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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
76.

HumanNature    

Michael Jackson Manslaughter Trial: Conrad Murray Defense Witness Calls Propofol Expert a "S***bag"


UPDATE 4 p.m.: Court has adjourned for the day and will resume Friday at 12:45 p.m. The defense, which had expected to start its case tomorrow, has yet to cross-examine Dr. Shafer.

UPDATE: 3:10 p.m.: White, who described Shafer as a friend and colleague, tells E! News that Deputy District Attorney David Walgren's treatment of the evidence has been "unethical and unconscionable." Shafer's testimony, however, has changed the way he thinks of him, White says. "I am going to take the high road, not the low road with him," he adds. "I was his teacher when he was a medical student. The truth will come out. It always does."

UPDATE 3:05 p.m. Pastor immediately called for a break after Murray lost his cool in response to Shafer using an actual infusion stand to demonstrate how Murray could have dosed Michael Jackson with propofol. "Can you believe that?" Murray whispered to Dr. Paul White, an expected defense witness. "What a s***bag," White told the media seated near him.

MORE: Propofol expert calls Michael Jackson's death an "expected outcome" of Murray's neglect

UPDATE 1:15 p.m.: Shafer also disputed the defense's contention that Jackson ingested eight 2-miligram tablets of lorazepam, the sedative that Murray's attorneys are now training their sights on, between 8 a.m. and noon on the day he died. The true amount was "much, much smaller," the anesthesiologist said. As far as the propofol went, Shafer added, Jackson had been given more than the 25 miligrams Murray told police he'd administered to the singer.

UPDATE 10 a.m.: Shafer said that injecting propofol into a vein with a syringe or finding an injection port would take a bit of "time and coordination." The Columbia University Medical Center doc noted that Murray told police that Jackson's veins were so unavailable he had started giving him IVs below his left knee.

UPDATE 9:20 a.m.: Dr. Shafer says there is "zero" chance Michael Jackson died from oral ingestion of propofol, citing tests that had been done on mice, piglets, dogs and monkeys. Shafer adds that there hasn't been a study on humans because "it was obvious" it wouldn't work because there would be no bio-availability. Plus, when ingested orally, Shafer said, the drug is quickly broken down by the liver. He cited a test on patients in Chile who showed "no sedation" after swallowing 200 or 400 miligrams of propofol.

UPDATE 8:55 a.m.: Dr. Steven Shafer takes the stand to continue his testimony for the second day under questioning from prosecutors.

UPDATE 8:30 a.m.: Jackson family members Katherine, Joe, Rebbie and Randy in the courtroom for this session.

Conrad Murray's team has a tough nut to crack today.

On day 14 of his trial on an involuntary manslaughter charge in the death of Michael Jackson, the defense will commence its cross-examination of Dr. Steve Shafer, an expert on propofol who on the stand yesterday absolutely castigated Murray's treatment of Jackson.

"The facts in this case, in my view...virtually none of the safeguards were in place when propofol was administered to Mr. Jackson," Shafer testified. He also called it "inexcusable" that Murray did not immediately call 911 the second he noticed Jackson in respiratory distress, especially considering Murray was apparently "clueless in what to do."

Deputy District Attorney David Walgren is expected to rest his case once Shafer steps down. Murray's camp has informed Judge Michael Pastor that they plan to call 15 witnesses and wrap their own case toward the middle of next week.

Read more: http://www.eonline.com/news/michael_jackson_manslaughter_trial/270524#ixzz1bNv8Ni51

THIS "QUACK" GOT SOME NERVE!!!

1066 days ago
77.

HumanNature    

Pegasus:


EXACTLY!!!


THE "QUACK" DEFENSE PROBABLY WANTED DR. WHITE TO "LIE" AND THAT IS NOT GOING TO HAPPEN!!!


DR. SHAFER HAVE DEBUNK EVERY THEORY THAT THIS "QUACK" DEFENSE COULD COME UP WITH!!!


WE WILL SEE WHAT TYPE OF DEFENSE THE "QUACK" PUT ON!!!


THE PROSECUTION PRETTY MUCH STRIPED THEM OF ANY PLAUSIBLE DEFENSE!!!


CON "QUACK" THE MURDERER SHOULD JUST THROW IN THE TOWEL AND PLEA "GUILTY!!!


ANY WITNESSES FOR THE DEFENSE WILL BECOME A STAR WITNESS FOR THE PROSECUTION!!!

1066 days ago
78.

igotfleasfromtmz    

Perhaps Dr. White came to his senses and will not testify.

1066 days ago
79.

HumanNature    

WHEN DR. SHAFER STARTED DEMONSTRATING AND EXPLAINING THE INFUSION OF PROPOFOL AND THE SALINE BAG ON THAT IV POLE IN COURT!!!


BRILLIANT!!!!


BROUGHT IT HOME FOR THE PROSECUTION!!!

1066 days ago
80.

HumanNature    

DR. SHAFER WAS ABSOLUTELY "GENIUS"!!!!


AND PROSECUTOR WALGREEN "BRILLIANT"!!!!

1066 days ago
81.

JLS    

What a fabulous expert witness!

The defense has nothing. Certainly nothing that would be REASONABLE doubt.

1066 days ago
82.

Janeny    

Michael had a big problem sleeping. He had a problem with being thrown out of his country for being himself. I never believed he abused kids. He was attracted to them because they were little people he felt safe around. He was persecuted for being not like others. He lost his fortune to that lawsuit, he was deep in debt up to his neck. His doc miscalculated the dose because he didn't know how else to deal with MJ's sleeping problem, or any other problem. I don't know if he is a good doc or a bad one. We have a lot of bad docs in the U.S. who get away with theuir incompetence and bad attitudes. I know from my own experience. So perhaps this one did MJ a favor.

1066 days ago
83.

gayforliztaylor    

mj was kicked out of surgery centers because he begged for meds. he went around the world with excuses for prescription aliases and injections.
he didn't care who destroyed his organs and veins; mj never cried with needles everyday, when his children were nearby.

he got propofol from a gynecologist by getting his face treated for pimple scars. doctor best male friend, doctor filmed mj's wedding

unpredictable for you phony fans.
"mj sycophantic fans: fraud pity partiers"

1066 days ago
84.

Pegasus    

Not only did I love how Dr. Schafer demonstrated the IV drip and how Murray used a "Jerry Form" of IV on that day - but also how Dr. Schafer & David Walgreen showed how the drip line could be rolled up and placed in the pocket or anywhere to dispose of at a later date. Brillent piece of detective work and that there! And odds are - that is what Murray did at the hospital or somewhere - dispose of the evidence where no one would suspect or bother to look.

1066 days ago
85.

Pegasus    

Prosecution To Rest Its Case Friday In Dr. Conrad Murray TrialProsecution To Rest Its Case Friday In Dr. Conrad Murray Trial
--------------------------------------------------------------------------------
Posted on Oct 21, 2011 @ 07:00AM print it send it
Ramey/WENNBy Radar Staff

The prosecution will likely rest its case Friday in the trial of Dr. Conrad Murray, charged with involuntary manslaughter in the death of pop superstar Michael Jackson, and the defense could then call its first witness.

The start of court will be delayed Friday; it will begin at 12:45 pm PDT because a funeral will be held in the morning for the father of Dr. Steven Shafer, the prosecution’s final witness whose damning testimony has taken center stage this week. As always, RadarOnline.com will live stream coverage of the trial as soon as it starts today.

As the prosecution winds down its case, the defense will have its shot to cross-examine Dr. Shafer, a propofol expert, who has testified that Murray committed 17 “unconscionable” acts that could have resulted in Jackson’s death.

The crucial cross-examination will be handled by lead defense attorney Ed Chernoff. In the past, defense attorney Michael Flanagan has handled the previous medical experts, and it’s not known why the defense switched lawyers to handle Shafer’s cross.

Meanwhile, during testimony on Thursday, Shafer said it was "extremely unlikely" Jackson would have caused his own death by swallowing propofol.

(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 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 has pleaded not guilty -- could face four years in prison if convicted.

PHOTOS: Katherine Jackson Holds Memorial For King Of Pop In His Hometown

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

1066 days ago
86.

Pegasus    

Hi HN!


And you are right! Dr. White will not place his integrity and reputation on the line for Murray's sake! Nor will he contradict anything his friend/colleague Dr. Schafer has already said in court. In addition, Dr. Schafer is not representing either side by testifying as he stated in the beginning. He is only there to testify so that the publics misconception of the use of propofol and anesthesiologist is clarified in the publics mind to alleviate fear and concern as a result of Murray's actions. And Dr. Schafer is not being paid by the Posecution or anything with regards to his testimoney as he stated in the beginning.

1066 days ago
87.

Pegasus    

Defense shows strain in trial of Michael Jackson's doctorBy Alan Duke, CNN
updated 11:33 AM EST, Fri October 21, 2011

Dr. Shafer: Propofol drip 'dangerous'STORY HIGHLIGHTS
Defense lawyer Michael Flanagan is replaced for cross-ex of anesthesiology expert
Dr. Steven Shafer testifies Dr. Conrad Murray's IV drip of propofol killed Jackson
Jackson died because Murray failed to notice he stopped breathing, Shafer says
Murray's involuntary manslaughter trial should to go the jury next week
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) -- Cross-examination of the prosecution's anesthesiology expert is crucial for Dr. Conrad Murray, but his defense team's most knowledgeable lawyer when it comes to propofol will sit on the sideline Friday.

Michael Flanagan, who has handled the previous medical experts, has been replaced by lead defense lawyer Ed Chernoff for the questioning of Dr. Steven Shafer, Chernoff told the judge in Murray's involuntary manslaughter trial Thursday. The defense did not cite a reason.

Murray appeared visibly shaken by Shafer's testimony Thursday, especially when the prosecution's expert demonstrated to jurors how he believes Murray set up an IV drip to give singer Michael Jackson the drugs that killed him.

Jackson died because Murray failed to notice that his patient had stopped breathing while he was hooked up to an IV drip of the surgical anesthetic propofol, Shafer testified. The doctor should have realized Jackson had stopped breathing about 11:45 a.m. on June 25, 2009, he said.

"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.

Expert details how he thinks Jackson died

'Heated' discussion in the court hallway

Doctor: Oral propofol death not possible

Katherine Jackson 'pleased' with case "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 Thursday 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 in 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 inconsistent with this explanation," 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 any time 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.

1066 days ago
88.

moni    

Pegasus: about an hour ago

Prosecution To Rest Its Case Friday In Dr. Conrad Murray TrialProsecution To Rest Its Case Friday In Dr. Conrad Murray Trial

The start of court will be delayed Friday; it will begin at 12:45 pm PDT because a funeral will be held in the morning for the father of Dr. Steven Shafer, the prosecution’s final witness whose damning testimony has taken center stage this week.
--------------------

Do I get that right? Dr Shafer attends his father's funeral in the morning and afterwards takes the stand to face the cross examination by Chernoff? This man must have a very strong psyche and nerves of steel!

1066 days ago
89.

moni    

Hi HN and Pegasus,
.
I wish I could be as sure as you that Dr. White won’t contradict Dr. Shafer’s (brilliant!) testimony. I mean – why would he call him a s***bag then? And what does it mean – “Shafer’s testimony has changed the way he (White) thinks of him”? For better or for worse? After all Shafer has expressed his “disappointment” about White’s theory that Michael could have swallowed propofol, and it may very well be this comment the conversation in the elevator was about, where – I can’t find the post anymore – someone witnessed Chernoff and White disputing about “not taking things personally”.
.
Unfortunately White will testify AFTER Shafer, and it frightens me that his testimony might superpose Shafer’s in the jury’s mind. Basically he doesn’t have to prove anything, it’s enough for the defense if he creates some reasonable doubt.
.
If the trial was finished now I’m sure Murray would be convicted. But who knows what is yet to follow...

1066 days ago
90.

Brigha from UK    

"We are in pharmacological never-neverland here," Shafer said, "something that's only been done to Michael Jackson."
-------------------------------------
That is so typically Michael. He was so unique that he couldn't even die like anyone else!

1066 days ago
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