Conrad Murray Trial: Recapping Key Events (Weeks 1, 2, and 3)

The Conrad Murray trial has been filled moments of drama, shock, tenseness, sadness and admonition.  During week one, members of Michael Jackson’s inner circle (including director/producer/choreographer Kenny Ortega, security staff, and personal chef) testified to his medical care not being Murray’s top priority… Paramedics and an ER physician confirmed Jackson could have been saved had they been summoned sooner, and had Murray not been preoccupied with gathering potential evidence and dispensing false information (such as the existence of propofol in MJ’s system).  Jurors also learned how Jackson’s children witnessed their lifeless father in bed.

During cross examination of the litany of witnesses, the defense team seemed to be pinning their hopes on salvaging Murray’s reputation, and dismantling the sympathy for Jackson by portraying him as an addict who self-administered the lethal propofol dose.  Week two commenced with medical personnel testifying MJ was clinically dead by the time he arrived at UCLA Medical Center, despite efforts at resuscitation.  Murray told an emergency room physician he administered 4 milligrams of the sedative Lorazepam which caused cardiac arrest. Testimony followed from AT&T and Sprint Nextel employees regarding data residing on Murray’s iPhone. Tuesday revealed 4 women who were in contact with Murray around MJs death – one employee and three girlfriends. Notably, the prosecution showed the very interesting relationship between Murray and Nicole Alvarez, the woman with whom MJ  fathered a son in March 2009.  Alvarez was accepting FedEx packages on Murray’s behalf.  She testified during the preliminary hearing of seeing a faxed contract for $150,000, but claimed she could not remember seeing such a fax (which detailed Murray’s $150,000.00 contract from MJ) during the trial.  Later that day, Las Vegas pharmacist Tim Lopez – who mysteriously left for an extended trip to Thailand after admitting he sent Murray copious quantities of propofol during the preliminary hearing – testified his relationship with Murray began in 2008 for orders of Benoquin cream (used in treating Vitiligo). Orders for propofol ramped up steadily.

Wednesday, Sally Hirschberg testified.  She is a customer service and inbound sales employee of Seacoast Medical, a pharmaceutical distributor in Omaha, Nebraska.  She relayed how an account was opened by Murray in December 2006, as well as various medical items he ordered in April 2009, including a ‘safe site’ IV set, and an order cancellation for condom catheters on June 26, 2009 (a day after MJs death).  Cross examination, however, seemed to assert that the items Murray ordered were not unusual for a medical practice specializing in cardiovascular treatment.  DEA computer forensics examiner, Stephen Marx, testified about data collected from Murray’s iPhone, including screenshots, e-mails and voice recordings.  Among these e-mails were requests of MJs medical records by his insurance company before they would agree to cover the planned “This Is It” tour; MJ was heard to have denied this request.  A recording of a conversation between Murray and MJ from May 10, 2009, was heard; MJ, almost incomprehensibly with slurred speech, spoke about healing the world and helping children because he didn’t have a childhood.  The recording ended with Murray saying “Are you OK?” and Jackson replying “I am asleep.”  Next, L.A. County Coroner, Elissa Freak, testified she arrived at UCLA Medical Center several hours after Jackson was pronounced dead in order to examine notes, photographs, and the body for cause of death.  After no clues were gleaned, she extracted 4 vials of his blood, and made her way to Jackson’s home for scene investigation. Prescription drugs were strewn about the bedroom, including an empty 20ml bottle of propofol.  Items included an oxygen tank, alcohol prep pads, a 10cc syringe with the needle removed, an IV catheter on the floor under an Ambu bag (for resuscitation), an IV pole with saline bag and tubing draped over it, an aspirin bottle, a syringe box, catheters, and a jug of urine.

The oft referenced evidence Murray advised MJ’s bodyguard, Alberto Alvarez, to secure the day emergency medical personnel were summoned to the house was introduced. Alvarez testified he was advised to place various vials, including propofal, inside a saline bag, and various other bags as follows:

A black bag, containing a Starline blood pressure cuff box and 3 bottles of Lidocaine, a local anesthetic.
A blue Costco bag (recovered from a closet) containing various “medical debris:” a pulse oximeter (a medical device that indirectly monitors the oxygen saturation of a patient’s blood and changes in blood volume in the skin), a lanyard, vials, an empty 20ml propofol bottle, 2 bottles of the sedative Midazolam, an opened IV administration set, a urinary leg bag, a wideband bag, 2 empty dressing bags, 2 empty catheter bags, opened alcohol prep pads, dressing backings, an empty syringe packet, 4 vial tops and a needle cap. Also, the aforementioned saline bag cut and containing the “more or less empty” 100ml propofol bottle which Alvarez recalls removing from the IV stand.

A blue Baby Essentials bag contained an array of bottles including 100ml propofol and 20ml propofol bottles (filled to various levels, some opened, some closed), and the medications Lorazepam, Flumazenil, Lidocaine and Benoquin cream.  Additionally, some of Murray’s business cards from his Houston practice were inside.

Thursday continued Ms. Fleak’s testimony.  She confirmed the presence of various medical apparatus by MJs bed.  After a subpoena for his medical records, she was only provided those prior to 2009.  The defense cited several mistakes she made during her examination.  Dan Anderson, chief toxicologist at the L.A. Coroner’s office, testified to the content of blood and urine collected at UCLA, and later at the autopsy.  Not surprisingly, propofol along with various other medications, were present.  An awkward exchange via cross examination revealed drugs redistributed and reconcentrated in the blood post-mortem.  Friday, Fleak was recalled briefly to go over photographs.

Next, LAPD Detective Scott Smith (24 years experience) took the stand.  During June 2009, he was working for Robbery Homicide.  Though he did not see Murray, he collected closed circuit television footage of Murray leaving the ER at 4.38pm and appearing in the west lobby at 5.02pm.  Before Smith left he interviewed Mohammed and Alvarez (MJ’s security).  Smith went to the Carolwood residence to assist and support coroner’s investigators.   On June 26th, Smith attended the autopsy which was deferred pending toxicology.  He continued his investigation; the Jackson family relinquished certain items to LAPD, including rotten cannabis in a shaving kit, some lotion, paper, an envelope and other debris.  The shaving kit contained a bottle of Temazepam prescribed by Murray to Omar Arnold, Sep 26 2008.  Smith also saw various empty pill bottles in the master bathroom.

The court heard more than half the highly anticipated two hour tape recorded interview Murray had with police investigators two days after MJ died.  It revealed Murray detailing his relationship with Jackson and portraying him as an insomniac who, perhaps inadvertently, was sabotaging his planned “This Is It” tour.  He also insinuated MJ was already addicted to propofol (or “milk”, as it was referred to) from other doctors who preceded and coincided with his tenure as caregiver.  Purportedly, MJ was led to him by “divine guidance” after a six hour infusion of propofol while under another doctor’s care.  Nightly doses of propofol under Murray’s watch became a routine, although an attempt was made to start weaning MJ off three days prior to his death.  In the early morning of June 25, a steady increase of pharmaceuticals was given, until the final fatal dose of proposal was administered.  Week 3 commenced with Murray’s tape recorded interviews as follows:

–         A social worker opined bringing MJs children to the hospital would bring them “closure.”  Paris said she didn’t want to be “an orphan.”  Other members of the family arrived, but Joe Jackson did not show up.  Katherine Jackson asked Murray why MJ died, but Murray did not know. Murray then went to another wing of the hospital for a press release, which explains why hospital surveillance cameras recorded Murray leaving the ER.
–         Murray suspected MJ was doctor shopping by prescription pill bottles near MJs bed bearing other doctors’ names.  He maintains MJ never spoke of them.   MJ’s production team noticed his performances visibly suffered after each visit.
–         Murray felt MJ was legally blind.
–         At the close of the interview, Murray advised detectives the location of his medical bags and seemed surprised they were not yet recovered.

Smith’s testimony revealed his notes did not mention propofol at any location listed in the search warrant, which included Murray’s Las Vegas home, or, offices in Vegas or Houston, Nicole Alvarez’s apartment, his car, etc.  Statements from Mohammed of MJ’s security team and Michael Amir Williams (MJ’s personal assistant) revealed Murray did not wish to be brought back to Carolwood post-mortem.  Alvarez failed to mention the presence of propofol in an IV bag, or, Murray asking him to put things in bags until after the cause of death was released on August 29, 2009.  Defense attorney Ed Chernoff admonished Smith for his incomplete notes, especially those involving Murray’s medical bags in MJs closet.

Deputy Medical Examiner (now chief of forensic medicine at the LA Coroner’s office) Dr. Christopher Rogers took the stand next.  Conducting MJs autopsy June 26, 2009, was another in a series of thousands he previously performed.  Results showed the 50 year old MJ neither suffered heart disease, nor were there any heart irregularities.  He suffered no trauma, his esophagus was intact and no propofol was found to be in his stomach.  Similarly, no foreign matter was found in the mouth, upper airway, trachea and stomach, namely pills, or, capsules.  A visceral reminder of MJs mortality was felt when a displayed photo revealed MJs body during the autopsy with his genitals covered.  Roger’s request to Murray for MJs medical records was ignored.  Rogers then remitted samples from each organ to resident experts for a toxicological analysis.  Results showed acute propofol intoxication with contributing effects from benzodiazepines, which exacerbated respiratory and cardiovascular depression.  Rogers felt the evidence showed the manner of death was homicide due to the following:

–         no prior medical issue
–         propofol not a viable option for insomnia
–         propofol was used outside the care of a hospital or clinic
–         excessive amounts of propofol administered
–         lack of requisite equipment needed to administer propofol (eg: EKG monitoring, dosing decide, resuscitation/endotracheal equipment, medication)

Under cross-examination by Michael Flanagan, Rogers softened his initial position – claiming it could have been possible MJ injected himself with a fatal dose of propofol, but the probability is low.  Prosecution intended to introduce a study conducted in Chile; 6 people orally ingested propofol without experiencing any of its intended effects.  Such position forced the defense to drop the “drinking” argument regarding MJs as part of a variety of ways he could have accidentally committed suicide; they are now limited to the possibility MJ injected propofol or swallowed a number of Lorezapam pills, which could have an effect on establishing the reasonable doubt of the prosecution’s involuntary manslaughter case.

Wednesday (10/12), Dr. Alan Steinberg, cardiologist and expert reviewer/consultant for the Medical Board of the State of California, took the stand.  Based on transcripts from the police interview, Steinberg felt Murray demonstrated an “extreme deviation” from standard practices in his care for MJ.  Specifically, Steinberg labeled Murray’s behavior “bizarre” and cited 6 separate and distinct deviations from the standard of care; each one amounted to gross negligence on its own merit. The administration of propofol in an unregulated environment without the use of basic resuscitation/battery backup equipment for the treatment of insomnia permeated the thread of these deviations. Instead, Murray should have administered Flumazenil (antidote to Propofol), called 911 and used an Ambu bag.  Instead, Murray summoned Alvarez for assistance, instead of 911, and gave MJ chest compressions, which were not needed since MJs heart was still pumping.  Every moment of delay in paramedic care was crucial to MJs survival.  Additionally, Murray did not take notes (regarding vital signs, etc.) for insurance and legal purposes in order to establish proper protocol.  Defense suggested Murray did not need notes because he only had one patient.  Steinberg disagreed, stating Murray couldn’t recall what he gave MJ when they arrived at the hospital.

Prosecution then called Dr. Nader Kamangar, a pulmonary and critical care doctor – and adviser for the California Medical Board – who specializes in sleep medicine.  His contention was Murray’s use of propofol outside of a monitored facility was “inconceivable,” “disturbing,” and “unethical” and his treatment of MJ amounted to “gross negligence.”   Like Steinberg, he found “multiple extreme deviations” in Murray’s standard of care as it relates to insomnia.  Propofol should only be used in a regulated monitor or pump, and in a monitored setting with extreme caution, especially when used in conjunction with other sedatives.  Kamangar said MJ was dehydrated with low blood pressure and thus should not have been given any sedatives whatsoever.  He strongly felt Murray’s failure to call 911 was an “unconscionable deviation of care,” adding how critical time was wasted summoning Alvarez.  He felt Murray broke the cardinal rule of medicine by putting the patient first when he withheld information from the ER doctors.  Additionally, Murray displayed a lack of ethics when he chose to ignore MJ’s ongoing drug dependency.

Finally, anesthesiologist Dr. Steven Shafer briefly testified as the last of the prosecution witnesses. During his brief time on the stand, he advised he was hired 20 years ago by the company which produces propofol to determine proper levels of dosing.  His testimony is expected to continue next week, and will presumably echo the sentiments of Steinberg and Kamangar.  Stay tuned…

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