Dr. Steven Shafer's testimony resumes - Day 13 -
Leading Propofol expert Dr. Steven Shafer resumed his testimony today.
In his review of Murray's conduct, Shafer testified he found 17 "egregious violations" of standard medical care that contributed to the death.
Last Thursday, Shafer told prosecutors he was hired 20 years ago by the company that produces Propofol to calibrate the correct dosing for the drug.
Shafer said the exact dosage of Propofol is crucial, because even a slight discrepancy could be the difference between a patient sleeping for a few minutes, and one sleeping for several hours.
Jurors then watched a video that showed how Propofol should be used in the OR. The clip showed nurses and doctors successfully reviving a patient -- played by an actor -- suffering from a cardiac arrest. The video has been played to show the jury Murray was not equipped to handle an emergency situation when he treated Michael Jackson.
As the video was played, Dr. Shafer gave a blow by blow how Propofol is administered.
Shafer's key points:
- Infusion of drugs should be done only through a pump to avoid overdosing.
- "Informed consent" is not just a piece of paper but a process in which the doctor informs the patient of all the risks, benefits and alternatives.
- A verbal consent is not binding.
- Record keeping is paramount
- If the patient stops breathing, the first thing a doctor should do: call for help.
Shafer told prosecutors even when administering "a little bit" of Propofol, guidelines should be strictly followed because the worst disasters occur during sedation, when doctors "cut corners."
Shafer said Murray's treatment of Michael Jackson is both an "egregious" and "unconscionable" violation of standard care.
He also called 15.5 liters of Propofol Murray bought -- about four gallons worth -- "an extraordinary amount" for one person.
Shafer said Murray's lack of basic and essential monitoring devices are an egregious violation of care and contributed to death.
The fact that Murray never kept any records is "unbelievable," according to Shafer.
He said Murray "left the steering wheel" when he went to bathroom to relieve his bladder calling the doc "quite clueless."
Shafer told prosecutors there are 2,500 articles about Propofol sedation... and only one -- very flawed -- article about Propofol and insomnia. He said, "We're in a pharmacological Never-Never Land. It's only ever been done to Michael Jackson in history as far as I know."
"He was not putting Michael Jackson first. He was putting Dr. Murray first," he said.
The prosecution asked Shafer for his opinion on Murray allegedly not calling 911, but instead leaving voicemails for members of Jackson's staff on June 25, 2009.
"A physician would not call and leave a voicemail for somebody when a patient had arrested," Shafer said. "I almost don't know what to say, that is utterly inexcusable."
In court papers filed late last month, prosecutors wrote that the Columbia University professor had strong words about Murray's care of Jackson. Prosecutors wrote that Shafer said "there is almost nothing in Murray's care of Michael Jackson that reflected the actions of a trained physician."
Shafer wrote guidelines and warnings that are included with every bottle of propofol. Prosecutors claim Murray ignored those warnings by giving Jackson the anesthetic in the bedroom of his rented Holmby Hills mansion.
Shafer told jurors he is not charging for his work on the Jackson case, in part because he wants to restore public confidence in the medication and doctors.
"I am asked every day in the operating room, 'Are you going to give me the drug that killed Michael Jackson,''' Shafer said. "This is a fear that patients do not need to have."
Shafer said he was testifying without a fee in the case, partly to reassure the public that propofol is a safe anesthetic when used properly.
"In the operating room every day," he said, "patients ask me, 'are you going to give me the drug that killed Michael Jackson?' This is a fear that people do not need to have. Propofol is an outstanding drug."
The state's final witness Dr. Steven Shafer walked the jury through a video demonstrating the proper way to administer the anesthetic propofol to a patient. The video also showed the procedures taken when a patient's heart stops beating.
Shafer told the court that Michael Jackson could possibly have been saved by simply tilting his chin back.
"Michael Jackson was trying to breathe, but the tongue had fallen in the back of the throat," Shafer said. "Either a simple chin lift, just that alone, or an oral airway to move the tongue out of the way might well have been all that was required to save his life."
Shafer detailed the exacting medical standard of care with which anesthesiologists like himself administer propofol. To aid the jury, he narrated from the witness stand a 16-minute silent video showing operating-room procedures. Specially made for this trial, the video emphasized the sophisticated monitoring and emergency resuscitation equipment Shafer said was needed even for the small, 25-milligram dose of propofol that Murray told police detectives he had given Jackson.
When asked about Murray's relationship with Jackson, Shafer described it more like an "employee-employer" relationship rather than a "patient-doctor" relationship.
"'Yes' is what an employee says," Shafer said. "'Yes' is not what a doctor says to a request from a patient that is not in the patient's best interest."
Evidence at the trial showed Murray had little such equipment on hand as he treated Jackson with propofol in his bedroom for insomnia.
Before the jury entered the courtroom Wednesday, lead defense counsel Ed Chernoff objected to introduction of the video. It simulated a patient suffering apnea -- a cessation of breathing -- and cardiac arrest on the operating table. An anesthesiologist is depicted as saving the patient's life by first calling for help, then using various means to revive the patient.
Chernoff called the video "a terrifying dramatization." He said it was meant to convince the jury that "the only possible way to provide propofol is in this environment." Superior Court Judge Michael Pastor replied, "I thought that was what the people's case was all about." He ordered redactions of some short sections but allowed most of the video to be shown.
It was a stark contrast between the equipment and procedures used by Conrad Murray in Michael Jackson's bedroom and what Dr. Shafer calls the standard way to care for a patient, which was depicted in the video.
The video began with the equipment needed to put a patient under anesthesia safely. The doctor in the video checked all the equipment to make sure it was in working order.
The necessary equipment includes tools to open the airway, oxygen delivery devices, resuscitative tools and monitoring equipment. Dr. Shafer testified that all the equipment must be organized so it can be found in an emergency.
The video also showed a simulation of a patient going into cardiac arrest. The doctor responds to the emergency following this list of steps:
1. Checks to see if monitoring equipment fell off
2. Calls for help
3. Begins chest compressions
4. Ventilates lungs
5. Begins to administer resuscitation drugs or defibrillator
It's not a comparison we would have thought to make: Sedating a patient is like driving a motorhome. And what do you do when nature calls?
"You don’t get up, leave the wheel and to go to bathroom," said Dr. Steven Shafer in court today.
Murray told police that he gave Michael Jackson a small 25mg dose of the anesthetic propofol and stepped out of the room for a couple of minutes to relieve himself. But Dr. Shafer testified that there's no such thing as a little bit of anesthetic and safety guidelines must be followed every time drugs like propofol are administered.
"It's a slippery slope and every patient is different," said Dr. Shafer.
He also said the varying conditions of each patient creates a need for doctors to plan for the worst case scenario every time they prepare to sedate a patient.
Deputy District Attorney David Walgren walked Dr. Shafer through his review of Murray's treatment of Michael Jackson.
Dr. Shafer said he found several violations of the standard of care including:
- There was no emergency airway equipment in Jackson's bedroom. Dr. Shafer says this was an egregious violation because no competent physician would administer an anesthetic without the ability to clear an airway if needed.
- Murray did not use an infusion pump. Dr. Shafer says this increased the chance of an overdose because an infusion pump is the only way a doctor can precisely regulate dosing.
- The monitoring equipment Murray had was inadequate. Dr. Shafer says this would make it impossible for Murray to know if Jackson was in serious trouble.
- Murray did not have emergency drugs on hand. Dr. Shafer says these drugs could have helped resuscitate Jackson.
- Murray failed to take up to 80 days worth of records on Jackson's treatment. Dr. Shafer says this was an unconscionable deviation from the standard of care because Murray violated the rights of his patient. Dr. Shafer passionately told the court the patient and his family have a right to see what's being done to him.
Murray's defense team has reportedly commissioned tests on animals in an effort to dispute the charges.
According to news reports, Murray's lawyer, J. Michael Flanagan, revealed "in open court that he had commissioned his own study about the oral ingestion of propofol." A source close to Murray told RadarOnline.com, "A study was done on beagle dogs to determine how much propofol would have to be orally consumed to cause death. The study definitely involved more than two dogs. It's unknown if the dogs died or suffered any harm."
In toxicology tests, large doses of chemicals are pumped into dogs' bodies, slowly poisoning them. Not only are these tests cruel and irrelevant to human health, they are also redundant because substantial data are publicly available about the oral toxicity of propofol in dogs, humans, and other animals. The tests are also in potential violation of the Animal Welfare Act (AWA), which prohibits procedures on animals that "unnecessarily duplicate previous experiments."
PETA has filed a complaint with the State Bar of California and is urging the U.S. Department of Agriculture to also investigate how and why the cruel test reportedly commissioned by Murray's defense team was approved and to issue citations and fines for any violations of the AWA. We will keep you updated as the case progresses.
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