People vs. Dr. Conrad Murray Anesthesiologist: My Patients Fear Propofol

10/21/2011 8:00 AM PDT

People vs. Dr. Conrad Murray -- Anesthesiologist: My Patients Fear Propofol

Anesthesiologist -- Dr. Steven Shafer Testifies
Updated 10/24/11 at 8:49 AM

**For today's testimony, click to continue below.**

Leading Propofol expert Dr. Steven Shafer --  the final witness for the prosecution -- told the jury,  Dr. Conrad Murray corrupted his patients ... because now, they're all terrified of Propofol.

He told the jury today -- "I am asked every day I'm in the operating room ... 'Are you going to give me the drug that killed Michael Jackson?'"

In his review of Dr. Murray's conduct, Shafer testified he found 17 "egregious violations" of standard medical care that contributed to the singer's 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. Prosecutors were trying to show the jury Dr. Murray was not equipped to handle an emergency situation when he treated MJ.
* Shafer explained to the jury that Jackson probably died because his tongue blocked the back of his throat ... but could have been saved with a simple chin lift.

* 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 MJ is both an "egregious" and "unconscionable" violation of standard care. 
* He also called the 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 MJ's 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 is practically no research on Propofol use to treat insomnia ... adding, "We're in a pharmacological Never-Never Land."
* Shafer took a shot at his former colleague and friend, defense expert Dr. Paul White... telling the court he was "disappointed" to learn that  White thought MJ could have died from drinking Propofol. Shafer went over several studies on rats, dogs and even humans that show the drug doesn't work when it's swallowed.
*  Shafer also bulked at the defense's argument that Jackson may have caused his own death by swallowing 8 pills of Lorazepam ... because the toxicology report showed the amount of Lorazepam found in MJ's stomach was "trivial." According to his calculations, Murray would have had to inject MJ with 10 consecutive shots of 4 mg each to reach the the blood levels in the toxicology report.
* Dr. Shafer debunked another theory by the defense, telling jurors there is no way Jackson woke up and then injected himself with a fatal dose of Propofol. He said people don't wake up  "hell-bent" on grabbing the next dose, calling it a "crazy scenario."

* Shafer said the only theory that fits is this: Murray started MJ on a 1000 mg Propofol drip at around 9 AM ... which caused the singer to stop breathing around noon.
* Had Murray been in the room he would have noticed MJ's breathing slowing down around 11:45 AM and could have saved him by stopping the drip.
* In a dramatic moment, Shafer demonstrated  to the jury how, he believed, Murray set up a Propofol drip ... inserting a Propofol bottle into an empty saline bag.
* Shafer said Murray never used an automated pump, which caused the anesthetic to drip at a dangerous rate. The defense claims Murray only gave MJ a single dose of 25 mg of Propofol with a syringe on the day the singer died.
* Defense attorney Ed Chernoff came out swinging during cross examination, challenging Shafer's testimony from Thursday in which he said there is no way Jackson killed himself with either Propofol or Lorazepam. "That's a bold statement isn't it?" Chernoff  "asked " ... "That's what I think happened," Shafer shot back. "Everything you said is an opinion..." Chernoff said... to which Shafer responded, "To say that one should not lie to UCLA Medical Center is my opinion."
* Chernoff  tried to discredit Shafer's testimony ... saying the IV tubing he used in his demonstration was not found at the scene. Shafer said Murray could have easily shoved it in his pocket before leaving MJ's room.
* Chernoff also pointed out Shafer used the wrong size syringe and IV bag in his demonstrations. Shafer brushed it off, saying he didn't think  "size mattered."
*  Chernoff also asked Shafer about his relationship with Dr. Paul White, the defense's Propofol expert... asking him if it's true that he nominated White for an "Excellence In Research" award. Shafer said he did.
* During his cross examination on Monday, Shafer told Chernoff it's hard to know the precise effect Propofol may have had on MJ because the singer had been given so much of it in the 2 months before he died.