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People vs. Dr. Conrad Murray

Anesthesiologist:

My Patients Fear Propofol

10/21/2011 8:00 AM PDT BY TMZ STAFF

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

101911_doctor_still

**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."

1020_iv_demonstration
* 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.
164 COMMENTS

No Avatar
63.

MiMi    

UW shutup


YOu have misspelled more words on these boards than a 5 year old.

1014 days ago
64.

MiMi    

Remember Brutice????


ROFL

1014 days ago
65.

MiMi    

NO LIfe? Not here hiding all day like you are dui.


LoL

1014 days ago
67.

jason    

How in the world did Jackson survive all those other nights doing this dangerous drug? The doctor said the patients he treats always stop breathing when put under so how did this not happen sooner?? Why did Mike never stop breathing before? This Murray guy sure did not react well to the emergency thats for sure.

1014 days ago
68.

HumanNature    

DIZZY duilama:


STILL SNIFFING "CRAZY GLUE"?????


NICE TO SEE THAT OhWell CAN WAKE UP THE "DELUSIONAL DEAD" WITH A LICK, LICK!!!


WHICH IMAGINARY CLONE/TROLL ARE YOU TODAY????


TODAY, YOU ARE "DUMB AS A ROCK"!!!


AND EVERYDAY THEREAFTER, YOU WILL STILL BE "DUMB AS A ROCK"!!!!


ROTFLMAO

1014 days ago
69.

RosseJackson17    

Michael J. Jackson I miss you so much! You´re my everything. Thanks for all the things you made. AAauuh! ♥♥♥

1014 days ago
70.

igotfleasfromtmz    

After Dr. Shafer testified today it was very clear what happend. Murray lied the 25mg loading dose would not even make it to the end of the IV Tubing. I believe he did clamp the NS off and loaded the propofol with a vented tubeing and hung it> He used his loading dose from the the hangning propofol botttle BUT THE IDIOT - he forgot to unclamp the NS and overdosed Michael.

1014 days ago
71.

igotfleasfromtmz    

I think the unkown delay is that MURRAY is going to plea out in the am.
I am going to be watching those Defense DR.'S very very close - if even on of them get close to saying this was not outer space beyond the scope of practice - I will spend my next week finding thier lic numbers and turn them in one by one to the boards in each state they belong.

1014 days ago
72.

Tracy R    

I'm kind of sad that the prosecution is on their last witness. I want them to keep going. They have done an esqusite job proving that Murray was negligent in the care of MJ. MJ put his life in the wrong hands. It doesn't matter if MJ had an addiction. We all know he did. No doubt he noticed signs when MJ was request stuff by name. That should have been a red flag right there. But that doesn't matter. The fact is that MJ trusted Murray with his life and it was taken in a obscene way. I'm interested to see how the defense is going to be with their witnesses. I've noticed that Mr Chernoff (Murray's lawyer) is a "leader". He led Murray in some of his police interview. Made him seem more quilty. They were also thinking that Murray wouldn't be prosecuted (dummies).I find it funny that they are trying to say that MJ "woke up" and injected himself with the propofol and OD on himself. Hilarious. Quite impossible. With all the drugs that he gave MJ, I really don't see how that is possible.

I wish the UCLA doctors were successful in reviving MJ, so he could have learned from this experience. No doubt that after a situation like this, he would have changed for the better. He is and will always be missed. Love you MJ.

1014 days ago
73.

Pegasus    

Conrad Murray Trial Recap: Expert Says ‘Extremely Unlikely’ Michael Jackson Caused Own DeathConrad Murray Trial Recap: Expert Says ‘Extremely Unlikely’ Michael Jackson Caused Own Death
--------------------------------------------------------------------------------
Posted on Oct 20, 2011 @ 11:30AM print it send it
Splash NewsBy Radar Staff

An expert on the powerful anesthetic Propofol says it is "extremely unlikely" Michael Jackson would have caused his own death by swallowing the drug.

Anesthesiologist Steven Shafer took to the stand Thursday in the case against the late singer’s personal physician Dr. Conrad Murray, who has been charged with involuntary manslaughter of the pop star after he was accused of giving him an overdose of Propofol while trying to help him sleep.

Coroner's officials have determined the singer died from acute Propofol intoxication and also noted there was anti-anxiety drug Lorazepam in Michael's system.

PHOTOS: Key Players In The Trial Of Dr. Conrad Murray

Shafer - who is expected to be the prosecution's last witness - told jurors that the drug cannot enter the bloodstream in a sizeable quantity if it is swallowed and said based on Murray's timeline of events, where he says he was away from the pop star for just two minutes, there would not have been sufficient time for Michael to inject himself.

He explained: "The possibility of a direct self-injection seems extremely unlikely."

EXCLUSIVE PHOTOS: Inside Michael Jackson's Mansion On The Day Of His Death

Shafer reminded the jury that injecting Propofol is a complicated process and showed them various formulas and diagrams on a large screen.

He said the defense's argument that Michael gave himself the powerful anesthetic was also unlikely because he would've been groggy from other drugs administered throughout the night.

PHOTOS: Michael Jackson's Kids Star In Tribute Concert

He explained: "He can't give himself an injection if he's asleep.

"People don't just wake up from anesthesia hell bent to pick up a syringe and pump it into the IV. It's a crazy scenario."

PHOTOS: The Jackson Family Arrives To Dr. Conrad Murray’s Trial

Shafer said it was more likely that Murray gave the singer a higher dose of Propofol than he told police and he also explained the defense's own testing showed Michael hadn't swallowed any lorazepam pills in the four hours before his death.

Murray's attorneys have previously argued Michael gave himself extra doses of Propofol and lorazepam without the doctor knowing - but the anesthesiologist said those doses would've amounted to just 10 per cent of the drug found in his body at the autopsy based on the timings Murray has given.

PHOTOS: Michael Jackson Through The Years

He said: "It's only 10 percent of what was measured, so this did not happen.”

Prosecutor David Walgren asked Shafer: "The blood levels proved that there is more than four milligrams of lorazepam administered to Michael Jackson?"

PHOTOS: Stage Shots of Michael Jackson Performing

And Shafer replied: "Absolutely."

Murray - who denies involuntary manslaughter - could face four years in prison if convicted.

1014 days ago
74.

HumanNature    

Did someone get their feelings hurt?


CNN's Alan Duke was reporting from the 12th floor of the courthouse when he heard an argument going on at the elevators behind him. He says the heated words were being exchanged between Dr. Conrad Murray's lead defense attorney, Ed Chernoff, and one of the defense experts, anesthesiologist Dr. Paul White.

He didn't want to go into details but says they were talking about people "taking things personally."

As we all know by now, Dr. White is longtime friends with Dr. Steven Shafer, who has been on the stand all day testifying for the prosecution. Dr. Shafer took a jab at Dr. White's research earlier today, saying how he was "disappointed" that his colleague would suggest Michael Jackson could have died by drinking propofol.

We're not ones to gloat, but we have to say we totally called this one. Will their friendship survive the trial? It'll be interesting to see what Dr. White has to say when he takes the stand next week!

Watch Alan's report here:


http://insession.blogs.cnn.com/2011/10/20/did-someone-get-their-feelings-hurt/


FIGHT! FIGHT!


ROTFLMAO

1014 days ago
75.

Pegasus    

Expert: IV drip is 'only scenario' in Michael Jackson's deathBy Alan Duke, CNN
updated 7:10 PM EST, Thu October 20, 2011

Shafer: Murray lacked care with JacksonSTORY HIGHLIGHTS
NEW: A doctor demonstrates IV drips he believes killed Michael Jackson
NEW: Murray could've saved Jackson if he was watching him, prosecution expert says
"It's just a crazy scenario," doctor says of defense theory Jackson gave himself propofol
Murray's lawyers should start their defense Friday
Tune in to HLN for full coverage and analysis of the Conrad Murray trial and watch live, as it happens, on CNN.com/Live and CNN's mobile apps.

Los Angeles (CNN) -- Michael Jackson died because Dr. Conrad Murray failed to notice that his patient had stopped breathing while he was hooked up to an IV drip of the surgical anesthetic propofol, an expert anesthesiologist testified Thursday.

Dr. Steven Shafer, probably the last witness before the prosecution rests in Dr. Murray's involuntary manslaughter trial, said Murray should have realized Jackson had stopped breathing about 11:45 a.m. on June 25, 2009.

"When you're there, you see it, you know it," Shafer said.

Phone records and testimony showed that Murray was on the phone with one of his clinics, a patient, and then a girlfriend about the time that Shafer calculated the oxygen in Jackson's lungs became depleted, causing his heart to stop beating.

"Had Conrad Murray been with Michael Jackson during this period of time, he would have seen the slowed breathing and the compromise in the flow of air into Michael Jackson's lungs, and he could have easily turned off the propofol infusion," Shafer said.

Murray could have then easily cleared Jackson's airways and restored his breathing by lifting his chin, he said.

Earlier testimony from paramedics and emergency room doctors said Jackson was clinically dead by the time an ambulance arrived at the pop icon's Los Angeles home nearly a half-hour after Murray realized there was a problem.

The last three prosecution experts, all medical experts, focused the Murray trial on the science surrounding Jackson's death, a contrast to earlier testimony from Murray's girlfriends and Jackson employees.

After the defense cross-examination of Shafer on Friday afternoon, Murray's lawyers will start calling witnesses, including their own anesthesiology expert.

Shafer demonstrated for the jury how he believed Murray set up the propofol infusion by hanging a 100-milliliter vial from a stand with tubing attached that would have led to a catheter port in Jackson's left leg.

"This is the only scenario that I could generate" that would produce the high level of propofol found Jackson's blood during his autopsy, Shafer said.

"This fits all of the data in this case, and I am not aware of any data that is consistent," he said.

Shafer examined and ruled out other scenarios, including Jackson injecting himself with propofol or Murray administering a fatal dose with a syringe. Computer model projections could not identify a scenario that would duplicate the high blood levels found, he said.

Although Murray told police he used an IV drip to give Jackson propofol on previous nights, the defense contends that he did not use it the day Jackson died. Instead, they say, Murray put Jackson to sleep about 10:40 a.m. with a single injection.

Sometime after that, Jackson woke and used a syringe to inject himself, the defense contends,

Shafer said the theory makes no sense.

"People just don't wake up hell bent to grab the next dose in a syringe, draw it up and shove it in their IV again," Shafer said. "It's just a crazy scenario."

The Los Angeles County coroner ruled that Jackson's death was caused by a combination of sedatives with the propofol, which Murray admitted in a police interview that he used to help Jackson sleep.

The defense contends that Jackson swallowed eight lorazepam tablets, a claim based on testing of lorazepam levels in Jackson's stomach contents. Shafer discredited the defense lab tests, saying a new test showed the equivalent of only "1/43rd of a tablet" of the sedative in the stomach.

The level of lorazepam in Jackson's blood was far higher than what would be expected based on the dosages Dr. Murray told detectives he gave Jackson in the hours before his death, Shafer said.

Murray said he gave Jackson a total of 4 milligrams of lorazepam in two separate doses starting 10 hours before his death. Toxicology results indicated that Jackson was given 40 milligrams -- not four -- in a series of 10 doses, he said.

Although the defense recently abandoned the theory that Jackson may have swallowed propofol, the prosecution still worked to use its old theory to discredit Dr. Paul White, the anesthesiologist who will testify soon for the defense.

A report prepared by White in March concluded that oral ingestion of propofol could have killed Jackson, but Shafer testified that it ignores the "first pass effect" that is taught to first-year medical students.

The liver is a "powerful mechanism" for filtering propofol from the digestive tract so that only a very small percentage can reach the blood, Shafer said.

Shafer cited several studies on rats, mice, piglets, dogs, monkeys and humans that he said proves swallowing propofol would have no effect.

"There was no sedation at anytime following oral consumption of propofol," Shafer said, describing the results of research he commissioned on university students in Chile over the summer.

The human study was done not only to prepare for the Jackson trial, Shafer said, but also to counter an effort by the Drug Enforcement Agency to consider tighter restrictions on propofol.

The drug is not currently a controlled substance, but publicity over the theory that Jackson's death might have been caused by oral ingestion prompted federal regulators to considered a new requirement that "it to be handled almost like morphine," he said.

"Patients will be hurt if it is restricted," he said. "Anesthesiologists have to have ready access."

The new study assures that if the drug is abused, it would be done only with the intravenous route, which only health care providers have, he said.

Shafer testified Wednesday that Jackson would be alive now but for 17 "egregious deviations" by Murray from the standard of care required of physicians.

Murray's use of propofol almost every night for two months to help Jackson sleep was so unusual, there is no do***entation on the dangers, Shafer said.

"We are in pharmacological never-neverland here," Shafer said, "something that's only been done to Michael Jackson."

The trial, in its fourth week, is expected to conclude with the start of jury deliberations near the end of next week.

1014 days ago
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