng, who had contacted the manufacturer directly, and that small urine collection bags were not made. SH states that on 6/22/09, Murray's invoice order includes catheters external wide band (small) was backordered and not shipped, urine bags, which were shipped, leg bags for catheters (medium) were ordered but not shipped. SH states that she told Ng that there would be increased cost, as Ng requested the order was shipped overnight.

SH states that she spoke to Ng on 6/26/09 at 9:26 am PST, and that SH cancelled the order per Ng's request.

Chernoff Cross

SH states that Murray's company, Global CardioVascular has been doing business with SeaCoast since 2006.

SH states that it is not unusual for Murray's practice to order lidocaine or infusion pump sets, but not often. SH states that her records go back to July, 2007. SH states that 7/20/07, a horizon pump set was ordered, and it was the same set that was ordered in April 24, 2009. SH states that on October 5, 2007 a horizon pump set, the same set that was ordered on 6/24/08. SH states that just by looking at certain items, she is able to identify them, others she cannot.

SH reaffirms that on April 25, and May 12 a set of IV administrations were ordered, and that there are 50 per case.

Stephen Marx Testimony

Prosecutor Walgren Direct

SM states that he was employed in the computer forensics lab for the DEA in June, 2009. SM states he had at that time, he had worked there for 5 and a half years. SM states that he is familiar with the iPhone, and that it is basically a mobile computer. SM states that he analyzed Conrad Murray's iPhone.

SM states that he did a forensic analysis on the iPhone on 7/28/09. SM states that he found screenshots on the phone dated 6/25/09, the first screenshot shows that at 7:03 am the phone was viewed for data. SM states that at 9:45 am, the screenshot indicates that the phone was viewed for data. SM states that the screenshot shows that Connie Ng was sending emails to Murray's phone on 6/25/09. SM states he was able to determine the contents of the emails.

SM states that there was an email sent from Connie Ng to Conrad Murray, indicated by a screenshot on CM's iPhone on 6/24/09 at 5:33 pm, and the subject was Omar Arnold - Progress Notes. SM states that the body of the email states "here are his progress notes, please let me know if you can't open it" with attachments. SM states that the attachment is written notes reflecting various dates, 11/19/08, insomnia, anxiety, 12/08, 3/07, with notes attached. SM states that there is a medical record reflected for Omar Arnold, and various handwritten notes, including primary MD Conrad Murray, indicating c/o meaning complained of. SM states that other handwritten medical notes and dates are reflected, including 1/1/07, and the last reflecting handwritten notes but no date mentioned.

SM states the next email from Connie Ng to Conrad Murray was sent on 6/24/09 at 5:34 pm - Omar Arnold - 2D - Echo. SM states the report date states 1/17/07, another stating 3/26/07 entitled Echocardiograph dated 1/17/07. SM states that the next email is headed MRI Paul Forance, stating that Ng has Forance's MRI results. SM states the next email is regarding another MRI, dated 11/13/07 SM states that the next email is from Connie Ng to Murray, header states Omar Arnold Medication Log, on 6/24/09 at 5:38 pm.

SM states the Murray's iPhone received an email on 6/25/09 at 5:54 am. SM states that the email that the email had been read. SM states that the email was from Bob Taylor, begins with Hi Conrad, and that the email has a London phone number and a London street address on it.

SM states that the body of the email is about issues of well being, press reports of the Artist, and issues of full disclosure of an insurance policy for Michael Jackson.

SM states that the iPhone reflects that Murray responded to Bob Taylor in the UK on 6/25/09 at 11:17 am, and the body states "Dear Bob, I am in receipt of your email. I spoke with Mr. Jackson and requested release of his medical records in order for you to procure a cancellation policy for his show, however the request was denied. I therefore request that AEG consult with kindly with Mr. Jackson for its relevance because he is under the impression that he is already secured in the US. As far as the statements published by the press, let me say they're all fallacious to the best of my knowledge. Sincerely, Conrad Murray"

SM states that there was a voicemail on the iPhone on 6/20/09 from Frank Dileo. Dileo voicemail is played, and states, "Dr. Murray this is Frank Dileo, Michael's manager, I'm the short guy with no hair. I'm sure you know Michael had an episode last night, he's sick. ...I think you need to get a blood test on him, we gotta see what he's doing."

SM states that there is an app on the iPhone called iTalk, and a recorded at 9:05 am on 5/10/09. Prosecutor Walgren then plays Michael Jackson with extremely slurred speech, for a little over 4 minutes.

Transcript and Audio of the recording

[/B]MJ: Elvis didn't do it. Beatles didn't do it. We have to be phenomenal. When people leave this show, when people leave my show, I want them to say, "I've never seen nothing like this in my life. Go. Go. I've never seen nothing like this. Go. It's amazing. He's the greatest entertainer in the world" I'm taking that money, a million children, children's hospital, the biggest in the world, Michel Jackson's Children's Hospital. Gonna have a movie theatre, game room. Children are depressed. The -- in the hospitals, no game room, no movie theatre. They're sick because they're depressed. Their mind is depressing them. I want to give them that. I care about them, them angels. God wants me to do it. God want me to do it. I'm gonna do it , Conrad.
CM: I know you would
MJ: Don't have enough hope, no more hope. That's the next generation that's gonna save our planet, starting with -- we'll talk about it. United States, Europe. Prague, my babies. They walk around with no mother. They drop them off, they leave -- a psychological degradation of that . They reach out to me -- please take me with you.
CM: Mmnh.mmmnh
MJ : I want to do that for them.
CM: Mmnh mmmnh
MJ: I'm gonna do that for them. That will be remembered more than my performances. My performances will be up there helping my children and always be my dream. I love them. I love them because I didn't have a childhood. I had no childhood. I feel their pain. I feel their hurt. I can deal with it. Heal The World, We Are The World, Will You Be There, The Lost Children. These are the songs I've written because I hurt. You know I hurt.
Silence
CM are you okay
Silence
MJ I'm asleep

Gourjian Cross

SM states that the recording of Michael Jackson was on May 10, 2009 which is a Sunday. SM states that the email regarding the insurance email was CC'd to several other people, including a John, Paul and a Tim. SM states that a thread of emails, a series of linked communications appeared on Murray's iPhone. SM states that he recognizes Email from Justin Burns to Ian France on 6/22/09, discussing Michael's physical well being, as well as a return email on 6/24/09 discussing insurance health requirements. SM states that there is an email from Paul Gongaware on 6/24/09, it was also sent to Murray, Randy Phillips, etc. discussing a meeting at MJ's house. SM states that an email sent from Bob Taylor to Paul Gongaware, stating that there are concerns with the Artist's (MJ's) insurance. SM states that there is an email from Bob Taylor on 6/25 on 1:54 pm.

Walgren Redirect

SM states that in order to use iTalk, you need to open it manually. SM states that regarding that within the multiple emails, there is concern about obtaining a five year medical history.

 

[ivy]

Re: Murray Trial _ All daily trial Summaries - No discussion October 4th / Day 6 Morning Testimony

Murray Trial Day 7 October 5 2011

Elissa Fleak Testimony

Walgren Direct

Fleak states she has worked for the LA County Coroner for 8 years. Fleak states she went to UCLA to examine MJ and the circumstances of his death at 5:20 pm on June 25, 2009. Fleak states she examined MJ and documented his physical condition in a private room at UCLA.

Fleak states that she took the picture of MJ on the gurney, deceased. Fleak states that there were other pictures taken of MJ, but this was the first picture she took (the one that was shown on the first day of testimony). Fleak states that initially there were no obvious causes of death.

Fleak states she took four bottles of blood from MJ and turned them into the coroner's lab for further toxicology testing. Fleak states that at 7:10 pm on 6/25, she went to MJ's Carolwood home. Fleak states that in the bedroom where MJ died, she located a 20 ml bottle of propofol on the floor next to the left side of the bed. Fleak states that she found the propofol bottles under a glass/metal table to the left of the nightstand, which is directly left of the bed.

Fleak is asked to identify items she found in the bedroom:
- A propofol bottle with few drops of fluid, Fleaks affirms it is the same bottle.
- An empty bottle of flumanezil nearly emptyfound near propofol bottle, Fleak affirms
- Prescription bottles: Diazepam, Lorazepam and Flomax, Fleak affirms
-Diazepam- prescribed to MJ, Murray prescribed to MJ on 6/20, 10 mg tablet
-Flomax - prescribed to MJ, Murray prescribed to MJ on 6/23
-Lorazepam - Murray prescribed on 4/28/09, 2 mg Fleak affirms all prescriptions

Fleak states additional prescriptions were found on the lower shelf of the table. Fleak states she found Trazadone, Flomazepam, and another drug.
Tizanadine - to Omar Arnold by Arnold Klein, 6/7/09
Flomazepam -to Mick Jackson, 1 mg tablet, Dr. Alan Metzger, 4/18/09
Trazadone -to Mick Jackson, 50 mg tablet, Dr. Alan Metzger 4/18/09
Temazapam -to MJ by Murray, filled 12/22/08
Hydroquinone - Applied Pharmacy name on it
Benoquin - Applied Pharmacy name on it
Lidocaine 4% - Applied Pharmacy, Conrad Murray's name on it

Fleak affirms that all of the above medications were found on the nightstand in the bedroom where MJ died. Fleak states that an ambu bag was found on the floor and an oxygen tanks, one on a rolling dolly, were all found in the room. Fleak states that alcohol prep pads, IV catheters, latex gloves, a 10 cc syringe with no needle attached to it, were also found on a nightstand in the room.

Fleak states that there was an IV catheter underneath the ambu-bag, to the left. Fleak states that she recovered a bottle of Bayer aspirin and other medical items, such as needles and supplies. Fleak states that there was a wooden chair with a jug of urine sitting on it with medical pads sitting next to it. Fleak states that all of the items were recovered on 6/25, except for the IV tubing and bag. Fleak states that she left Carolwood at 8:20 pm on 6/25, and returned on 6/29/09, to search for further medical evidence.

Fleak identifies that there is a large closet which adjoins the bedroom that MJ died in. Fleak states that she recovered items from the top of the closet area, including various bags, gloves and items. Fleak states a small black bag, a blue Costco bag, light/blue bag, a box of gloves and tubes of various lotion were recovered. Fleak states that the black bag had contents of a blood pressure cuff inside of a manufacturer Starline box. Fleak states that 3 bottles of lidocaine were found, 2 were essentially empty, 1 was half full and found inside the same black bag as the pressure cuff. Fleak states that the Costco bag contained a plastic grocery bag, a pulse oximeter, various items and a cut open saline bag with a 100 ml propofol inside the saline bag, Fleak states that she removed the propofol bottle from the saline bag to photograph them. Fleak states that the empty propofol bottle found within the saline bag was a 20 ml bottle.

Fleak states a 10 vial of bottle of Lorazepam was found inside the Costco bag. Fleak states that 2 individual bottles, each 10 ml in size, of Midazolam were found inside the Costco bag. Fleak states that a small bloody cotton gauze pad was in the Costco bag. Fleak states that a pulse oximeter was inside the Costco bag as well as a plastic bag with various medical items in it. Fleak states that inside the plastic bag, an IV administration was found, a urinary bag was found, a wide band bag was found, Tegaderm transparent dressing was found, IV catheter empty packaging was found, various alcohol prep pads were found, Tegaderm dressing backings were found, 10 ml disposable syringe with needle packaging was found, 2 individual straps were found, a dark blue and light blue vinyl top were found, a needle or IV catheter top were found, as well as miscellaneous plastic debris were found inside the Costco bag.

Fleak states that the light blue baby essentials bag contained 2 100 ml propofol bottles which were full, 7 20 ml propofol bottles, 3 were opened with various levels of liquid in them, 3 lidocaine bottle unopened, 2 unopened, 3 10 ml vials Midazolam, 2 unopened, 4 bottles of Flumanezil 5 ml in size, 2 bottles of Lorazepam, 1 unopened, 1 half full, 1 bottle from Applied Pharmacy combination of ephedrine, aspirin and caffeine, Bausch and Lomb eye drops, Medex bag containing IV tubing and syringes, a blue tourniquet, Murray's business cards were all found inside the Costco bag.

Fleak states that on 6/29 she recovered the IV bag and tubing from the Carolwood home. Fleak states that 18 tubes of Benoquin cream were recovered from the cabinet next to the bags already mentioned. Fleak states that she recovered a saline bag on 6/29 that she had observed on 6/25. Fleak states that she recovered IV tubing with a spike at one end, with a roller clamp on 6/29, as well as a Y connector with attached tubing, s capped syringe inside a sharpie container.

(during this time Walgren places all the items on the table for the jury to see)

Fleak states that on July 1, 2009, she sent a subpoena seeking all relevant medical records of MJ to Ed Chernoff, Murray's attorney. Walgren wants to ask questions about the records Fleak received from Murray via Chernoff. Objection. Sidebar.

Court is adjourned for the day

 

[ivy]

Re: Murray Trial _ All daily trial Summaries - No discussion October 5th / Day 7 Full Testimony

Murray Trial Day 8 October 6 ,2011

Elissa Fleak Testimony continued

Walgren direct continued..

Walgren enters more photographs into evidence.

Walgren talks about "broken syringe". EF says she shouldn't have described it at broken syringe. She says she misdescribed the item, she should have written them seperately. She made an assumption that it was the pieces of the same syringe but she was wrong. EF says that she later realized that they have different tips (one square, one circle) and they don't fit together.

Fleak's thumb print was found on the syringe. She doesn't know when that happened. EF says it might have happenned when she was moving the tables to take photos or repackaging the items.

EF subpeonad CM through his counsel Chernoff. EF wanted any and all medical records of MJ on July 1. Chernoff provided records to her. Walgren asks if the records covered April, May, June 2009. EF says they were all dated before that date.

Walgren goes over the medical records they are from 2006 , 2007, 2008 and use the names of Michael Jackson, Omar Arnold and Paul Farance (also Mike Smythe but letter crossed out).

Chernoff Cross

Chernoff asks if EF took more photos then it was shown to the jury. EF says yes.

Chernoff talks about EF's role in this case. Chernoff talks about being a coroner investigator and the importance of her job. EF's job is to collect as much as information about the cause of the death and the motive for death. Chernoff mentions the importance of being accurate and being through with the investigation.

Chernoff is asking who was there on June 25th. Detective Scott Smith from LAPD, her supervisor coroner Ed Winters and LAPD Crime Scene photographer. EF took notes, took photos and collected evidence.

June 29. She went to the residence based on the information she got from Detective Smith. Smith told her that there would be additional medical evidence to be collected from the room next to the bedroom. EF didn't ask any more questions and she said that she would meet him at Carolwood. In Carolwood Smith told her where the bags he was told to would be. EF , Smith , another detective (possibly Myers) and LAPD crime scene photographer was at the house collecting evidence.

They got the items out of the closet and placed it on a table. They took pictures. EF doesn't remember if she or LAPD took the pictures. She laid items out on the table. Defense shows a picture of items on the table. She and Smith was taking notes and observing.

IV bag with slit and Propofol bottle. Chernoff asks if there were more photos taken of it. EF doesn't remember.

3A form- evidence log form to record medical evidence in coroner's office. She did 3 3A forms on June 25, June 29 and July 8th.

EF goes over her June 29 record. In her handwritten notes she list the cut IV bag and the propofol bottle. Chernoff asks if any of her reports that she mentioned the propofol bottle was in the IV bag. She says no. Chernoff says that "propofol in IV bag" was added to her notes in March 2011. Chernoff tries to ask question about her revised notes. A lot of objection and sustained.

A week before she revised her notes , EF met with Chernoff at Coroner's office with other coroners and lawyers. Chernoff says he asked her about the IV bag and what was in it. EF says she doesn't remember. Chernoff asks when was the first time she told prosecution about the propofol bottle in the IV bag. Chernoff asks if she heard about Alberto Alvarez and his testimony. EF says that he didn't know him or didn't hear about his testimony saying that he saw a bottle in an IV bag.

Chernoff asks about her handwritten notes from June 25th. She says after she copies her notes to her reports, she destroys her handwritten notes intentionally in all her cases.

Chernoff asks if she would agree that she made substantial mistakes. She doesn't agree. Chernoff asks if not keeping her notes was a mistake, she says no. EF says she has her report and put everything from her notes to the written report.

Flumanezil bottle found on the floor but she moved to the table. Syringe Chernoff asks if she moved the syringe from the floor to the table. EF says no, she found it on the table.

Chernoff again mentions the "Broken syringe" - EF says she should have described it as two pieces and not broken. Chernoff asks about her scene report and how she wrote there was gloves on the floor and asks her to show it in the picture. She says it was closer to the urine bottle chair and cannot be seen in the current picture. Chernoff shows a picture of gloves on a chair and asks if she wrote about them in her notes. She says no. Chernoff asks if that's a mistake, EF says no.

Chernoff asks about the droplets in the IV bag and argues that they are clear and it's not a milky liquid. Chernoff asks if the IV bag was tested. Yes it was.

June 25 . She was primarily working on the bedroom. Chernoff asks if she went into other rooms. Chernoff asks if she went into the far left bedroom or not. EF says she did not go to that bedroom. That bedroom also has a bathroom attached to that bedroom. Coroner collected some items from that bathroom on June 26.

mid morning break

Several photos of urine on the chair from different angles marked by the defense. Pictures of EF shown. Chernoff asks when those pictures was taken. EF doesn't know the exact dates whether it was June 25th or 29th.

Chernoff asks how far was the table from the bed. EF says a couple feet.

Syringe on IV. Chernoff asks when that picture was taken. Chenoff shows 2 different pictures one taken on June 25th and another taken on June 29. One of the pictures showing the tubing around the IV pole and one does not. Chernoff says that someone was moving evidence.

Chernoff asks who's decision was to not the secure the house. EF says such decisions are up to LAPD. EF also doesn't know if the house was open for access of not.

Detective Smith informed her about the additional medical items CM mentioned there. EF went to the house on 29th. EF says she doesn't know if LAPD went to the house between June 27 and June29.

Chernoff mentioning some items such as the IV stand and IV bag being collected on June 29. EF also did not mention the IV stand, saline bag or the syringe in her June 25 record. EF mentioned those in the case notes in June 27 case notes. She wrote she had additional items to write that she did not mention in the first narrative.

After June 29, EF did not go to Carolwood. EF collected medical records from other doctors as well. EF collect those to get a better understanding of MJ's medical history. She requested medical notes from Murray, Klein, Metzger, Adams, Tadrissi, Slavit, Rosen, Lee, UCLA medical center, Kopplen, Hoefflin. Objection. Sidebar. She collected extensive records. There were other doctors that said there wasn't any records or did not treat MJ.

Chernoff asks about the juice bottle on the stand. EF says that she did not collect the juice bottle.

Walgren redirect

Walgren goes over the documents EF prepared. Investigator's narrative : Overall description of the scene. Evidence log : things are itemized and logged into evidence. Case notes : additional information for a case is listed here. 3A form medical evidence form that will detail the medical evidence versus the physical evidence or trace evidence.

Handwritten notes from June 25 was put into these documents.

Walgren asks she observed the IV stand on June 25 and have it photographed. Yes she did. On June 27 she mentioned IV stand in her notes. June 29 she picked up the IV stand and the bags from residence as evidence.

Walgren mentions her preliminary hearing testimony and how she mentioned Propofol bottle inside IV bag in January 2011. EF removed the propofol bottle from the IV bag to see what it was. She put propofol bottle on the IV bag to photograph it. Walgren asks if there was a reason if she photographed them together. She says she intentionally photographed them together because they were found together inside one another.

March 2011. Walgren, EF, Dr. Rogers examined some evidence. At that time Dr. Rogers mentioned that it was an IV catheter and EF found out that they don't go together.

Walgren asks if this was a perfect investigation, she says no. Walgren asks if she ever conducted a perfect investigation , EF says no. Walgren asks if she in other investigations she thought she could do a better job. EF says yes and she did her best.

Chernoff cross

Chernoff again goes over to say EF didn't take the picture of the Propofol bottle in the IV bag.

Chernoff shows a bunch of photos asking if EF took them.

Fingerprints information is stipulated

Murray's fingerprint was found on 100ml Propofol bottle found inside the IV bag.
Fleak's fingerprint was found on the syringe on the table.
IV bag with the slit had 4 fingerprints on it. 2 fingerprints was found on saline bag and 20ml Propofol . 1 fingerprint was found on 20 ml propofol bottle. but no identification was made about these fingerprints. The following people were eliminated by manual comparison: Michael Jackson, Conrad Murray, Alberto Alvarez, Michael Amir Williams, Faheem Muhammed, Scott Smith, Mark Goodwin, Martin Blount, Jimmy Nicholas, Blanca Nicholas, Elissa Fleak, Kai Chase.
No useable fingerprints on : 2 midozolam vials, 1 lorazepam vial, 2 lidocaine vials, 1 lidacaine vial, eyedrops, tube marked bq, a bottle labelled ephedrine/caffeine/asprine , 2 100ml propofol vials, 7 20 ml propofol vials, 2 lidocaine vials, 1 lidocaine vial, 2 lorazepam vials, 4 flumanezil vials, 3 midazolam vials, IV tubing, IV y connector tubing, syringe with needle.

In short MJ's fingerprints was not on any of the items. Murray's fingerprints was only found on a 100ml Propofol bottle.

Dan Anderson Testimony

Walgren direct
Anderson is employed by LA Coroner as a toxiologists for 21 years. His current position is the supervisor. He's responsible for the people and the results. Anderson mentions his education, work history and certifications.

Anderson talks in detail about toxicology, the type of tests they do ,the terms used and how they do the tests and the equipment they use.

Walgren starts talking about this case. Anderson received 4 samples of blood taken at the hospital and hand delivered to him by Fleak.
June 26. Anderson attended to the beginning of autopsy to tell what he wanted as samples. June 26 afternoon they started testing. Tests take several hour and days. They started evaluating them by Monday. They generated a 8 page report about all the samples tested.

ng/ml - nanogram ug/ml - micrograms. micrograms are 1000 times bigger than nanograms.

lunch break

 

[ivy]

Re: Murray Trial _ All daily trial Summaries - No discussion October 5th / Day 7 Full Testimony

Murray Trial Day 8 October 6, 2011

Afternoon session

Dan Anderson testimony continued

Walgren direct continued

Anderson goes over each of the findings in the report. Most majority of the test is done is using heart blood. It's the starting point.
-Femoral blood is taken from leg.
-Heart blood is taken from heart.
- Hospital blood is taken at hospital.
- Vitreous fluid is taken from behind the eyeballs.
- Liver they took a portion.
- Gastric contents are stomach contents.
- Urine samples : Urine from scene brought in a plastic urine bottle also they collected urine from the bladder during autopsy

Anderson lists all the findings. You can see some of them in the following pictures. For full details check the the autopsy report.

Important findings: MJ had no alcohol, no Demerol (Meperadine) , no metabolized Demerol (normeperidine) and no Cocaine, Marijuana and such. MJ had Valium, Lorezepam and Midazolam, Propofol in his system. They tested femerol blood, heart blood and hospital blood. They did 2 tests on liver for lidocaine and propofol - both was detected in liver. Stomach contents showed Lidocaine and Propofol. Urine from autopsy shows lidocaine, Midazolam, Ephedrine and Propofol. Jug of urine was tested and it showed Lidocaine, Midazolam, Ephedrine and Propofol. Vitreous (clear fluid behind the eye) showed Propofol.

Anderson made a summary about positive toxicology findings.

Walgren again clearly states that there was no Demerol in MJ's system. Anderson says correct.

Walgren mentions Propofol in MJ's stomach. Anderson compares amount of propofol in MJ's stomach is equivalent to 'specks of sugar granules'. So they are basically saying that it's too small.

Syringe on the nightstand was tested. They found 4 drops of liquid in it. They detected propofol and lidocaine in it.

Saline bag, tubing, Y connector and syringe on the IV was tested. They draw a diagram and determined how to test it. Walgren identifies each of the items.

Propofol, lidocaine and flumazenil was found on the IV on the syringe and the short side of the tubing. Saline bag and long section of IV tubing had no drugs detected.

mid afternoon break.

Flanagan Cross

Flanagan is going over the summary report about positive toxicology findings.

Flanagan asks why Propofol was tested on 3 different blood samples. Anderson says they generally make tests on 2 samples : general blood and peripheral blood (such as from the leg femoral blood) due to postportem distribution. Anderson explains that the body tissue releases the drugs back into the circulation after death and moving the body will also distribute the drugs. On this instance they also got hospital admittance blood.

Flanagan asks if the reason for hospital blood result be higher is due to the drugs not having chance to be redistributed. Objection. Judge finds the question vague. Flanagan " Do you know why the hospital blood results are higher?" Answer : No. Flanagan "why is the femoral blood results are the lowest?" Answer : Postportem distribution. Flanagan confuses the witness to the point that he can't understand what is being asked. Flanagan "Why is femoral blood has the lowest results?" Answer : That's typical because tissues release drugs to the central cavity artifically raising the heart blood.

Lidocaine higher in femoral blood then the heart blood. Anderson says it's drug dependent. Some drugs might have different distribution pattern.

Flanagan asks why the eye fluid was analyzed. They analyzed it for Propofol because Propofol was the real issue. Anderson says that they didn't have enough fluid to make a full analysis. It tells him that Propofol doesn't distrubute very well to the eyeball fluid. They didn't give an exact number amount for Propofol in the eye fluid because they didn't have enough sample. Protocol tells that they can't give exact numbers in such instances as they can't gurantee the accuracy.

Urine from the scene. Flanagan asks why they couldn't get the exact number amount for Propofol amount. Again It was below their lowest caliber. It was almost negligible.

Ephedrine was present in the urine but wasn't in blood. It's because bladder can store things for a long time. Flanaggan asks how long ago it was used. Anderson says it can't be recent as it's not in the blood and it could be used anywhere between 24 to 72 hours ago.

Propofol was found in the urine from the scene. Flanagan asks if it could be from a few days ago as well. Anderson agrees and says that it could also be recent. Flanagan asks if the urine from the scene was accumulated before urine from autopsy. Anderson says he has no idea when it was collected or even it's from MJ.

Flanagan gives a scenario that the urine from the scene was in 7 AM and the time of death being around 12:00 and 2:26 and says that not much urine is collected after death. Anderson corrects him that they actually had over 500 ml of autopsy urine which he says to be alot.
Flanagan is trying to say that MJ got/given propofol after the urine in the scene was deposited in the plastic bottle because the propofol level was higher in the autopsy urine. Flanagan again confuses the witness and no one can understand what he's asking.

Lorazepam. Flanagan asks if it's high. Anderson says it's normal high therapeutic range. Flanagan asks how much lorazepam MJ was given in mg. Anderson says that calculation could be done but it would not be a perfect calculation as there has to be several assumptions made. Anderson says it shouldn't be done.

Anderson mentions assumptions that needed for such calculation :drug fully distributed, redistrubution didn't happen after death and the heart blood level is not falsely elevated.

Flanagan shows a book saying that Lorazepam is not subject to redistribution after death. Anderson doesn't agree with it and says there have been only 2 cases stating that but he wouldn't be comfortable with generalizating it to the whole population.

Flanagan still asks Anderson to give a mg number. Anderson goes over his records saying that based on several assumptions, it's approximately 11 mg. Anderson says that they can't determine how Lorazepam was given (orally or IV) from a blood level and he doesn't know when it was given.

Flanagan asks if the results indicate that lorazepam has been in the system for a while. Anderson says yes. Propofol levels was not equilibrium. Flanagan asks if a person was on a drip , would he expect the propofol levels to be in equilibrium. Anderson says he doesn't know how Propofol metabolizes.

Flanagan mentions that the summary Anderson did has no information about Lorazepam in the stomach contents. Anderson says that they only analyze stomach contents for overdose cases. Their blood test results showed Lorazepam to be in the acceptable range so they didn't test it in the stomach.

Defense has tested the stomach for Lorazepam , it was .634 micrograms/ml.

Flanagan says Lorazepam is 4 times concentrated in the stomach then the blood. Anderson disagrees saying that it's not significant in it's opinion. Flanagan asks if it's consistent with oral digestion. Anderson says no and explains that drugs will be in stomach in small levels due to "ion trapping" and doesn't necessarily mean that it's taken orally. Anderson converts it to mg : 0.046 mg , that means 1/40th of a normal 2 mg pill. Anderson says that it could come from the blood.

Flanagan asks questions about Midazolam. Anderson has not made calculations about it because the amounts are really small.

Flanagan by looking to urine level of Midazolam trying to establish blood levels for it. Anderson says it's not a comparison that could be done.

Flanagan talks about urine and whether it would be representative of the metabolization of the drugs such as if a person urinated at 1 AM and then at 7 AM , Flanagan asks if the 7 AM urine would be representative of the 1 AM - 7AM period. Anderson says there will be some contamination. Flanagan asks if the autopsy urine would be an average level of 12:30 - 7:30 AM time period. Anderson is having trouble with understanding the question. Judge and Walgren also doesn't understand the questions. Flanagan asks if urine would be in equilibrium with the blood, it's beyond Anderson's level of expertise. Anderson says just from the urine results he cannot tell when the person would have higher levels of Midazolam in his system. Anderson says he can't do it for Propofol as well.

Back to stomach contents and not analyzing it for Midazolam and Lorazepam. Switching to IV set testing. Saline bag and the tubing that goes down to the y port had no propofol or lidocaine. Propofol, lidocaine and flumazenil was found in the syringe and short tubing. Flanagan asks about the amounts of those drugs. Anderson says that they didn't quantify them because they didn't think it was relevant and they didn't have a standard procedure to quantify fluids from medical evidence. Flanagan asks if they can tell the proportions of lidocaine and propofol and flumazenil. Anderson says they can't. Anderson says they also had a very small amounts of liquids that complicated the testing as well.

end of day 8

 

[ivy]

Murray Trial Day 9, October 7, 2011

Morning Session

Dan Anderson Testimony continued

Flanagan Cross continued

Flanagan starts off by asking about the IV bag on the stand in MJ's room where he died. Flanagan asks if the bag was analyzed for all chemicals and the only thing was saline solution, Anderson states they do not analyze for solution, but there were no drugs found in it. Flanagan asks about the tubing (hanging from the IV stand), and Anderson states that it was not found to have any drugs in it.

Flanagan asks repeatedly whether the tubing and the IV bag were attached, Anderson repeatedly states that they were not attached when received into medical evidence, according to notes. Flanagan asks if Anderson tested two syringe barrels, Anderson states yes and when asked, states that both barrels tested positive for propofol and lidocaine. Flanagan asks if Anderson tested any apparatus that had only propofol in it, Anderson states no. Anderson states that the only medical equipment that had propofol and lidocaine in them were the Y tubing (connector) and the syringe barrels. Anderson states that each of the syringes and the Y tubing each had Flumanezil. Flanagan asks if the proportion of propofol and lidocaine were the same in both the Y tubing and the 2 syringe barrels, Anderson states that proportionality testing was not performed.

Flanagan asks for Anderson to define equilibrium as it relates to bodily fluids, Anderson states he believes it is when the samples of the drug or their concentrations are equal. Flanagan asks how long it takes for the blood system to come to an equilibrium, Anderson states its beyond his scope of expertise. Flanagan asks Anderson to define therapeutic range (of a drug), Anderson states that a concentration of the drug that achieves the desired effect, generally it is a safety concern because they are not safe at all concentrations. Flanagan asks what determines therapeutic range, Anderson states clinical trials from the FDA, as well as the literature provided with each drug. Flanagan asks if there is a therapeutic range for propofol, Anderson states no. Flanagan asks about therapeutic range for Lorazepam, Anderson states that it averages 100-200 micrograms per mililiter. Anderson clarifies that the average can be 180, but that everybody tolerates medications differently, and he cannot give specific ranges.

Flanagan shows a Lorazepam bottle, prescription for MJ, asks Anderson to read the bottle, Anderson reads Lorazepam 2 mgs, 1 tablet by mouth. Flanagan asks about MJ's blood concentration of .16% and asks if that would equal about five Lorazepam tablets, Anderson states yes, regardless of the route, whether it was in tablet or IV form. Flanagan asks if MJ had the equivalent of 11 mg of Lorazepam, Anderson states yes, approximately. Flanagan asks how many pills would MJ have to take to get to that level (11 mg), Anderson states that it could be an accumulation over several days, and that he does not feel comfortable with assumptions of routing of medications or form of medications.

Flanagan asks about ion trapping with respect Lorazepam, Anderson states that he knows little about Lorazepam and postmortem redistribution. Anderson states that the only way to get propofol in the stomach is through oral ingestion or ion trapping, it's not postmortem redistribution.

Flanagan asks Anderson to define the term ion trapping. Anderson states that an acidic environment traps the ions of the drug in that environment, beyond that, is beyond his area of expertise. Anderson states that other than ingestion, the only way propofol can get into the stomach by diffusion of the surrounding specimens. When Flanagan asks about the surrounding specimens, Anderson answers that the liver is close, blood samples and blood itself are close to the stomach.

Flanagan states that Anderson is saying that Lorazepam can get into the stomach through redistribution, Anderson states that it can get into the stomach by ion trapping. Anderson states time and time again that this information is beyond the scope of his expertise. Anderson states that he has seen many different decendents who had stomach contents with drugs in them, and that the drugs were not given orally.
Anderson states he does not have personal experience with a decendent that had Lorazepam in their stomach.

Flanagan asks Anderson about ephedrine. Flanagan asks if Anderson came to understand that propofol was the most important drug in the case, Anderson states yes he did. Flanagan asks if Lorazepam was important, Anderson he thinks it has its importance, but that it does notraise a flag. Anderson states that propofol in any case is important, Lorazepam was in therapeutic range, and that he previously testified that propofol was within range only a proper setting. When Flanagan asks what does a setting have to do with therapeutic range, Anderson states that it's very important. Flanagan states that therapeutic range is desired effect, Anderson states yes. Flanagan states that the literature does not take into consideration the setting, Anderson states that every drug literature takes setting into consideration.

Flanagan asks if Anderson did the calculations with regard to Lorazepam last weekend, Anderson states it was two weekends ago, Anderson states that he did them because of the Lorazepam in the gastric sample, and the two urine samples done by the defense. Anderson states that the urine is a historical perspective, and could be an accumulation from several days. Anderson states that the Midazolam testing was done in the urine because the concentration is much higher, which helps to confirm the blood level of Midazolam. Anderson states that Lorazepam levels were much more elevated in the urine than the Midazolam. Anderson states Lorazepam 12,974 nanograms/ml (13 micrograms/ml) Midazolam 0.025 nanograms/ml. Anderson states that the Lorazepam concentration goes up in the autopsy urine, and with Midzolam much less than Lorazepam.

Anderson states that the half life of Lorazepam is 9-16 hours, and that he looked it up in a medical reference book to gain that information. Anderson states he doesn't know what the absorption time and/or the peak time of Lorazepam, that it is in the book, but he doesn't remember what it said.

Walgren Redirect

Anderson clarifies that he never went to 100 North Carolwood. Anderson states that he received vials of blood, a broken syringe with plunger, an IV catheter from Investigator Fleak. Anderson states that the IV bag and IV tubing was brought to him at the lab, simply marked medical evidence #2.

Anderson states that the difference between blood sample and urine sample, is that the blood is what is usually happening in the body, and in the urine represents everything that the body is metabolizing out, and that the urine concentration expectation is that it would be much higher. Anderson states that the urine is historical in nature and what is being expelled from the body over a certain amount of time.

Anderson states that the PACTOX gastric contents analysis, shows 634 nanograms/ml of Lorazepam. Anderson states that the lab measured in concentration, he was provided 73.5 mls of gastric contents, in which he would multiply the two numbers to get the nanograms of stomach contents which would be 46,599 nanograms of Lorazepam left in the stomach. But the numbers Anderson should have used for calculation (micrograms not nanograms) he needed to divide by a thousand, so 46,599 divided by a thousand equals 46.599 divided by another 1000 to get a mg amount, equals 0.04599 of Lorazepam in the stomach. Anderson states that he went further and got a more exact amount and arrived at 0.046599. Anderson states that with a 2 mg Lorazepam pill, the gastric contents are equal to 1/43rd of a single 2 mg tablet, which is a very small amount

Flanagan Recross

Flanagan asks if there is a high concentration of ephedrine in the urine, but a low concentration in the bladder, would it be fair to say it was recently taken, Anderson says it’s a fair assumption. Flanagan asks if it's the same with propofol, Anderson states that he is not familiar with the excretion patterns of propofol.

Flanagan asks if a person were to take 7 or 8 Lorazepam tablets, and he found 14 miligrams in the stomach, would Anderson state that the person had taken it recently, Anderson states yes. There are numerous questions asked after this by Flanagan, but prosecutor Walgren objects and judge Pastor sustains them.

Elissa Fleak recall testimony

Walgren Direct

Walgren goes over evidence collection and when Fleak recovered multiple evidence items. Walgren asks if there are a lot of photographs taken on multiple days. Fleak looked over the photos to identify which photograph was taken which day (June 25th or June 29th). Fleak says she went into the master bedroom briefly, looked around but did not search it.

Walgren talks about IV stand and the photographs about it. 2 photos of IV tubing taken on June 25th. Tubing is draped over the handle. June 29 photos of IV stand /tubing. June 29 it's still draped over as it was on June 25. Later photos taken same day, it's no longer draped over the handle. One June 29, the investigators freed the tube (undraped it) so that the syringe can be photographed.

mid morning break

Chernoff Cross

Chernoff again questions about whether she went into MJ's master bedroom or not. And again brings the subject of master bathroom and photographs taken in it.

In MJ's master bedroom fire place is on , TV is on as well. Chernoff shows pictures inside the master bathroom and asks if Fleak remembers the pill bottles. Fleak says she wasn't there in June 26 and those bottles were collected on June 26. Fleak says she doesn't know who collected them and who took those pictures. Chernoff shows a picture where there's no pill bottles. Chernoff asks about the briefcase in the pictures.


Detective Scott Smith Testimony

Walgren Direct

LAPD Detective for 20 years. He was assigned to robbery-homicide division in June 25, 2009. He learned about the death of MJ 3:30PM from his supervisor. He arrived at UCLA at 4:25 PM. Smith went to the emergency area. He stayed there till 7:00PM. Smith did not see Murray at UCLA. Smith obtained security footage from UCLA showing Murray. They got footage of Murray leaving at 4:38PM.

Walgren plays the video and then shows an aerial photo of UCLA and asks Detective Smith to mark the way Murray let the hospital.

Smith talked with Faheem Muhammed, Alberto Alvarez at UCLA very briefly. FM just told he was employed by MJ and gave his contact information. AA said the same things and also mentioned he went into the room to help MJ and called 911. Detective Smith didn't do any more interviews at that day. He arrived to Carolwood around 7:30PM.

Smith didn't know the cause of death at that point of time. At that time this was a death investigation and not a homicide information. Death investigation could be natural causes and detectives may or may not be involved. If it is homicide investigation the police department takes full responsibility. It becomes a homicide investigation if there's an obvious cause of death such as gunshot etc. This was a death investigation and coroner was leading the investigation not the police department. Detectives was on the scene to assist and support coroner's office as needed.

Walgren asks if this had been an homicide investigation would LAPD be leading the investigation and collect evidence. Smith says yes. On June 25th evidence was collected by coroner's office. Det. Smith was assisting and overseeing the LAPD photographer. Smith says they left the residence around 9:30 PM. They released the house at the request of Jackson family to private security.

June 26, Detective Smith attended the entire autopsy of MJ. He didn't have cause of death by the end of autopsy. They had no information to assist with the investigation. It was deferred pending toxicology results. At this time it was still a death investigation and not a homicide investigation. On June 26th Smith went to Carolwood again. Coroner Ed Winters called him and said some items were given to him by family. Smith went to take those items. They initially thought it was tar heroin which turned out to be old rotten marijuana. It was found in a shaving kit. Those items had no relevance to MJ's death and determining the reason of his death.

In the shaving kit there was also temazepam bottle prescribed by Murray. Smith had also found some empty pill bottles on June 26 in MJ's master bathroom.

Walgren goes over the pictures of MJ's master bathroom taken over several days. June 25th pictures. Bathroom appears to be messy, drawer doors open, a few notes taped on the bathroom mirror. Pictures from June 26. There was no empty pill bottles or briefcase on June 25th pictures. On June 26th there's a briefcase, Smith doesn't know whose suitcase it is. June 26 pictures show empty pill bottles on a ledge. Smith says that he placed them on the ledge to photograph them.

On June 27 Murray's attorney Michael Pena spoke with Detective Martinez. They made arrangements to meet at Ritz Carlton at 4 PM. Murray's attorneys had chosen the place. Detective Martinez and Smith met with Murray and his lawyers in a room at the hotel. They conducted and recorded the interview.

Audio of Murray’s interview with the police is played

June 27th Ritz Carlton. Murray is at the interview with his lawyers Chernoff and Pena. Detective Smith and Martinez is doing the interview.

First part of the interview: Officer is going through and asks Murray basic information as his address, phone number, weight, when he was born, how tall he is etc.

Detective says the detectives at the hospital was from another division and was not handling the case. They took some notes but didn’t do a formal interview. Murray seems surprised to hear that other detectives took notes after he left.

Murray talks about how he met Michael. They met in 2006 and saw MJ on and off since 2006. The first time Murray saw MJ was because MJ and his kids had the flu, a bodyguard of MJ whose parents were patients of Murray referred him.

Murray says he had been caring for MJ for the last 2 months. Murray tells that he received a phone call from MAW. MAW said MJ was going to do a concert-tour in London and MJ wanted Murray with him. Murray said he needed more details before accepting. He then say MJ called and said he was happy Murray was going to join him – although he had not yet committed to join MJ’s team.

Detectives ask about who is Murray is working for AEG or MJ. Murray says he’s an employee of MJ but paid through AEG.

Lunch break

 

[ivy]

Murray Trial Day 9 October 7 2011

Afternoon Session

Audio of Murray&#8217;s interview with the police is continued

Murray says he had no idea that AEG were going to pay him.

Detectives ask about MJ&#8217;s general health. Murray says generally speaking MJ did not eat well and was very thin. He did not find any major physical change in MJs condition except for something called subluxation of his right hip (MJ&#8217;s right hip would slip out and slide back to the joint). MJ had fungal disease on his toes which was treated. Nothing more that Murray noticed.

On June 24th &#8211; Murray got a called from MAW around 12:10 am that MJ was done with rehearsals. MJ had attended meetings and did a partial performance (not a full rehearsal). MJ wasn&#8217;t complaining about anything but wanted Murray to be at Carolwood by the time he came home.

Murray spent every night at Carolwood except nights he where off, which were Sundays. He spent the night there per MJs request.

Murray arrived to MJs home at 12:50am before MJ and waited at MJs room. MJ arrived shortly after, around 1am. Once MJ arrived, they greeted each other and talked about their days. MJ told Murray he was tired and fatigued and was treated like a machine. MJ took a quick shower and changed and came back to the room.

When MJ came back to the room, Murray put on some cream/lotion on his body and back for Vitiligo.

Detectives ask Murray about the bedroom. Murray tells that MJ had 2 bedrooms. No one not even cleaners would be allowed to go into the master bedroom and it would be in a bad state. Murray would see MJ in the second bedroom , the one that had IV stand and oxygen tanks.
After cream, MJ wants to sleep. Murray says MJ is not able to sleep naturally. Murray says he would put an IV for hydration on MJ&#8217;s right or left leg below the knee. They then talked a bit and he gave MJ Valium 1 pill 10 mg orally.

As Valium&#8217;s effect was delayed so around 2 AM Murray gave MJ 2 mg of Lorazepam which it was IV pushed slowly. Murray says he observed MJ but he continued to be awake for 1 hour, he says he watched him because he wanted to be cautious. So Murray decided to give him Midazolam (2 mg injected slowly) around 3 AM. Murray waited again but MJ was wide awake. MJ said he couldn&#8217;t sleep. Murray suggested to lower the music MJ likes to sleep with and dim the lights and told MJ to meditate while he rubbed his feet. MJ did that reluctantly and MJs eyes closed. Murray estimates that MJ closed his eyes around 3:15-3:20; he doesn&#8217;t know it for certain because he wasn&#8217;t looking at his watch at that time. 10-15 minutes later MJ was again awake.

MJ was surprised that he managed to sleep after he had meditated. And they tried mediating again but by 4:30 AM MJ was sill wide awake. MJ starts to complain saying that says he has rehearsals he needs to perform and tomorrow he will need to cancel his rehearsals because he can&#8217;t function if he can&#8217;t sleep. Murray says then he gave MJ another 2mg of Lorazepam at 4:30 &#8211; 5:00 AM because a safe time had passed. That didn&#8217;t put MJ to sleep as well.

MJ complained that if he can&#8217;t perform he would have to cancel the rehearsals and it would put the show behind and cannot satisfy fans if he&#8217;s not rested well. Murray says that it put a lot of pressure on him. Murray tells MJ he isn&#8217;t normal and the medications that he gave would make a normal person sleep for 1-2 days. (due to wanting the medications/can&#8217;t sleep)&#8230;

By 7:30 MJ was still awake.At that time he gave another 2 mg Midazolam. There was still no effect. Murray says he cautiously checked the IV site to make sure the fluid and medicines was going to MJ because he wondered why MJ wasn&#8217;t responding to medications.
At this time Murray says Michael also urinated.

10 AM in the morning. Nothing has worked. Murray was watching and trying to get MJ to sleep. MJ is complaining he can&#8217;t sleep, he has to cancel the dates and everything has to be pushed back.

MJ at that time asks &#8220;Please give me some milk so that I can sleep, because I know this is all that really works for me&#8221;. Detectives think that they are talking about actual milk and asks if MJ wanted hot or warm milk. Murray tells them it&#8217;s a medicine Propofol which is &#8220;a sedative that could also be used for anesthesia&#8221;. Murray gave MJ propofol through IV around 10:40. Murray had asked him how long he would sleep if he gave him Propofol because MJ needed to get up at a certain time. MJ told him it doesn&#8217;t matter when he wakes up, told him to just make him sleep.

Murray say he gave him small amounts to get him to sleep, he administered 25 mg of Propofol together with Lidocine, he pushed it slowly. This time it must have been 10:50, effect is quick and Michael was sleeping now.

Detectives ask if Murray had any monitoring equipment. Murray says he took all the precautions that were available to him such as oxygen and pulse oximeter.

Detectives questions Murray about the dosage. Murray says 50 mg propofol was the highest amount propofol he had given MJ ever. That night he gave less due to the other medications he had given to MJ. Murray says he roughly gave MJ Propofol every day, there were rarely exceptions. Murray also says that three days leading up to MJs death, he tried to wean MJ off propofol

He was not aware that MJ was taking this on a daily basis before he was hired. Murray was surprised by MJs pharmacological knowledge and his mention of &#8220;milk&#8221; and &#8220;antiburn&#8221;. MJ said he had taken propofol before.

MJ said he used it in Germany but never disclosed other doctors&#8217; names. MJ never told him he administered it himself but other doctors let him infuse it by himself.Murray told him NO he wouldn&#8217;t let him to that.

Murray says MJ knew that propofol was the only thing that worked for him. Murray says he often warned him about it.

MJ told him he was seeing a Dr Lee that she was giving him a cocktail for energy. Murray says there were a lot of IV sites on MJ&#8217;s body and his veins were sclerotic. Murray asks MJ what is in the cocktail and wants to review it. MJ says he doesn&#8217;t know. Later they got of Lee because MJ felt she was unprofessional and cancelled an appointment. MJ felt she wasn&#8217;t telling him the truth.

Once in Las Vegas Murray got a call from MAW. MJ was in Vegas with his children for a show and he was staying at Wynn Hotel. MJ says he having difficulties to sleep. Murray tells MJ to use sleep medications (lorazepam or restoril) that he gava to him. MJ tells Murray nothing that he or Klein or Metzger gave to him works. Murray says he doesn&#8217;t have any other alternatives. MJ then asks about Diprivan / Propofol and says that he knows that it works. Murray says he doesn&#8217;t have it. MJ mentions Dr. Adams and that he gave him Propofol. Murray doesn&#8217;t know Adams. MJ gives Murray Adams phone number. Murray calls Adams. The plastic surgeon&#8217;s office Adams used doesn&#8217;t allow them in the office so Murray lets them into his office on a Sunday. Adams puts MJ on a Propofol drip for 6 hours. Murray says he had monitoring equipment. Murray comes back to his office after 6 hours and MJ says he&#8217;s feeling wonderful because he has slept.

MJ tells Murray that this is divine guidance and other doctors helped MJ sleep for 15 10 18 hours. MJ mentioned of having another doctor &#8211; Adams- on tour with them. Adams was willing on to go on tour with them and wanted $1.2 - $1.3 million a year. Murray told it to MJ but there was no follow up and Adams didn&#8217;t end up joining the team.

Murray mentions that MJ wanted him to be around forever, after the tour. Murray mentions MJ&#8217;s plans for a children&#8217;s hospital and wanted Murray to be medical director.

Detectives go back to the night of June 25. Murray gave MJ 25 mg Propofol. MJ falls to sleep but he&#8217;s not snoring. Generally when he&#8217;s in deep sleep he snores so he&#8217;s not in deep sleep. Murray monitors him. Everything looked stable and he was comfortable. Murray needed to go to the bathroom to pee and empty MJ&#8217;s urine jar.

When he came back after 2 minutes he sensed MJ wasn&#8217;t breathing because he usually looked at his chest to see if he was breathing. He immediately checked MJs pulse and got a thread pulse from the femoral area and MJs body was WARM and he assumed everything happened quickly and immediately started CPR and mouth-to-mouth. He wanted to apply medicine as well but not first because he wanted to ventilate and compression first. He saw MJs chest rise. Murray says he couldn&#8217;t move him from the bed to the floor by himself. He then got his left hand under MJs body and then gave him CPR and also ventilating him and made sure his chest was rising completely. He looked for the phones but phones do not work in the house. He doesn&#8217;t know the address zip-code; only know its North Carolwood. The house is closed during nights and only MJ, he and the children would be there. Murray tells that security doesn&#8217;t come to the house. Murray thinks it&#8217;s inhumane that the security are not allowed into the house to pee.

He says to talk to 911 would be to abandon him and he didn&#8217;t wanted abandon him. He reached his cell phone and called MAW. Murray tells MAW to send up security. Murray says he didn&#8217;t ask MAW to call for 911 because then MAW would have asked why and Murray was trying to assist MJ. Murray realizes that MJ doesn&#8217;t have a pulse now so he lifts MJs legs for a brief moment for auto transfusion and continue to do CPR etc. No one came to the door, no one knocked on the door. So he gave Michael 0.2 mg Flumazenil because he wanted to reverse the affects of the other drugs but MJ would not still breathing and no help was coming. He then opened the door and ran down to the kitchen and saw the chef (Kai Chase) to have the security immediately and security (Alvarez) comes upstairs. Murray tells Alvarez to call 911 and want help to move MJs body to the floor and still helps with chest compression.

Alberto talked to 911 but Murray told him to just tell the paramedics to hurry up because he wanted help to move MJ to the floor. Paramedics came and called UCLA, MJ was not breathing. They were doing chest compressions. Murray says Michael was PEA &#8211;pulseless electrical activity &#8211; which means you don&#8217;t shock a patient. MJ was given starter drugs. Murray says that he felt the communication and the orders coming from UCLA was kind of slow.

After 20 minutes of effort &#8211; which Murray thinks was limited &#8211; he knew MJ hadn&#8217;t been gone too long and he had felt a femoral pulse. So Murray asked UCLA instead to calling MJ dead to transfer the patient to him. Murray took over the care and they took MJ to UCLA. Emergency personnel met them. They worked on MJ for an hour. Murray says probably they would have stopped sooner if Murray wasn&#8217;t insisting. They don&#8217;t know why MJ died but thinking pulmonary embolism could be a reason (a clot in the lungs that would shut the circulation in the lungs). MJ is pronounced dead. Murray doesn&#8217;t want to sign the death certificate as he doesn&#8217;t know the cause of death.

Chernoff jumps in and changes the topic to Murray trying to wean off MJ 3 days before leading up to MJs death. Murray says he didn&#8217;t know MJ used propofol before and that it was kind of a habit. Murray says he wanted to MJ to sleep naturally and tried to wean him off. Murray asks what MJ would do once the tour was over; MJ tells him he thinks he can be able to sleep then. Murray switches to lesser drugs (such as Lorazepam) to wean MJ off. Murray says MJ knew it but he was reluctant. Murray says he never told MJ that he believed he had drug dependency. He was trying a strategy and was trying Michael to transfer his confidence in Propofol to something lesser. First night Murray reduces Propofol and starts Lorazepam and Versed. Second night he removed Propofol and only gave Lorazepam and Versed. Michael told him he felt a little hangover in the day. The night MJ died Murray started with Lorazepam and Versed but nothing was working. Murray doesn&#8217;t know if it was withdrawal from Propofol or if it was psychological. Murray says after trying all night with those 2 drugs he finally gave MJ Propofol so that he can sleep and so that he can produce the next day. Murray says he didn&#8217;t want MJ to fail and he cared about him.

Judge stops the tape.. Rest will be continued on Tuesday.

Court ends early due to Yom Kippur (Jewish Holiday)

 

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Re: Murray Trial _ All daily trial Summaries - No discussion October 7th / Day 9 Full Testimony

There won't be any testimony on Monday October 10, 2011. It's Columbus Day and it's a federal holiday in USA.

Testimony will continue on Tuesday October 11, 2011. At that time they will continue to play the audio of Murray's interview with the LAPD Detectives. You can find the summary of the remaining portion of the interview below.

Murray mentions Michael probably having withdrawal symptoms to Propofol on June 25. He says that it can be either physical or psychological or mental.

In the hospital Murray talked to the detectives briefly and gave them his phone number.

Murray says he and emergency room doctor went into the room Katherine Jackson was waiting and told her that MJ had died. Murray says he stayed with her to console her and asked UCLA to bring in a psychologist to help Katherine. Murray then learns that children are in another room and decided to notify the children. Murray , Dileo and Michael Amir Williams and a social worker went into the room the children were and told them MJ was dead. Murray says the children were weeping and the stayed there to console them. Murray says Paris mentioned her unhappiness and said she didn't want to be an orphan. Dileo and Murray say that they will take care of her. Murray tells Paris that he tried her best to save Michael. They bring MJ's kids and Katherine together. Murray says he doesn't know how close they are.

The children want to see Michael, psychology team says it's a good idea and it would bring them closure. UCLA was prepping MJ's body for viewing. During this time Jermaine, Latoya and some cousins of MJ came to the hospital. They were briefed about what happened. Murray went into the room where the family was, family asked Murray if he knew why MJ died. Murray said no and recommended them to get an autopsy. MJ's body was ready for viewing and the children went to see MJ. Murray asked Katherine if she wanted to see MJ as well, she said no.

Murray talked with the bodyguards and asked them where would the children go. Bodyguards told him they can't go back to the house because it was on lock down. Murray talked with Randy Phillips, Frank Dileo and the bodyguards and asked if he can do anything. Murray says Jermaine as asked to make a announcement and they wanted Murray to review the press release. Murray says he added the cause and Jermaine edited the part that asked fans to respect their privacy to ask media to respect their privacy. Murray says he talked with Jermaine a little bit. Murray says then he was tired and let the hospital to go home.

Murray again mentions he talked to Detective Porche and gave him his phone number. Detectives mention that they called Murray several times but the calls went to voice mail. Murray's lawyer Pena says it was his advice to Murray to leave his phone off and wait for his lawyers to talk to detectives later.

Detectives ask if Murray knew MJ had any preexisting conditions. Murray says he treated MJ for pneumonia in 2008, fractured toe in 2008, upper respiratory issues multiple times over the years, lethargy and for callouses on his feet. Murray also treated fungal infection on MJ's feet. Murray says he gave MJ Lamisil and did a full blood work before to make sure that his liver was okay.

Chernoff asks detectives if there's any preliminary toxicology results and the detectives say they are not aware of it. Chernoff then asks Murray if he knew of other medications Michael might be taking. Murray says he heard that MJ was seeing Klein. Murray says around 3 weeks ago he hear MJ calling Jason Pheiffer and asking him if he can squeeze him to see Klein. Murray says he also saw pill bottles with Dr. Metzger's name on them. Murray says MJ doesn't disclose all the physicians that he's seeing.

Detectives list a number of medicines and ask Murray if he prescribed them and what are they used for. Murray explains Flomax and says that MJ has hard time urinating. Murray is surprised to find out that MJ had some sort of eye drops. Murray says that MJ had a very bad eyesight and he thought that MJ could be legally blind. Murray arranged for an appointment but MJ didn't go to see the eye doctor so Murray is surprised to hear about eye drops.

Murray says MJ's production team has told him that MJ's worst days was after he came from seeing Klein and MJ would be wasted and require 24 hours to recover. Detectives mention finding marijuana and Murray says that MJ denied it and surprised to find out MJ would be using stuff like that. Detective tells Murray it was old and rotten. Detectives ask about empty cigarette packs they found , Murray says he doesn't know if MJ smoke. Detectives ask if MJ packed his suitcases and Murray says he did. Murray mentions MJ using excessive cologne and could not understand why he would use that much and says it might be to dismiss any odor.

Detectives ask how many syringes Murray used and Murray replies 2. He says he would recap them and he would use medication and mix them with saline. Detectives asked Murray what he did with those syringes Murray say he would put them in his bag and put them into the cupboard. When detectives ask where those syringes are Murray tells them he left them at the house at the closet. Detectives ask which closet and Murray describes it to them. Murray says MJ showed him the cabinet and told him to put his stuff there.

Detectives ask for the keys to Murray's car so that they don't have to break into his car and damage it.

At the end of the recording Detectives ask if Murray ever gave MJ Demerol. Murray responds no. Detective Smith says they didn't find any and Detective Martines says he doesn't know how that came up.

 

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Re: Murray Trial _ All daily trial Summaries - No discussion October 7th / Day 9 Full Testimony

Murray Trial Day 10 October 11, 2011

Morning Session

Detective Smith LAPD Testimony continued

Walgren Resumption Direct

They finish playing the Murray interview tape.

Smith states that the first time propofol was mentioned was in his interview with LAPD two days after MJ died, and that prior to that Murray had only mentioned he administered a sedative.

Smith states that he responded to UCLA and also attended the autopsy but that his knowledge was limited.

Smith states that very little of the questioning of Murray was limited, but that they allowed Murray to speak freely. Smith states that Murray did not mention the phone calls he placed or received on June 25, and was unaware of Sade Anding at that time.

Smith states that Murray was surprised by the fact that LAPD had not recovered Murray's medical bags at the time of the interview, dated June 27, 2009.

Smith states that on June 26, 2009, there were some business cards belonging to Conrad Murray and David J. Adams found in the Carolwood home. Smith states that the business cards were recovered from MJ's master bathroom by a LAPD detective. Smith states that also recovered were Latanoprost, a skin cream, and three vials of eye medication from the master bedroom, prescribed by Arnold Klein. Smith states that a large plastic bag with Applied Pharmacy on it, inside with benoquine to Dr. Murray was recovered the bathroom area of MJ's bedroom.

Smith states that there were a series of search warrants issued, the first being on June 29, 2009, to 100 North Carolwood Drive and the tow yard where Murray's BMW was. Smith states that a contract recovered from the pocket of the door, and a few business cards. Smith states no propofol bottles were recovered from the car.

Smith states the next search warrant issued on July 22, 2009 to Murray's cardiology practice and a storage unit in Houston, but that no propofol bottles were found.

Smith states that next search warrant issues on July 28, to Murray's Las Vegas office, home or storage unit were done, no propofol bottles found.

Smith states that the next search warrant was issued on August 11 to Applied Pharmacy at Las Vegas, owner Tim Lopez. Smith states that this is when LAPD discovered that propofol was being sent to an apartment in Santa Monica, CA belonging to Nicole Alvarez. Smith states that then a search warrant was issued for Alvarez Santa Monica home, on August 13, 2009. Smith states that there were no propofol bottles recovered from Alvarez' home.

Chernoff Cross Examination

Smith states that attempts had been made to contact Murray by the LAPD by phone, but that he did not personally make those calls, and that the detective who had made those calls, states that the calls went to voicemail.

Smith states he was aware that the press release for MJ's death was done by Jermaine Jackson, but not aware whether the press conference was actually done.

Smith states that he and Detective Orlando Martinez were initially assigned to MJ's death case, but that Detective Porsche was the original detective who tried to contact Conrad Murray.

Smith states that on June 27, 2009, the initial meeting between Murray and LAPD was set up for 2 pm, but it was rescheduled for 4 pm by LAPD.

Smith states the he spoke with Michael Amir, Faheem Muhammad, Alberto Alvarez, Larry Tolbert, Nanny Roslyn Muhammad, Kai Chase, MJ's family members, some housekeepers, Larry Muhammad had all spoken to LAPD on June 25, 2009. Smith states that Chernoff/Murray never made any limitations as to what he did not want to talk about or time limits, during the initial meeting with LAPD.

Smith states that he did meet with Michael Amir Williams on August 31, 2009 and that he vaguely remembers that Williams had to leave the room briefly at one point to speak to his attorney. Smith states that Murray did not leave the room, nor did he put time limitations on the interview with LAPD on 6/27/09.

Smith states that he had been with robbery/homicide for 1 and half years, before that he worked in another division for 10 years, 24 years as a police department, 14 in homicide. Smith states that he is an avid note taker, and that he took notes for various individuals and evidence collected regarding MJ' death, because he understands the importance of those notes. Smith states that he was in and out of the room while Elyssa Fleak was investigating on June 29, 2009. Smith states that while Fleak was removing items, he did not make notes about what she was removing them, but after that when all items had been laid out for display purposes for photographs.

Smith states that on June 29, 2009, he never mentioned that he never mentioned that a propofol bottle was found in an IV bag. Smith states that he was very specific with miligrams, lot numbers, etc., empty IV bags, empty pill bottles. Smith states that on June 29, in the search, he found Murray's medical bags exactly where Murray said they were.

Smith states that there were Lorazepam bottles found in the master bathroom of MJ's bedroom, but that he was not the person who found them. Smith states that the business cards were found in the vanity of the master bathroom, and that Detective Sanchez told him where they were found.

Smith states that he interviewed Dr. David Adams in Las Vegas.

Smith states that while he was at UCLA, he spoke to Alberto Alvarez. Smith states that Alvarez said he was called into the bedroom, and that Alvarez was told that MJ was having a bad reaction. Smith states that Alvarez never mentioned CPR, or that the propofol bottle was inside the IV bag was on August 31, 2009. Smith states that Faheem Muhammad made a statement on June 25, but that he said nothing about Murray wanting to go back to the Carolwood home on that date, nor did Michael Amir Williams until 8/31/09.

Smith states that there was another interview with Alberto Alvarez after August 31, 2009, and but he can't remember when. Smith states that he requested fingerprints from Alvarez, and he did turn them in, and they were analyzed.

Smith states that SID came in and downloaded surveillance video, that there were video cameras were not pointed toward the front door of the home door, but there was one on the front gate, on the keypad at the front gate, and one in the back of the house. Smith states that the video that was selected to download was made collectively, but Detective Martinez did the actual downloading. Smith states that they never requested any more video surveillance after June 25, 2009. Smith states that although the Carolwood home was locked and guards were there, that there were people allowed in the home for the 26th, 27th, 28th of June, 2009. Smith states that he does not know if a log had been kept regarding visitors at Carolwood after MJ died through June 29, 2009.

Smith states that he never talked to the new security at Carolwood to get a list of the people who had been in the house on the 27th, 28th, 29th. Smith states that marijuana was found by family members in MJ's closet in a suitcase.

Smith states that he asked upon leaving Carolwood if he the home would be sealed, he stated that he was told no.

Smith states that Conrad Murray told Detective Porsche that he would not sign a death certificate because an autopsy needed to be performed.

Smith states that he interviewed other doctors besides Dr. Adams and Dr. Murray.

Smith states that Murray gave him the keys to his car in order to search it.

Smith states that he did not go personally to search Murray's property in Houston. Smith states that in Las Vegas, Smith recovered Murray's cell phone from his home, computer hard drives from his office, paperwork involving his practice from his offices in Las Vegas.

Smith states that he can't recall if he interviewed a Patrick Muhammad was interviewed, Isaac Muhammad was interviewed, and a Derek Cleveland was interviewed by Smith, all of whom were security at Carolwood.

Smith states that MJ's death was deemed a homicide case on August 27, 2009. Smith states that there was some discussion and that the lieutenant from LAPD told Ed Winter from the coroner's office to stop looking into other doctors besides Murray.

Walgren Redirect

Smith states that a lieutenant from LAPD contacted Ed Winter, who had already contacted Arnold Klein, which caused some friction between the two. Smith states that the DEA was assigned to look into specific doctors ultimately and that LAPD was to focus on the homicide investigation.

Smith states that when Conrad Murray stated he gave MJ milk, Smith asked whether the milk was hot or cold. Smith stated he had no idea that milk meant propofol.

Smith states that only one IV bag was recovered on June 25, 2009. Smith states he was not present when the propofol bottle inside the IV bag was discovered, but was present when it was all laid out on a table.

Smith states regarding video cameras, first pointed at gate area on the outside of gates, second on an entrance underneath the residence but inoperative, third and fourth were on either side of the back side of the entrance facing pool and backyard, fifth pointed at right portion on exterior of house, one pointed facing at the inside of the gate. Smith states no camera showed any door entrances, primarily for exterior perimeter video surveillance.

Chernoff Recross

Smith states that when he found an empty Lorazepam bottle inside an empty IV bag, he starred it and underlined it, marking the lot number. Smith states that he did not note that the propofol bottle was inside an IV bag in his notes, as he did with the Lorazepam bottle.

Re-redirect Walgren

Smith again states he did not see the propofol bottle inside the IV bag, and that is why he did not document it.

Re-recross Chernoff

Smith states that the DEA was going to investigate Mickey Fine Pharmacy, and that Arnold Klein was linked to the pharmacy.

Dr. Christopher Rogers LA County Coroner's Office Testimony

Walgren Direct

Rogers states that he is a deputy medical examiner for LA county, and that he does autopsies to find cause of death, and that he has done this since 1988. Rogers' current position the Chief of Forensic Medicine.

Rogers states he has been present for several thousand autopsies over his career. Rogers states that he did the autopsy report for Michael Jackson on June 26, 2009. On that specific day, Rogers states he was not able to specify a cause of death, there was nothing anatomically obvious to state cause of death.

Rogers states that MJ was healthier than the average person of his age. Rogers states that there were incidental findings, that MJ had an enlargement of the prostate gland which meant that it was difficult to urinate so he was retaining urine, he had vitiligo, and he also had a polyp in the colon. Rogers states that the nervous system showed mild diffuse swelling, lung exam showed chronic inflammation and scarring, radiology showed an extra rib and also some arthritis. The dental examination showed root canals and implants were done. Rogers states that an anesthesiology consultation was also done.

Rogers states that a previous scalp injury caused an area of pigmentation at the top of the scalp which was scarred, Rogers was aware of the scalp injury. Rogers states that MJ was 5'9" and that he weighed 136 pounds, BMI index was within the normal range, however a thin individual.

MJ's autopsy photo is shown in court. Rogers states that is, indeed Michael Jackson. Rogers states that also the autopsy photo shows 8-25-09, the date is incorrect.

Rogers states that MJ did not have heart disease and no abnormalities were detected in the heart. Rogers states that coronary arteries were clear, and that almost everybody has some athrosclerosis in their coronary arteries, but that MJ had none, meaning no fat or cholesterol in MJ's arteries.

Rogers states that initially he felt there was no natural disease that caused his death. Rogers states that MJ's esophagus was intact, and that there was no white, milky substance in the esophagus.

Rogers states that the stomach content was examined, and that Rogers found 70 grams of drug fluid but did not show pills or capsules. Rogers states that he looked for that specifically to determine cause of death.

Rogers states that he checked the mouth and upper airway (meaning the entrance to the breathing passages, mouth down the throat into the windpipe or trachea) and found no foreign material.

Rogers states that he requested toxicology reports to assist him to report cause of death. Rogers states that he sought out other doctors in specialties to help him with cause of death. Rogers states he read Conrad Murray's interview with LAPD to help him and asked for medical records from Murray, but was never able to obtain any records from Murray.

Rogers states that he was at some point, able to determine cause of death, and the manner was homicide. Rogers states that he based his homicide report on 1) Murray's statement to the police he administered the propofol and benzodiazepines 2) it's not appropriate to give propofol for insomnia, that the risk outweighs the benefit, and in addition, the setting in the home did not provide for the use of an EKG monitor, a precision dosing monitor, equipment available to revive MJ adequately, not an endotracheal tube, no meds to improve circulatory function and 3) and that the circumstances do not support self-administration of propofol, because Murray stated that he only gave MJ 25 mgs, went to the bathroom, returned from the bathroom to find MJ not breathing. Rogers states that you would have to assume that even though MJ was under the influence under the influence of propofol and other sedatives, injects himself with propofol, seems less reasonable than Murray giving MJ propofol from time to time.

Rogers states that since they did not find a precision dosing device, and that he feels that it would be easy for the doctor to give too much propofol, rather than MJ self injecting propofol himself.

Rogers states that the cause of death was acute propofol intoxication, and the contributing condition was the benzodiazepine effect. Rogers states that Lorazepam and Midazolam, both sedatives were a smaller contribution to MJ's death, and could exacerbate respiratory depression, causing someone to stop breathing. Rogers states that it could have also stopped the heart from beating.

Rogers states that a diagram was made of MJ's body during the autopsy, noting various IV puncture marks during revival efforts. Rogers states that on MJ's right arm, left arm, neck, just below the left knee (where Murray had administered the IV, not revival puncture mark). Rogers states that he observed the empty propofol bottle that was found in MJ's bedroom, noting that it was unusual as the stopper had a center which had a linear opening, showing that it did not show any needle punctures. Rogers states that the linear opening is an opening from side to side in the center of the rubber stopper of the empty bottle of propofol, indicating it was not made by a syringe needle. Rogers states that the linear opening could have been made by a spike.

 

[ivy]

Re: Murray Trial _ All daily trial Summaries - No discussion October 7th / Day 9 Full Testimony

Murray Trial Day 10 October 11, 2011

Afternoon Session

Dr. Rogers Testimony Continued

Walgren Direct continued

Walgren asks if Roger checked the autospy picture during the lunch break and if the picture was corrrectly dated as June 25th. Rogers says yes.

Walgren reminds that when they went to break they were talking of a spike. Walgren shows a spike and asks Rogers to identify it.

On March 2011 Rogers reviewed some evidence. Rogers identified what Fleak called a needle as IV catheter with a needle still present. It appeared unused. Rogers also examined the syringe from the nightstand. According to Rogers it did not appear to fit.

Flanagan cross

Defense asks if Rogers reviewed his preliminary testimony, the coroner's report,his notes, expert reports to refresh his memory before today's hearing. Rogers says he reviewed those items as well as another autopsy report and reviewed toxicology results. Flanagan asks if he reviewed a report from Dr. Shafer who is an anesthesiologist in Columbia University. Rogers reviewd that as well. Flanagan asks if he has reviewed toxicology results from outside labs about stomach and urine. Rogers did not see those.

Flanagan asks if Midazolam, Diazapem and Lidocaine toxicology results are consisted with what Murray told the cops. Rogers answers yes.

Flanagan asks if it's correct that what Murray said about Lorazepam in his interview doesn't match with the toxicology results and also mentions that Propofol is hard to determine as it metabolizes fast. Rogers says it's true and they also don't know how much and how fast Murray gave MJ Propofol.

Flanagan asks if they can't be sure who gave it. Rogers says yes.

Flanagan asks why would IV bottle be spiked. Rogers says it's done for giving it continuosly to maintain sedation. Flanagan asks if spiking would also help to emptyPropofol bottle quickly than getting it out with syringe. Flanagan asks if you wanted to mix Propofol with saline spiking it would make it faster to pour it into the saline bag.

Flanagan mentions a way of doing Propofol drip by mixing with saline solution. Flanagan again mentions that emptying the Propofol bottle with a spike would be more efficient than using a syringe to get it out.

Flanagan asks if propofol - saline mix was done, you would expect to see an IV bag with Propofol in it. Rogers says there was no Propofol found in the bag. Flanagan asks if any evidence of propofol was in the y connector, syringe and the tubing below the y connector. Rogers answers yes. The portion above the y connecter was negative for Propofol.

Flanagan mentions Propofol's shelf life of 6 hours. If it's not used it has to be thrown out. Flanagan says that it doesn't make sense if one will only use 5ml of Propofol to get it from a 100 ml propofol bottle as they will need to throw away the 95 ml.

Flanagan asks about lidocaine and Rogers explains why it's used.

Flanagan asks about if Propofol needs to be slowly infused and not rapidly. Flanagan asks what the blood levels will show if a person is given 25mg of propofol. Rogers doesn't know. Flanagan asks how much sleep would such dose of Propofol would bring. Rogers says 5 minutes and Propofol would have no effect after 5 -10 minutes.

Flanagan asks what happens if 25 mg is injected rapidly. Rogers say that you'll have a locally high concentration and it would mean a higher risk of cardiao respitory arrest. Flanagan goes over the information that propofol needs to be slowly administered. Flanagan asks if someone is slowly administering Propofol if they would see any negative effects such as breathing stopping. Rogers answers yes.

Flanagan asks if a slow injection is given and the patient is watched for 15-20 minutes and if after that time period if something goes bad if it wouldn't be due to Propofol. Walgren objects because it's not considering other benzos. Flanagan changes his hypothetical to ask if a person is sleeping more than 5 minutes that wouldn't be due to Propofol and if he could be sleeping due to being tired / fatigue. Rogers agree.

Therapeutic level of Propofol. Rogers says it's dependent on intended use. MJ had 2.6 mg Propofol in his femoral blood. Flanagan asks if due to post mortem redistribution if that numbers could be problematic. Flanagan goes over articles to say that Lorazepam does not redistribute and ask Rogers about the Lorazepam amounts. Rogers say that they are very close and it might or might not show that there was no redistribution.

Pills in stomach. They wouldn't distribute to the body until they are disolved. Flanagan switches to stomach contents. It was a dark liquid. Flanagan asks if there could be fruit juice in the stomach and asks if they ever identified the content of the stomach. Rogers say they didn't. Flanagan asks if they saw any tablets or capsules. Rogers says they didn't. Flanagan says they could get dissolved and they can't tell if a person has taken tablets by looking to stomach contents. Toxicology would be needed to determine it. Flanagan asks if toxicology results show that Lorazepam , would it mean consumption of Lorazepam. Flanagan shows the Lorazepam in stomach toxicology results. Flanagan mentions Lorazepam concentration being 4 times higher than the femoral blood levels. Flanagan mentions the amount equals to 1/43 of a tablet but it doesn't show how many tablets are actually taken as the pills dissolve over time.

Lorazepam levels in the blood didn't cause any red flags because it wasn't too much. Flanagan shows 2 Lorazepam pill bottles found in MJ's house. Both had 30 pills (60 total), one bottle is empty the other one has 9.5 pills left in it.

Flanagan mentions that Rogers thought benzodiazepines had an effect on the death. Midazolam and Diazepam found in the blood was low and insignificant. Flanagan asks what level one Lorazepam pill would cause. Rogers says it should be at therapeutic level. Flanagan brings out the Baselt book that says for 1 pill .018 in 2 hours. Flanagan tries to ask if 1.69 blood level would mean it would require 9-10 pills. Objection.

By judge's order Flanagan goes into hypothetical scenarios. Rogers can't understand questions. A lot of objections and judge sustains them one after another very quickly.

Mid afternoon break

Flanagan mentions half life of Lorazepam (9 to 16 hours) and bioavailability. It's beyond expertise of Rogers.

Flanagan asks if what level of Propofol would be lethal. Rogers says 1 to 17 mg per ml. Flanagan asks if a person with 2.6 level of Propofol would feel pain. Rogers says yes.

Flanagan again asks Lorazepam levels of 1.69 and how many pills it would mean. Overruled due to improper hypothetical. After several hypotheticals Flanagan gets Rogers to say it would equal to 9 pills.

Flanagan mentions that stomach and urine wasn't tested for Lorazepam. Flanagan talks about urine samples. If urine sample in autopsy has higher levels of Lorazepam then the scene urine, would the blood would have higher level of Lorazepam then the blood at 7:30 AM as well. Rogers says he can't answer because there are too many variables. Flanagan gives the scenario of 2 mg Lorazepam at 2AM and 5 AM and then 8 pills being taken around 10 AM , if the urine level of Lorazepam would be higher at autopsy urine then the scene urine. Rogers answers yes.

Flanagan goes over the homicide conclusion. Rogers mention 4 factors contributed to that conclusion.

1st factor propofol and benzodiazepines is administered by another. Flanagan again asks questions about Lorazepam which is beyond expertise of Rogers.

2nd factor non hospital setting. Flanagan asks if chronic insomnia cannot be treated by Propofol. Rogers says that it's not general way to treat it. Flanagan mentions insomnia has different levels and if Propofol might be used. It's beyond Rogers expertise.

3rd factor standard of care. Rogers made that determination with the help of the anesthologist.

4th factor Circumstances do not support self administeration. Rogers says that he thought what was reasonable. To Rogers it's reasonable to believe that Murray miscalculated and gave too much Propofol. He finds it less reasonable for Michael to wake up and while still under influence of sedatives and manage give himself Propofol and it killed him and all these happened within 2 minutes.

Flanagan talks about the positioning of the IV line. IV was beyond left knee and it was 6 inches long till the y connector. Flanagan asks if a person can touch an area around their knee. Rogers agree. Flanagan asks about if anyone can do a bolus injection and if it can stop the heart.

Flanagan asks if someone else was giving the injection other than MJ would they see if there's a problem. Rogers say you hope that they do.

Walgren redirect

Walgren brings up what was mentioned earlier and asks is it true if a person found with eyes open it would mean they died quickly. Rogers says it's not true. People can die slowly and still have eyes open.

Oxygen tank was analyzed at july 13, 2009. It was empty.

Walgren says that most of the defense questions pharmacology - what happens to drugs when they enter into the body. It's not Rogers area of expertise. Rogers is an expert in determining cause of death. He's not an expert in propofol or lorazepam.

Walgren mentions the lethal levels of 1 to 17 mg Propofol and asks if smaller numbers than we have seen in MJ can cause death. Rogers answer yes.

Walgren goes over Lorazepam bottles. They are both prescribed by Murray. One is filled April 28, 2009. It was for 30 pills - 9.5 remaining. Second one is filled April,2.2009. It was for 30 pills and it's now empty.

Walgren mentions the hypotheticals Flanagan asked. Tells Rogers to assume Murray was telling the truth in his interview and gave MJ Valium and then 2 injections of midozolam and lorazepam and then propofol. In that scenario if he left the patient alone to swallow lorazepam pills, and there's no monitoring equipment, no airway management equipment and no resusitive equipment. Rogers says it's still homicide. Walgren gives the same sets of events but the scenario self administration of Propofol instead of Lorazepam. Rogers would still classify it as homicide.

Flanagan cross

Flanagan asks about the oxygen and asks if the valve was open or closed. Rogers doesn't know. Flanagan asks how long would it take it to become empty. Rogers say it depends on how open the valve is. Flanagan asks if it's in therapeutic levelswould it empty in 2 weeks. Rogers say probably.

Flanagan mentions Rogers answers about how he's not knowledgeable about Lorazepam and asks doesn't he need to be knowlegeable about that to make determination in this case in regards to the cause of death. Rogers says he doesn't know how these levels are achieved but they are the cause of death.

Flanagan talks about Lorazepam levels being close to the levels required to be unresponsive to painful stimuli and Propofol levels are half the required to be unresponsive to painful stimuli.

Flanagan asks Rogers to assume that Murray was telling the truth in his interview. Flanagan mentions the midazolam and diazapam numbers match but Propofol and Lorazepam levels are a lot higher.

Walgren redirect

Walgren asks why he do an consult with an anesthologist. Rogers says because it was a comples problem. The doctor he consulted told him that the levels was consisted with general anesthesia.

Flanagan recross

Flanagan mentions rapid injection again and asks if rapid injection would have negative effects of respitory and cardiovasculary depression

 

[ivy]

Re: Murray Trial _ All daily trial Summaries - No discussion October 7th / Day 9 Full Testimony

Day 10 testimony has now fully posted

 

[ivy]

Murray Trial Day 11, October 12 2011

Morning Session

Dr. Alon Steinberg Cardiologist Testimony

Walgren Direct

Steinberg is a board certified cardiologist for 13 years. He is not an expert in anesthesia, sleep medicine, pharmacology or addiction medicine.

Steinberg has reviewed CM's resume. CM was not board certified on June 25th 2009. Steinberg tells board certification is an extensive 2 day test and 90% of the cardiologists that take it pass it.

Steinberg is an expert reviewer for the California Medical Board, he reviews other doctors' actions to ensure the standard of care has been respected. 3 levels are possible: no deviation, simple deviation and extreme deviation. Extreme deviation is also defined as gross negligence.

Steinberg has conducted a review for this case. He had conducted 8 prior reviews. In 4 cases he found no deviation; in 4 cases he found simple deviation of care. This is the first time he's seen an extreme deviation from standard of care.

Cardiologists use sedation for many procedures and sometimes they use Propofol. Cardiologists are expert in mild or moderate sedation. In conscious sedation the patient is able to talk and respond to touching. Deep sedation is when patients are only responsive to pain or repeated stimuli. General anesthesia is when patients feel no pain. Cardiologists are not trained in deep sedation. When deep sedation is needed, they call anesthesiologist and that’s the only time they use Propofol.

When they are giving mild or moderate sedation they use benzodiazepines. For deep sedation they are required to give Propofol with an anesthesiologist.

Steinberg has reviewed this case. He has focused his review based on CM interview with police. Steinberg wanted to judge CM on his own words.

Steinberg found 6 separate extreme deviations from standard of care.

1: Propofol was not medically indicated. Steinberg mentions Propofol is an anesthesia. Steinberg tells there was no written informed consent. The patient must be informed of the risks and benefits of treatment. Steinberg never heard of Propofol used for insomnia. Steinbers says that using propofol for insomnia is gross negligence and extreme deviation.


2: Propofol was given in a home setting, without proper equipment and without proper staff.

Walgren asks what equipment needed. Steinberg says that first a pulse oximeter with an alarm is needed but Murray's oximeter didn't have an alarm. Steinberg says he had to stare to MJ nonstop every second. Steinberg says he should have automated blood pressure cuff, to check blood pressure at least every 5 minutes. Murray had a manual cuff and did not use it. Next thing is needed is an EKG monitor to track the heart rhythm. Another thing that is needed is oxygen with a nasal cannula or mask. You need suction in case the patient regurgitates and you need to get it before it goes into patient’s lungs. Another equipment needed is an Ambu bag. Murray had an Ambu bag but did not use it, he did mouth to mouth. You also need to have a way to call for help. Backboard is needed in case CPR is needed. You also need a back up battery for the equipment in case of a black out. Other equipment needed is equipment needed for airway such as endotracheal tube. Endotracheal tube requires trained staff to place it. Also you need a defibrillator.

A lot of special drugs are also needed. Those are fluamzenil, narcan, lidocaine, betablockers, atropine, dopamine, epinephrine, prednisone, dextrose.

Steinberg says when giving sedation you also need BLS (basic life support) and ACLS (advanced cardiac life support) trained assistant.

3: Inadequate preparation for an emergency. You need to have the drugs ready, equipment ready, have a person ready to help you. You need to be prepared to use those medicine and equipment in the case of emergency.

4: Improper care during the arrest. MJ’s breathing had stopped and CM didn't follow proper protocol.
Steinberg explains cardiac arrest which is when heart stops beating. There’s no blood pressure and the patient collapses. In that case you call 911, use a defibrillator, and do CPR on a hard surface.

In MJ's case, it was a respiratory arrest. MJ stopped breathing and the oxygen goes down. Then heart started to beat harder while trying to distribute little oxygen in the body. According CM’s statement this is where CM found MJ. If you do nothing, the heart weakens because of lack of oxygen, and stops contracting but there is still an electrical activity. That’s PEA (Pulseless Electrical Activity). After PEA, there's asystole.

Steinberg says CM should have called 911 immediately then try to arouse MJ, should have used the Ambu bag and give him Flumanezil. Steinberg says it’s inexcusable that CM did chest compressions. This was a respiratory arrest not a cardiac arrest and there was blood pressure and pulse. CM should NOT have done CPR.

CM’s CPR was poor quality because MJ was on a bed. It has to be done on a hard surface such as on the floor and should have done CPR with 2 hands. Steinberg says it would have been very easy to put MJ on the floor.

5: Failing to call for help. CM should have called 911 immediately. CM should have known that he didn’t have any of the medications and the equipment and he had to call for help. But CM instead called MAW which caused a significant delay. EMS was only 4 minutes away. If CM had called them he could have gotten help sooner.

For every minute delay in calling EMS, there are less and less chances the patient will survive and there is a risk of permanent brain damage. Walgren: “Every minute counts”.

Steinberg also thought it was bizarre to call an assistant instead of calling 911. CM as a medical doctor should have realized he needed help and call 911.

6: Failure to maintain proper medical records. Medical records are important because of several reasons. Insurance companies want them. Second reason is litigation. The most important reason is for better health care for the patient. CM did not document a single thing. He didn’t ask when the last time MJ ate was, he had no vital sign records, he had no physical exam. There was no informed consent. He didn’t write what medication he gave and what was the reaction. CM was confused and was not able to explain MJ's history or what he gave him to the ER doctor or EMTs. Walgren asks if he could be dishonest rather than confused.

Steinberg concluded that these extreme deviations directly contributed to MJ's death. Without these deviations, MJ would still be alive.

Walgren asks based on CM’s statement if he gave benzodiazepines and only 25mg Propofol if the risk of respiratory depression is foreseeable. Steinberg answers yes.

Walgren assumes everything happened as CM described and as CM left MJ alone, MJ was able to take Lorazepam pills or Propofol. Steinberg says all the things he said still apply. Steinberg says you never leave the patient and always monitor patient. If MJ self administered, means that Murray was away, and that should not have happened. Steinberg compares leaving a patient under the effect of Propofol to leaving a baby sleeping alone on the kitchen counter. Steinberg says the baby might have woke up and fall down.

Steinberg also mentions that medication should not have been within MJ's reach. Steimberg explains how in hospitals every medication will be under lock and says that having medications out in the open is a foreseeable risk that the patient can self administer and take the wrong medication.

Mid morning break.

Flanagan Cross


Steinberg is not currently trained in using Propofol. When Steinberg was NY he had privileges to use Propofol. In his current work he does not have the privileges and he hasn’t used it in 7 years. When he was in NY he felt confident in using Propofol because he was trained in protecting airways.

Flanagan asks if there is a difference in the equipment needed for moderate and deep sedation. Steinberg answers no, they will be the same.

Flanagan asks if Steinberg thought CM's declaration to the cops was thorough and complete. Steinberg says he assumed it was complete.

Flanagan asks how Steinberg knows CM didn’t have informed consent. Steinberg says because there was none. Flanagan asks if the informed consent can be oral. Steinberg says it has to be written. “If it's not written it's not done.” Steinberg says he has never heard an oral consent. Flanagan asks if any written document had anything to do with MJ’s death. Steinberg says if MJ had been informed about risk and benefits, he might not have agreed to this.

Steinberg says he cannot know if MJ had been informed, but assumes he was not informed that a powerful dangerous drug would be used on him without proper monitoring. Steinberg assumes MJ would not have agreed to it.

Flanagan asks if Steinberg know anything about MJ's propensity towards drugs and mentions Demerol and Klein. Flanagan asks what if MJ was an addict; would he have agreed to it? Steinberg says if he was an addict, he wouldn't give it to him in the first place.

Other doctors that use Propofol could be dentists, gastroenterologist, pulmonary doctors, ER doctors. But their societies have advice on how to use it and they are trained. Their societies outline the same monitoring equipment that Steinberg mentioned. Steinberg says there’s no difference in equipment needed for conscious sedation.

Flanagan asks what killed MJ? Steinberg says a respiratory arrest because he still had a pulse that means there was a heart rate and blood pressure. CM said there was blood pressure and pulse, it was later PEA.

Steinberg says that according to CM he found MJ around noon and EMS arrived at 12:26. There was a delay in calling 911 for at least 12 minutes. Flanagan mentions CM made a lot of time estimations and it might be all precise.

Flanagan asks what 2mg of Lorazepam would do to a patient. Steinberg says he’s not an expert, he gave it as a sedative orally before but he never used IV. Steinberg says he gives it an hour before the procedure orally. Flanagan asks further questions about Lorazepam, Midazolam. Objections. Sustained. It’s beyond his area of expertise.

Flanagan turns the subject to Propofol and say that MJ and CM had been discussing Propofol for the past 3 night and CM told MJ it was not good for him and he was trying to wean MJ off.

Steinberg states that CM said that he gave 25mg initially and started MJ on IV. Flanagan denies that there was an IV. Steinberg understood that after that initial 25mg dose, there was a drip based on his police interview. Steinberg cites a lot of examples in CM interview referencing IV and says it makes sense because 25mg would not keep MJ asleep.

Flanagan insists there was no drip on the 25th, Steinberg insists there was a drip, they both give examples in CM's LAPD interview. They agree it's not clear, but Steinberg says it makes no sense. It's logical CM gave a drip. MJ logically would have woken up, and there was no reason that CM changed his methods.

Flanagan says that 25mg is not a heavy dose and it would make MJ sleep 4 to 7 minutes. Steinberg agrees. So Flanagan asks if MJ was still asleep he was sleeping for other reasons such as being tired. Steinberg says that he would have worried that MJ was still asleep if MJ was not on a drip. Protocol says that after Propofol you should watch the patient. Steinberg says just looking at MJ doesn't tell if he's in mild sedation or in deep sedation. Steinberg says they need to be continuously checked for their reaction to stimuli. Steinberg says CM should have woken MJ up. Steinberg says the fact that MJ was still asleep after 10 minutes, if there was no drip, is very alarming. Steinberg it might mean that something was going wrong.

Flanagan mentions a study that Propofol was successfully used on refractory chronic primary insomnia in Taiwan. Steinberg says that the article dates back to 2010, in 2009 when CM gave propofol there was no medical knowledge that Propofol could be given for sleep. CM was unethical in giving Propofol with no medical knowledge. Article mentions Propofol given for 2 hrs per night 5 nights, not 8 hours per night for 2 straight months. The article says that this test was successful, but it's still not used as a sleep medication because it's still experimental, there is not enough data about this. It needs to be extensively researched and tested. CM is the first doctor he's heard who used propofol for insomnia.

Flanagan asks how Steinberg knows CM didn't use Ambu bag, Steinberg says because CM said he did mouth to mouth. Flanagan asks how Steinberg knows CM didn’t use the blood pressure cuff, Steinberg says because it was not on MJ. Steinberg says pulse oximeter was not on MJ.

Steinberg says he doesn’t know what happened between 11 and 12 or how long CM watched MJ or when CM went to bathroom. Flanagan asks if he has an idea about the actual time of death. Steinberg says MJ was pronounced dead at 2:26PM but he was probably clinically dead for some time.

Steinberg says MJ savable when CM found him based on his interview. Steinberg says CM said he left MJ for 2 minutes. By using Ambu bag, by arousal and changing the effects of the medicines and if 911 was called MJ was savable.

Flanagan tries Steinberg to assume that CM was gone longer than 2 minutes. Steinberg is not comfortable making those assumptions as he based his report on CM’s statements. Flanagan mentions the phone calls; Steinberg does not want to comment on them. Steinberg says saying CM was on the phone tells him that CM shouldn’t have been on the phone and if MJ would only given 25mg it would wake him up. Steinberg says that it tells MJ was on a drip.

Flanagan wants him to assume if CM was gone longer than 2 minutes if MJ was savable. Steinberg says he was savable because according to CM’s statement MJ had a pulse, blood pressure and heart was still beating and with proper equipment he could have been saved. He could have given MJ oxygen. Steinberg says MJ wasn’t PEA when CM came back because he had a pulse. Flanagan asks how he knows know MJ had a pulse, Steinberg says because CM said so. Flanagan asks if it could PEA. Steinberg says in PEA there’s no pulse.

Flanagan asks what CM should have done. Steinberg says he should have called 911 and it would have taken 2 seconds. Steinberg says protocol says doctors are allowed 2 minutes to determine the situation. Flanagan asks if CM went down to ask for help in 12:05 – 5 minutes after – if it would be a violation of standard of care. Steinberg says he didn’t have the right equipment so he should have called 911 immediately.

sidebar

Flanagan tries to talk about Kai Chase. Steinberg says CM didn’t ask Kai to call 911. Flanagan asks what if CM called for help in 5 minutes but not in 2 minutes. Steinberg says it’s still a deviation from standard of care.

Flanagan asks if he talked to CM to review the case. Steinberg says no and he didn’t ask. Steinberg used CM’s 2 hour interview.

Flanagan asks what CM should he have done in 2 minutes. Steinberg says call 911, tilt the head to open airway, make him breathe with Ambu bag and give Flumazenil. Steinberg says he would have called 911 first. Steinberg says CM had to increase MJ’s breathing.

Flanagan asks if CM make a mistake in asking someone to call 911 Steinberg says he had no one around and he had to call 911. Steinberg says for the time it takes to call for security CM could have called 911. He had a cell phone. Steinberg says it would have taken him 2 seconds to say “I’m a doctor, there’s an arrest, come to 100 Carolwood now” and then CM could have put 911 on loudspeaker and continue to do what he was doing.

Flanagan asks if he’s aware that EMS said MJ was cool to the touch. Yes but CM said he was warm. Steinberg says you get cold in 26 minutes when you have no blood pressure.

Flanagan asks if Steinberg have no doubt that if 911 had been called immediately MJ would still be alive. Steinberg says he have no doubt about that, they could have saved him. CM said that he lost the pulse after calling MAW at 1212. So if the paramedics had been there at 1205 or 1210, they could have saved him.

Flanagan says that CM was in emergency situation and he could be mistaken in his estimations. Steinberg says there is clear evidence that there was a delay in calling 911 as CM went downstairs and called MAW rather than calling 911.

Flanagan asks based upon these facts if Steinberg thinks CM is responsible of MJ's death. Steinberg says yes.

Flanagan asks if CM should have dropped MJ on the floor, in spite of the IV line. Steinberg says he should stop the Propofol drip first and then he should be careful with the line when he’s putting MJ down the floor.

Flanagan asks rather than suction would it be okay to turn patient his side and clean the mouth with a finger will be okay. Steinberg says suction is needed.

Flanagan asks if a doctor has only 1 patient, he would still need to document everything he does. Steinberg says he does because obviously CM didn't recall what he had given when he talked to UCLA or with the paramedics.

Flanagan says that not having records did not kill MJ. Steinberg says it wouldn’t cause his death but it’s still deviation.

Lunch break .

 

[ivy]

Re: Murray Trial _ All daily trial Summaries - No discussion October 11th / Day 10 Full Testimony

Murray Trial Day 11 , October 12 2011

Afternoon Session

Dr.Steinberg Testimony

Walgren Redirect

Steinberg states that Murray did not act like he was ACLS certified.

Steinberg states that he used propfol in New York, but it was in hospital settings.

Steinberg states that gastroenterologists, dentists and ER doctors who use propofol receive appropriate training, with a trained staff and appropriate monitoring equipment are necessary.

Steinberg states that an article about the propofol study in Taiwan : published in 2010, was an experimental study. The patients were given propofol in a hospital , with the appropriate equipment, the experiment was approved by their ethics committee. Steinberg states that written, informed consents were obtained from the patients. Steinberg states that 8 hours of fasting occurred prior to being given propofol, and that the propofol was given by an anesthesiologist. Steinberg states that the patients were constantly monitored and pulse oximeters were attached to the patients. Steinberg states that the propofol was administered by an infusion pump, a drip was not used. Steinberg states that no other benzos were used. Steinberg states that the authors of the article specifically state that the study was experiment, and that is does not dictate a standard of care. Steinberg states that what Murray was doing was essentially an experiment.

Steinberg states that if he had to assume that Murray gave only 25mg, that there was no drip, would he draw the same conclusions? Steinberg states yes, that standard of care was deviated from in an unmonitored setting, without appropriate equipment, response was inappropriate, medical records were inappropriate and that it was be a foreseeable prediction that there would be respiratory depression (stop breathing).


Steinberg states that Murray played a direct, causal role in MJ's death.

Recross Flanagan

Steinberg states that the sleep study showed that propofol helped insomnia.

Steinberg states that in his analysis for the CA medical Board, that Murray deviated from the standard of care for MJ.

Steinberg states that the lack of a backup battery did not lead to the cause of MJ's death, however, 5 out of 6 deviations did lead to MJ's death.

Steinberg states that he did read Murray's interview with LAPD that he gave MJ propofol for 40-50 days without incident. Flanagan asks if Steinberg has made certain assumption, Steinberg states no. Steinberg states that he didn't assume that Murray gave propofol, that Murray didn't have the proper equipment, the delay in calling 911, improper care during the arrest, that all of these things are facts.

Walgren Re-redirect

Steinberg states that even if the defense theory that MJ self-injected propofol and therefore accidentally killed himself, according to Conrad Murray's own words, Murray would still be the causal factor in MJ's death.

Dr. Nader Kamangar/ Sleep Medicine Expert Testimony

Walgren Direct

NK states he is a pulmonary care/sleep medicine/critical care physician at UCLA. NK states he is board certified in four areas: internal medicine, pulmonary medicine, critical care, and sleep medicine.

NK states he is a medical reviewer for the CA Medical Board , and that he assessed Murray's care to MJ for the medical board. NK states that is propofol used in critical care unit on a daily basis. NK states he is trained in using propofol. NK states propofol is used for placement of endotracheal tubes, and for people on breathing machines. NK states that propofol is the most commonly used drug for this.

NK states that he found multiple deviations of standard of care with regard to Conrad Murray's care of MJ :

1. Propofol was given in an unacceptable setting : using this deep sedation agent in a home setting is inconceivable and an egregious violation of standard of care.

2. ACLS certified : the person who gives propofol must be trained in ACLS and airways management. There was a risk of hypoventilation (diminishment in rate of breathing), apnea and obstruction of the airway.

3. Need of assistance : Murray needed a second person (a nurse) to monitor, to pay complete and utter attention to MJ, especially if Murray was going to leave the room; this goes without saying. This violations Hippocratic oath, to abandon his patient.

4. Pre-procedure setup : imperative to be prepared for unforeseen circumstances. Things can change very quickly. A patient may look good, and the next minute there's a problem. Murray needed a suction catheter, because patients can regurgitate into their airway, and block the airway, this can cause death. A crash cart (medication on hand : adrenaline, ephedrine, medication to correct the heart beat, etc...) , pulse oximeter, defibrillator, automated infusion pump (precise dosing for propofol) even with people who are intubated;

NK states that all of these factors are extreme deviation of standard of care and are the equivalent of gross negligence.

NK states that he has never seen someone giving propofol at home in such settings, and would not have expected to see that.


5. Charts / medical documentation : or medical history, reactions to a medication. For example a blood pressure can look normal, but not be normal for a particular patient, and that change in blood pressure could be the indication of a problem.

6 . MJ was left alone, which is not acceptable, especially since Murray didn't have the right equipment.

7. Use of benzodiazapines: using lorazepam and midazolam on top of propofol can have higher effects : more significant respiratory depression, decrease cardiac output (often a consequence of respiratory depression), decreased blood pressure and cardiac arrest can occur directly, or because of low levels of oxygen.

8. Dehydration : blood circulation is not good when you are dehydrated , causes low blood pressure. Benzos and propofol would also lower blood pressure . Murray should not have used benzos or propofol if the patient is dehydrated.

9. Failure to call 911 : 911 should have been called immediately.

10. Improper CPR : Murray stated there was a pulse, therefore the heart was beating, so the problem was respiratory not cardiac. Murray should have dealt with airway management by placing an ambu-bag over MJ's mouth. Murray's administration of CPR was ineffective; it was not on a hard surface, and it was done with one hand . Correct CPR correctly allows about 20% of the normal blood circulation, so if you do it incorrectly

NK states that assuming Murray found MJ at noon, and calls MAW at 12:12 pm, the significance of the 12 minutes is that the what is the lack of blood flow to vital organs, especially to the brain. NK states that some individuals are more susceptible than others to a lack of oxygen. NK states that generally it takes 3 to 4 minutes before brain cells start to die. NK states that time is really important. NK states that because 911 was called at 12:20 pm, with the passage of 20 minutes, it reaches a point where it becomes irreversible.

NK states that Murray Deceived paramedics and ER staff because did not provide the accurate information, which is a deviation of standard of care.

NK states that Murray did not properly evaluate insomnia. NK states that insomnia can have many causes, so it's important to have a detailed history. NK states that Murray needed to exclude secondary problems (psychological problems, substance abuse, underlying conditions, chronic anxiety, depression , etc...)
NK states that insomnia is defined by no restful sleep for 4 weeks or more. NK states that once all the secondary problems are ruled out, primary insomnia is considered.

NK states that in order to diagnose/treat insomnia. a detailed sleep history is needed. : when do they go to bed, when do they fall asleep, when do you wake up, etc.. check sleep apnea. In some cases you need a sleep study.

NK states that a detailed pharmaceutical history was needed; both prescribed or over the counter (example migraine pills contain caffeine, that can cause insomnia), illicit drugs.

NK states that a detailed physical examination was needed; some underlying conditions can cause insomnia, for example asthma, congestive heart failure, diabetes, bladder problems, enlargement of prostate, thyroid conditions, etc..

NK stated blood testing was needed to rule out certain conditions : examples diabetes, kidney problem, restless legs , etc..

NK states that a good blood workup would reveal the use of narcotics, if the doctor asks the patient for one. NK states that if the patient is not giving the information, a doctor can simply refuse to treat the patient.

NK states that when all the above mentioned are done, then the doctor can treat the underlying condition that causes the insomnia.

NK states that in this case , Murray didn't have a detailed history. In addition, Murray didn't check what the root problem for MJ's insomnia was before treating him.

NK states that Murray did say that he saw that other doctors were treating MJ, he said he saw IV sites. NK states that if Murray could not get that info from MJ, Murray should have refused care, refused to give further medication. Murray didn't do that, and that was unethical.

NK states that Murray bypassed the evaluation of insomnia, bypassed the detailed history which was a deviation of care.

NK states it was obvious there was probably secondary causes in MJ's insomnia (substance abuse or anxiety or depression ) and that these underlying causes should have been treated.

NK explains about sleep hygiene techniques that can help in case of insomnia (using a bedroom to sleep only, among other things)

NK explains about sleep restriction, that the doctor should tell the patient to go to bed later , and limit their time in bed.

NK states that relaxation techniques can be used to treat insomnia.

NK states that all these can usually work better to treat insomnia than pharmacological approach, but that the pharmacological approach can also be used.

NK states that Murray did not use any of the above approaches on MJ, that Murray went direct to the pharmacological approach.

NK states that the pharmaceutical approach : 3 medications that are not benzos should be used first, because they are not addictive . NK states that a newer drug is melatonin something less addictive.

NK cites 4 different benzodiazepines that deal with insomnia. NK states that others are used also, but their main goal is to treat underlying conditions (anxiety). They are used in tablet form.

Midazolam : not appropriate for long term use for primary insomnia
Valium : not appropriate for long term use for primary insomnia
Lorazepam : can be used on short term basis, tablet form. Really addictive after 3 to 4 weeks. Used to treat underlying conditions, not primary innsomnia.

NK states that the use of midazolam and lorazepam to treat insomnia was an extreme deviation of care, especially in IV form.

NK states that it is inconceivable to use propofol for the management of insomnia, regardless of the setting. NK states that it is "beyond comprehension, inconceivable and disturbing." NK states that it is beyond a departure of standard of care, especially when underlying causes for insomnia were not treated.

NK states that even if MJ took lorazepam and propofol himself, Murray was the causal factor in MJ's death, especially if MJ had substance abuse problems. NK states that the lorazepam and the propofol should not have been readily available to MJ.

NK states that there is a risk of respiratory complications, especially if MJ was dehydrated, and that any competent doctor would have been aware of the risk.

 

[ivy]

Murray Trial Day 12 October 13, 2011

Morning Session

Dr Kamangar (NK) Testimony continued

Flanagan cross

CM treated MJ with Propofol with no problems for 2 months.3 days before MJ&#8217;s death CM tried to change the treatment. NK says he read it in CM&#8217;s statement police.

Flanagan asks if he experience any patient that was resistant to his recommendations. NK says he would send them to another specialist if it&#8217;s not in his area of expertise such as psychological issues. NK says he would realize his limitations.

NK says patients have right to refuse therapy as long as they make an informed decision.

Flanagan asks what if a patient is totally resistant and wants to do it in a certain way, what he would do. NK says he would refuse the treatment and try to understand the problem and why the patient does want it and may refer the patient to another specialist.

Flanagan asks if CM had these conversations with MJ. NK doesn&#8217;t know as there were no medical records.

NK says if a patient asks for inappropriate therapy you need to get to the root of it. You should try to understand why they are refusing an appropriate therapy and try to get the appropriate care for that patient. He would make sure that they get the right care and says that he would not give the patient a care that he thinks is inappropriate.

Flanagan says CM gave propofol for 2 months and MJ had no problems. NK says he can&#8217;t answer because he doesn&#8217;t know MJ&#8217;s state of mind and his situation.

NK says in the evaluation of the degree of deviation from standard of care, the end result doesn't matter. He didn&#8217;t consider MJ&#8217;s death. Flanagan says a doctor can practice bad medicine but the result might not be bad. NK says it doesn&#8217;t make it okay. Even if a treatment doesn&#8217;t cause death, it might still be gross negligence.

Flanagan asks if NK can tell what happened on june 25th. NK says MJ was receiving very inappropriate therapy in home setting, with inappropriate cocktail drugs, with inappropriate equipment, in a dehydrated patient, delay in calling 911. NK says it was a disaster that resulted in MJ's death.

Flanagan asks what was an inappropriate cocktail: valium + mizadolam +lorazepam+ 25 mg propofol. Flanagan asks if this cocktail can cause MJ&#8217;s death.

NK says &#8220;absolutely&#8221;, especially combination of Propofol and lorazepam, in a dehydrated patient, whose vitals were unknown ( blood pressure, heart rate etc ). NK calls this the &#8220;perfect storm&#8221; that killed MJ.

Flanagan says NK doesn&#8217;t know if Murray had that info or not. NK says CM didn&#8217;t record anything, had no records; there was no way to determine the trends and changes. Flanagan says not having documents doesn&#8217;t mean CM didn&#8217;t know those vitals. NK says not having documentation means that CM didn&#8217;t have the information. NK says you can&#8217;t take care of a patient only from a memory. NK says it&#8217;s a recipe for disaster.

NK gives an example of being with a single patient for long hours. NK says they keep notes. NK says needs to refer to the charts frequently to get a better picture. It's imperative to have charts. NK says without them you can&#8217;t see the trends and see differences.

Flanagan asks if NK thinks there's no way CM remembered what he was doing. NK says keeping records is standard care especially when you give such a powerful drug as propofol.

Flanagan says not keeping the charts, for example not writing down 2 mg Lorazepam, did not kill MJ. NK says he&#8217;s talking about vital signs, it&#8217;s not only about writing the medicines. NK says it's a combination of many factors that killed MJ and says the failure of chart is a contributing factor. NK says it&#8217;s bad medicine to not keep charts.

NK says MJ death was directly caused by Propofol + Lorazepam. NK says Lorazepam increased the side effects of Propofol. NK says it can be a lethal combination in a patient that is not monitored.

Flanagan asks questions about levels of the medicines, NK says he wants to defer it to a pharmacologist.

Flanagan asks if NK reviewed the records of Arnold Klein and saw that he gave MJ 6500 mg Demerol (pain killer) with Midazolam (sedative) over 3 months. Flanagan asks if MJ had a Demerol problem. NK says he cannot answer that question.

Flanagan asks if 200mg Demerol is a large dose. NK says it&#8217;s a significant dose and says he avoids using Demerol because it makes someone more hyper, excitable and creates more stimulation. Flanagan asks if Demerol can cause insomnia. NK says it&#8217;s correct.

Flanagan asks if MJ had insomnia problems. NK says he clearly had insomnia. Flanagan asks if NK made a determination of what type of insomnia. NK says doctors made no effort to determine that. NK says there were suggestions about the reasons for MJ&#8217;s insomnia such as performance anxiety and issues with certain medication (Demerol).

Flanagan asks if MJ had refractory insomnia. NK says he cannot say that.

Flanagan asks if he read CM&#8217;s records from 2006 -2009 on MJ. NK says CM gave MJ sleep medications as well as knew he was prescribed sleep medicines by other doctors. Flanagan says multiple doctors prescribed sleep medicines.

Flanagan asks if NK ever had a patient that was not forthright in their medical history. NK says he tries to get information from patient and from other doctors and hospitals. Flanagan says patients have to sign a release; they can&#8217;t get the medical records. NK says it&#8217;s true. NK says if they can&#8217;t get information from the patient, they would ask people that live with the patient for information and use sleep diary logs. NK says without getting these information we wouldn&#8217;t give Ambien to a patient. NK says if a doctor gives Ambien without a work up it would not be a serious deviation. NK says the doctor still needs to determine the cause and gather information.

Flanagan mentions physical examination and asks if an enlarged prostate can cause insomnia. NK says urination problems can keep a patient up. Flanagan asks if they would check the arms for needle marks. NK would be a part of a physical exam. Flanagan asks if he can determine if a person is taking intra muscular Demerol. NK says you can able to see it in some individuals and not by some.

NK says CM could have understand if MJ got Demerol from MJ&#8217;s behavior, slurred speech and from people who witnessed the change of behavior such as the bodyguards. NK says CM could have talked to his security, assistant and CM could have confronted the patient.

Flanagan asks if there are studies about Propofol as a treatment for insomnia. NK says they are just experimental and it&#8217;s in no way in a standard of care. They go over the Taiwan study. It dates back to November 2010. Patients had been extensively evaluated, informed consent was obtained, and they fasted for 8 hours. The study was done in a highly monitored setting, receiving propofol via an IV pump. 64 patients received propofol. Patient fell asleep better and have less sleep interruptions. Patients had no complications because they were highly monitored. It's very preliminary experiment with good results. It has no clinical applicability and the doctor that conducted the study stated that there was need for further study.

Flanagan asks why it is incomprehensible to use propofol for insomnia. NK says it was a study, in a highly monitored setting. NK says it is incomprehensible and inacceptable to give Propofol, especially with no monitoring and home setting.

Flanagan asks if 25 mg propofol is a very low dose. NK says yes. Flanagan states you wouldn't expect problems with such a small dose. NK says it depends on the patient. Such as if the patient is dehydrated (low blood pressure), had other medication (such as lorazepam) etc, there can be a problem that can lead to respiratory depression.

Flanagan asks questions about Lorazepam. NK says it&#8217;s not FDA approved for primary insomnia, especially the IV form. Lorazepam in oral form can be used if cause of insomnia is anxiety, for a very short period of time of 3 to 4 weeks. NK says oral form is appropriate for a short period of time as it created dependency and IV is inappropriate because monitoring is necessary. Even with monitoring, it&#8217;s not FDA approved for insomnia.

Flanagan asks if Lorazepam was appropriate with anxiety due to This is it. NK says there should have been a psychological or psychiatric help and says he would not have used it in this case and try to cure the underlying issue.

mid morning break

NK states that Ativan/Lorazepam in short periods of time, can be used for secondary insomnia associated with anxiety, even though it is not FDA approved. NK stresses that either drug should be only used for secondary insomnia, not primary insomnia.

NK states that Murray indicated he had a bag of saline infused, but because there was no charting of medical records, there is no way to know how much saline was being infused into MJ.

NK states that MJ was producing urine, based on Murray's interview with LAPD.

NK states that 25 mg of propofol would sedate someone for 6-10 minutes with no other meds, with no residual effects. NK states he would expect the person to have an increasing consciousness, and that the person would wake up by the 6-10 minutes. NK states he would not expect a patient to sleep after that time period, even if they were extremely tired. NK states that it would be the doctor's obligation to determine whether the patient was sleeping (if possible) and wake them up, and determine if they are responsive to stimuli.

NK states that even if a doctor has the lack of judgment to use propofol like Murray did on MJ, it is incumbent on the doctor to continually monitor the patient.

NK states that by visually monitoring, there is no way to determine if the patient is naturally asleep or still sedated. NK states that propofol can be used for conscious sedation in a highly monitored setting.

NK states that in his initial report, he stated that MJ had massive doses of propofol. NK states that he believes that MJ was given an unregulated drip IV of propofol, after the initial injection push of propofol.

NK states that he believes that the sequence most likely is that MJ had a respiratory arrest, causing cardiac arrest.

NK states that Murray should have called 911 first, especially given the lack of tools Murray had available. NK states that he should have determined whether he was breathing, determined his pulse, manipulate the airway, and tilt the jaw back to determine if there was blockage.
NK states that he is aware that there were no working landline phones at Carolwood. NK states that he is aware that the 911 call took 2:43, and that paramedics got there in less than 6 minutes.

NK states that even if MJ self medicated with excessive Lorazepam and bolus pushed propofol, Murray is still responsible for MJ's death.

Walgren Redirect

NK states that he would call 911 immediately, it's a moral/professional obligation, but it's basic common sense as well.

NK states that Walgren provided him with Dr. Klein's medical records. NK states that Murray stated in his interview with police multiple times that he was aware that MJ was seeing Dr. Klein.

NK states that the study done in China on propofol was done in a hospital, highly monitored, using a very precise drip, was used as an experiment and would need another study done to positively state that propofol could be used for insomnia.

NK states that one of the fundamental tenets of the doctor/patient relationship is putting the patient first. NK states that this means knowing when to say no to a patient, and that if, assuming MJ asked for the propofol, the doctor has the professional, ethical and moral obligation to say no.

NK states that he makes the final decision as to the appropriate care of the patient, not the patient.

NK states that Murray's interview indicates his inability to give precise information about oxygen saturation, although Murray indicated the oxygen saturation was in the high 90's and then stated 02 saturation was 90.

NK states that a doctor could be grossly negligent and survive, however in MJ's case, Murray was grossly negligent in multiple cases and this is what caused MJ's death.

Recross Flanagan

NK states that Murray said he immediately performed CPR, but that NK should have called 911. NK states that he is aware Murray said he went partially down the stairs, but that nobody could do the same job as the paramedics, so that should have been done first.

NK states that although Murray states he asked the chef to call security and she did not do so, NK is not sure whether he is aware of that fact.

Re-redirect Walgren

NK states again that Murray should have immediately called 911.

Re-recross Flanagan

NK states that if there was someone in a hallway, and he was in a room with a person who was medically down, he might shout to the hallway, but ultimately it is his responsibility as a doctor to call 911.

Dr. Steven Shafer Anesthesiology Expert Testimony

Walgren Direct

SS states that he is a professor of anesthesiology at Columbia University, adjunct professor and Stanford and UCSF. SS states that he has worked at Columbia since 2007, at Stanford since 1987, tenured at 2000. SS states that he teaches a class in pharmacokinetics at UCSF.

Pharmacokinetics deals with math models that deals with drug concentrations in the body to determine what the drug actually does to the body, which helps determine dosages of meds and what is effective and what is not.

SS states that pharmacokinetics is a discipline that is growing, and that it determines labels for every med, core of pharmaceutical companies, core of FDA, and services doctors on how to use the med safely and reduce toxicity.

SS states that the three schools he hold professorships at are ranked among the top medical schools in the US.

SS states that he is editor-in-chief for the journal Anesthesiology and Analgesia, which publishes manuscripts (studies) of issues related to anesthesiology. Among the 70 board members that sit under Shafer, SS states is defense witness Dr. Paul White. SS states that the journals' acceptance rate for manuscripts is roughly 21%, so about 4 out of 5 submitted are rejected. SS states that due to the editor in chief position for the journal, he is exposed to unusual cases that he never thought he might read about.

SS states that in 1987 the FDA had problems determining proper dosage levels of Midazolam, therefore the FDA was very particular about dosing instructions for infusing propofol. SS states that he did the infusion rate analyses and the start rate of propofol for the label AstraZeneca.

SS states that in particular, he analyzed the reduction of dosing in elderly patients, and that almost all label dosing was done by SS in 1991.

SS states that drugs that are marketed, one drug is marketed as a chemical name, in this case propofol. SS states that the retail name is Diprivan, and that it differs slightly from propofol because there is a fat solution (emulsion) added to the propofol.

SS states that max sedated means monitored anesthesia care, the care a patient expects, with a controlled dose, and monitoring. SS states that titration means increasing or decreasing the dose according to each patient.

SS states that pharma means drugs, kinetics means motions, so pharmacokinetics means drugs in motions. SS explains that when meds are given, drugs go thru several processes or motions, first when meds goes into the patient it becomes more diluted. Second the bloodstream takes the drug everywhere in the body, delivers to the brain, and will move the drug to the liver and metabolized there. SS states that the liver chews the drug up, that the pieces can go to the blood, or to the bile, then to the intestine. SS states that they can go to the kidneys and the kidneys then remove the blood from the body.

SS states that he is an expert in pharmacokinetics, specific to propofol. SS states that he developed the module of the software that eventually determined propofol dosing on labels for all propofol bottles.

court ends early due to a scheduling issue. There's no court on Friday October 14 as well. Testimony will resume on Monday October 17.

 

[ivy]

Re: Murray Trial _ All daily trial Summaries - No discussion October 13th / Day 12 Full Testimony

Monday October 17, 2011 session has been postponed due to death in Dr. Shafer's family. It's currently unclear when the testimony will resume. Court officials say that resumption of the trial will be announced when further information is available

 

[ivy]

Re: Murray Trial _ All daily trial Summaries - No discussion October 13th / Day 12 Full Testimony

Murray Trial will not be in session on Tuesday October 18 because of a new test done on Michael Jackson stomach content. DA Walgren told Judge Pastor that coroner's office re-tested for lorazepam levels and found that they were lower than the defense analysis suggested. DA Walgren said the real amount of the drug Lorazepam found in Michael Jackson's stomach is "inconsistent with oral consumption".

 

[ivy]

Murray Trial Day 13 , October 19, 2011

Dr. Shafer Testimony continued

Walgren Direct continued

Walgren goes over again the credentials of Dr. Shafer by showing the journal he's editor in chief and multiple research articles written by Dr. Shafer. Research articles examine the differences in regards to gender, age. Dr. Shafer also had research done on Lorazepam, Midazolam and Lidocaine. DA Walgren says that he will ask about these topics during testimony.

Walgren mentions difference between intensive care sedation and procedure related sedation (MAC). Dr. Shafer tells that intensive care sedation would be for longer time, MAC would be shorter.

Dr. shafer says that all the work he has done on this case was for free. He says he never charged money for testimony because he feels it's inappropriate and unethical to benefit from medical misadventures. Shafer says he doesn't want his integrity to be questionned as well Shafer also says he wanted to get involved in this case to restore general public's confidence in anesthesia and doctors. Dr. Shafer says that he's asked daily by his patients " Are you going to give me that drug that killed Michael Jackson?". He says that he hopes to alleviate this unneeded fear with his testimony.

mid morning break

Dr. Shafer has brought several medical items for demonstration. First he starts with explaining Saline bag and it's ports. Later Shafer tells what and IV is. Infusion(Drip) when drug drips in slowly. Shafer explains that Propofol comes in a glass vial, there's an aliminium seal and a rubber stopper on top. To get the drug out you need to go through with a slow needle or a large spike to get the drug out.
Walgren asks Shafer to demonstrate to get Propofol out of the bottle.

Shafer demonstrates to get out Propofol with a syringe / needle. Shafer tells to get Propofol out you need to replace Propofol with air so that Propofol will go into the needle.

Walgren asks Dr. Shafer to examine 100 ml Propofol bottle from the scene. Shaffer says that it has a spike hole and not a needle hole.

Dr Shafer has made a video for his case, to demonstrate what is necessary for sedation, even for 25mg propofol. Playing the video : «*an over view of safe administration of sedation*»

The doctor first prepares the room, checks the equipment. Video shows multiple equipment for airway management such a tube for the throat, a tube for the nose, an equipment for intibation, a throat mask for air. Organizes these items.

Then the doctor checks the oxygen equipment. Doctor checks if the oxygen supply work, checks nasal cannula, checks to see if nasal cannula is measuring carbon dioxide by capnometer. Doctor tests anesthesia breathing circuit. This is the equipment used if the patient stops breathing and the doctor needs to push oxygen into the lungs. Doctor then checks the back up oxygen. This is used if for some reason the breathing circuit fails.

Doctor then checks suction apparatus. This is important because if the contents of the stomach gets into the lungs or if the vomit (bile) gets into the lung, it would destroy the lungs. This is why patients are told to not to eat or drink prior to anesthesia. if the patient vomits or the contents of the stomach come to the mouth, the doctor has to be very quick to clean them with the suction equipment before it goes into the lungs and destroys the lungs.

Next step is to set up the infusion pump. It takes a few minutes to set it up. In the video they use a syringe pump. Doctor first draws Propofol into the syringe. As Dr. Shafer demonstrated this is not easy. You need to draw air into the syringe and do multiple draws to fill the syringe. Dr. Shafer tells a narrow tubing has to be used in the infusion pump as the wide tubing could be problematic. Then the doctor programs the pump, putting the patients weight, correct drug name, infusion rate. Doctor verifies the information for a second time.

Next step is to assess the patient. Anesthesiologist is repsonsible for knowing his patient. Makes a physical examination, first thing is airway, listens to the lungs, checks the heart. Always done for each procedure, for every patient. No exception.

Doctor also gets the informed consent of the patient. Doctor informs the patient of risks and explains what the procedure entails, asks the patient if he has any questions, then patient signs the informed consent form. Dr. Shafer says oral consent is not binding, and is not recognized.

Some steps are not shown on the video. These are: patient put on table, monitoring equipment such as blood pressure cuff, pulse oximeter, ECG are put on patient. Oxygen in place, intravenous catheter is put into the patient. Afther these doctor pauses to verify again. Doctor does one last check before injecting the propofol.

Propofol infusion pump is started. Anesthesiologist is close to the patient, monitors the patient. Doctor keeps records of the vitals. Chart is a necessity to track the patient and the patterns. It's a responsibility to the patient.

In this part of the video, we are shown examples of what can go wrong.

First example is when blood pressure drops. Dr. Shafer says this is very common and they see it everyday. Propofol lowers blood pressure especially if the patient is dehydrates. Doctor gives ephedrine through the IV line. Generally blood pressure comes to normal levels.

Second example is carbon dioxide. The monitor shows that carbon dioxide stopped. It means the patient is not exhaling and the airway is obstructed. Doctor immediately does chin lift and jaw thrust. Dr. Shafer this is also done very routinely. Shafer says the most common reason is because the tongue is blocking the airway and by doing a chin lift and jaw thrust you can move the tongue.

Third example is apnea. This is when the patient doesn't even try to breath. In this instance you need to take over for the patient and force air into the lungs. Doctor removes the nasal cannula, places the mask on the patient's mouth and nose and squeeze the bag to push oxygen into the lungs.

Fourth example is aspiration (not shown on video). This is when the patient vomits and/or stomach contents come to the mouth. Patient is turned sideways and before the next breath you need to suction everything.

Fifth example is cardiac arrest. Heart stops beathing and the patient stops breathing. Doctor does a 2-3 second assesment to make sure that the monitor has not failed. Then the doctor calls for help. First thing is always to call for help. One person begins CPR, one person is ventilating the patient and other person gives resuscitation drugs. Alls of this is done to keep the patient alive for enough time to fix the problem that caused the arrest. These efforts are continued until the patient is revived, or is pronouced dead.

Lunch break

 

[ivy]

Murray Trial Day 13 , October 19, 2011

Afternoon session

Dr. Shafer Testimony continued

Walgren Direct continued

Dr. Shafer says that the safeguards and requirements apply to all doctors who perform sedation, for any type of IV sedatives. Some nurses are also trained about sedation. These guidelines apply to them as well.

Walgren asks if CM's intent were to give 25mg would these standards still apply. Shafer says yes and continues to say the patient (MJ) had other IV sedatives, profound inability to sleep, he was exhausted, dehydrated; and he had been given sedatives for some time and he could have saome elements of dependency or withdrawal.

Walgren asks if it possible to go in saying I'll only give a small amount so I don't need these guidelines. Dr. Shafer says it's a trap. Even for a little sedation , it's a slippery slope, you may have to give more. You never know how the patient will react. Shafer says there's no such thing as a little sedation and the worst disasters happen when people cut corners.

Facts in this case suggest that virtually none of the safeguards for sedation were in place when propofol was administered to MJ.

Walgren asks Shafer explain how patients reacts different to the same dose of sedatives. Shafer says that some patients will need half the usual dose and some patients will need double the dose. Shafer says 25 mg is the limit when a patient migh stop breathing. Shafer says you can't assume that this will be an average patient. Shafer says you always assume your patient is at the edge of sensitivity and prepare for the worst case scenario.

Shafer did a report about this case dated April 15th, 2011. In his report he used some terms.
Minor violation : not consistent with standard of care, but would not expect to cause harm for the patient unless there are several other violations
Serious violation : expected to cause harm to the patient, in combination of other violations
Egregious violation : These should never happen in the hand of comptent doctors. An egeregious violation can alone be catastrophic for the patient. Competent doctors know that bad outcome is a high possibility
Unconscionable vioation : It goes beyond the standard of care. It's an ethical and moral violation as well as a medical violation.

Walgren goes over Dr. Shafer's report and 17 egregious violations he identified.

Lack of basic airway equipment, egregious violation. MJ died because he stopped breathing which is expected when you give IV sedatives. It must be there without question.

Walgren asks Dr. Shafer assume that CM had left only for 2 minutes and CM had the equipment if MJ could have been saved? Dr. Shafer says yes and probably MJ had an obstructed airway and even a simple chin lift might have been required to save MJ. Shafer says that CM says he didn't use the ambu bag. Shafer says mouth to mouth is less effective and gives used air.

Lack of advanced airway equipment. Those are eqipment such as laryngeal mask, or laryngoscope and endotracheal tube. Shafer had described it a a serious deviation originally but changed his mind to en egregious because of the setting. CM had no help.

Shafer says that it's his view that CM had anticipated to give 100 ml vials. CM had purchased at least 130 100 ml vials, Shafer believes that's at least one per night. Shafer says it's an extraordinary amount for one patient; between april – to 25th june, that 80 nights, 1937 mg/night. Walgren asks how he came to this determination. Shafer says Propofol is an environment for bacteria dveelopment. Once a bottle is opened with a needle, it has to be used within 6 hours. Shafer says this suggests CM planned to use 100ml, if he didn't he would purchase smaller vials.

Lack of suction apparatus, egregious violation. Shafer reminds the jury that any stomach content and/or vomit has to be suctioned so that it won't go into the lungs. Shafer says there's no evidence that MJ was asked to fast for 8 hours prior being given Propofol. Due to this MJ was at greatly higher risk. Therefore a suction equipment was needed.

Lack of infusion pump, egregious violation . There was no infusion pump. Without it the rate can not be precisely controled and the risk of overdose is very high. Shafer says in his opinion this is likely contributed to MJ's death.

Walgren asks without an infusion pump how can one person control the drip. Shafer answers by roller clamp. It's a plastic wheel that pinches the tubing to decrease the amount . Shafer says it's extremely imprecise and that was the only thing available to CM when he gave propofol.

Lack of pulse oximetry, egregious violation . The pulse oxieter that CM used was completely inappropriate. It's not intended to be used for continuous care as it had no alarm. Shafer says that on monitors in hospital they can see it on the screen and there is a tone. Doctors will hear the tone changes which alerts them that there's a problem. In MJ's case only way to monitor was to take his hand and continoiusly look to it. If there was a proper equipment, there would be a monitor showing the vital signs from distance and there would be an alarm that could have saved MJ's life.

Lack of blood pressure cuff,egregious violation. Propofol lowers everyone's blood pressure. Doctors would treat it with additional saline solution or with less propofol. MJ was dehydrated, the risk are higher for exagerated response. If blood pressure falls the body shuts down the flow to the arms and legs and concentrates on providing blood to heart and the brain. The drug becomes more potent. Dr. Shafer says the manual blood pressure cuff that CM had in his bag in the cabinet is useless.

Lack of ECG, egregious violation . ECG allows you te see he heart rate, the heart rythm. This is routine monitoring. In this case CM couldn't know what kind of therapy to use when MJ went into arrest.

Lack of capnography, an egregious violation. Dr. Shafer initially thought that it was not a violation as other specialist doesn't use it. However in MJ's environment it was a disaster. If CM had it he would have known immediately that MJ had stopped breathing.

Lack of emergency drugs, serious violation. Dr. Shafer doesn't think lack of emergency drugs contributed to MJ's death. Shafer says if MJ had a low blood pressure as he wasn't going through surgery, MJ could have been woken up and hydration and stopping propofol would have been enough.

Lack of charts, egregious violation as well as unethical. Shafer says a doctor needs charts to asses what's going on and the changes. Shafer says the patient or if the patient doesn't survive the family has a right to know what happened and what the doctor did.

Dr. Shafer gives an example and Dr. Shafer looks clearly upset. Dr. Shafer says he knows how he would feel if his father , brother or son went to a medical facility for 80 days and died and the doctors told him they don't know what happened because they have no reports. Dr.Shafer says it's unbelieveable that after 80 days of treatment there's not a single record of treatment. Dr.Shafer says that not keeping records is also illegal in California. Dr. Shafer says that doctors has to keep records even if the patient doesn't want them and confidentiality cannot be an excuse.

Shafer says that in CM's interview he mentioned MJ could have been dependent on Propofol and that would require a referral but he can't do that referral as he had no records.

Obligation to get information about the patient. Shafer says it's doctors responsability to know everything about their patient to provide care. Shafer says CM mentions IV sites but didn't follow it through and asked what's happening. Walgren asks what if the patient says it's none of your business, Shafer says that then he would say "Then I can not be your doctor".

Dr. Shafer the only physical evidence of Michael was done months ago. Shafer says CM mentioning MJ being dehydrated but yet he do a simple blood pressure check. Shafer says there's no history, not even a simple recording of the vital signs. Shafer calls this serious violation and that no doctor does that.

Failure to maintain a doctor patient relationship , egregious violation. In this relationship doctor would put the patient first. It doesn't meean to do what the patient asks, it's to do what's best for patient. If patient asks for something foolish or dangerous, doctor should have said no. Dr. Shafer describes the relation between Cm and MJ as employer employee relationship. Patient stated what he wanted, CM says yes. Shafer compares CM to a housekeeper that does what she's told. That's what an employee does. Shafer says CM was not exercising his medical judgement and he was not acting in MJ's best interest. CM completely abandonned medical judgement.Shafer says the very first time MJ asked for propofol, CM should have sent MJ to a sleep specialist.

Lack of Inormed consent , egregious and unconscinable. An informed consent would have involved that propofol is not a treatment for insomnia, It woud have explained risk of death and alternative treatments. Dr. Shafer says there's no proof that MJ knew that he was putting his life at risk. Shafer again mentions that the consent has to be written. MJ was denied his right o make an informed decision.

Need to continuously observe the mental satus, egregious and unconscinable. Dr. Shafer says that doctors need to stay with the patient and CM abadonned his patient. Shafer compares giving sedation to driving a motor home. Shafer says you cannot leave the steering wheel on a highway to relieve yourself. If you do it would be an disaster. Dr. Shafer says in 25 years he has been a physician he have never walked out of the room.

Continious monitoring / observation, egregious violation . CM left MJ alone and he was on the phone. Shafer says youcan't multi task especially if you have no monitoring equipment. Dr. Shafer a patient who is about to die, doesn't look that different from a patient that is okay. Dr. Shafer says from a distance you can't tell if a person is breathing. Shafer says he believes Murray may have been in the room and have not realised MJ stopped breathing.

Shafer says resuciation would have been easy as all needed is to stop propofol and make MJ beathe. Shafer once ahain reminds that it's common that patients would stop breathing during anesthesia and it's expected. Shafer says all CM was monitoring all he needed to do was to lift the chin and ventilate.

mid afternoon break

Lack of continuous documentions, egregius and unconscionable violation. Dr. Shafer says documentation is part of giving care. Shafer says if CM had the reports he would have seen that the oxygen saturation lowered or the heart rythm changed.

Failure to call 911 timely, egregious violation. Shafer says in that setting MJ could not have been revived without assistance. Shafer says calling 911 was the highest priority given the lack of help and equipment. Shafer says if calling 911 was not possible, Propofol should not been given at all.

Shafer says assuming CM realised there was a problem at 12:00 he doesn't understand that CM left a voice message to MAW and how it took 20 mn to call 911. Shafer calls it unconceivable and completely and utterly inexcusable.

Shafer says if CM left only for 2 minutes and called paramedics immediately MJ would be alive with some brain damage. If CM realized MJ was in trouble in 2 minutes and had the airway equipment MJ would be alive and uninjured.

Walgren asks how effective is a one handed CPR on a bed. Shafer says the patient sinks into the bed and it's ineffective. Even if CM had his hand behind Mj's back it's ineffective because you need your body weight to do effective CPR. Shafer says you need 2 hands, one hand is not enough. Shafer says CM hould have called 911 first and then moved Mj to the floor. Shafer also says based on CM's interview the issue here was not that the heart stopped; MJe stopped breathing. CM said there was pulse. If there was a pulse what he needed to do was to have oxygen into his lungs. There was no need for CPR if there was a pulse. Shafer says a lay person would use mouth to mouth as they have no other means. For a doctor it shows that the doctor doesn't have equipment needed.

Shafer says that he doesn't understand why CM raised MJ's legs. Shafer calls it a waste of time. Shafer says raising the legs is done when you thing there's not enough blood in the heart but that wasn't MJ's problem. His breathing had stopped. Shafer says that it shows CM was clueless about what to do.

Walgren asks what is flumazenil. Shafer explains it's a frug that reverses the effects of lorazepam and midazolam. Dr. Shafer says he's curious why CM gave it. Shafer says it doesn't fit with only giving 2 doses of 2 mg several hours before. Dr. Shafer says he believes that CM knew that there was a lot more lorazepam.

Dr. Shafer talks about deception of paramedics and UCLA doctors and not mentionning propofol, egregious and unconscionable violation. Dr. Shafer says a person's life was in the balance, it's inexcusable. Shafer says he also mischaracterized this event as a witnessed arrest. Shafer says a witnessed arrest is not an arrest for lack of breathing, it is usually something like a heart attack. So the therapy of the paramedics and ER doctors was not appropriate. In an arrest you have only seconds to choose a treatment, paramedics and ER doctors were not given the corect information. Shafer says witholding information is a violation of patient's trust.

Walgren asks what is polypharmacy. Shafer explains it's administering many drugs at once and it's a serious violation. Shafer says what CM gave to MJ didn't make any sense. Shafer says Midazolam and lorazepam are very similar drugs and the only difference is how long they stay in the system. Shafer says he doesn't understand why CM switched from midazolam to lorazepam and back. Shafer says that he thinks that CM did not understand the drugs he was giving.

Walgren asks if 25mg Propofol is a safe dose. Shafer says in this setting there was no safe dose. Midazolam an lorazepam were given. MJ had received benzos for 80 nights, he could have been dependant or in withdrawal from the benzos or propofol. Dr. Shafer says he never heard a person given propofol for 80 nights and doesn't know what would happen.

Walgren asks about the Taiwan study. Shafer says there are over 13000 medical articles about propofol, 2500 articles about propofol and sedation and there's only one article on Propofol and insomnia. It's this study done in 2010. Dr. Shafer says that he wouldn't published the Taiwan study because the dose of Propofol that was given is not mentioned. Dr. Shafer also says that the conditions of the study doesn't apply here. That study was done in a hospital, by anesthesiolgists, patients had fasted for 8 hours, they were monitored, an infusion pump was used, propofol was used for 2 hours for 5 days during two weeks. There was no other medication. The patients were treated within the standard of care. Shafer says the article actually highlights CMs deviations from standard of care.

Walgren asks even if MJ had taken Lorazepam and/or Propofol would these 17 deviations would still be relevant and if Shafer would consider CM responsible for MJ's death. Dr. Shafer answers yes.

Walgren asks about doctor patient relationship. Dr. Shafer says it's dated back centuries ago. Dr. Shafer says that doctors have power to give drugs and cut open a patient etc and this is because they are entrusted to do that because they are supposed put the patient first. Dr. Shafer reads hippocratic oath. Shafer says when Cm agreed to give propofol to MJ, he put CM first. When CM was showing up every night with propofol and saline bags, he was putting CM first. When Cm withheld info from paramedics and ER doctors, he put CM first.