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Conrad Murray-Trial - Day 20-October 28, 2011:
"Day 20, Session 1 (TMZ-stream)"
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"Day 20, Session 2 (TMZ-stream)"
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Exclusive tidbits from the trial:
There was an issue between the attorneys behind the scene that had to do with the subpoena of Murray's certification
Defense attorneys subpoenaed hospital for Dr Murray's certification on sedation and the document was delivered to attorney's office, not the court
Chernoff told judge Walgren has an issue with the document now but didn't have it 6 weeks ago when he received a copy of it.
Chernoff: if (Walgren) had a concern with the certification document he should've said something earlier. This is just, frankly, a ploy.
Walgren said he received the document some weeks ago and was not disputing whatever representation it was making. Judge allow them in for fairness.
Walgren was having an issue with the certification document. He claimed the process by which it was delivered to him violated the court rules
Judge admonished attorneys that he expects them to be in communication over the weekend and cannot have continuing issues with discovery.
Judge: (there is) seemingly no end to the case when it comes to the defense and potential rebuttal, potential surrebutal. I need to move this!
Judge told attorneys they need to be looking at the jury instructions he provided, involuntary manslaughter instructions, issues of causation
Chernoff told the judge he has never experienced anything like the jury charges he's seeing. He says it's very detailed and specific.
Chernoff says that in Texas the jury instructions is 2 pages.
Judge to attorneys: be aware of the jurors, we're now past the date. I don't want major surprises anymore
Some of the jurors were clearly disturbed that trial is lingering yet another week. It seems like some did not expect it.
Our sources say Murray will NOT testify on his behalf. But, as judge said, at the end it's his choice, no one else's.
So here's what's ahead in this trial: conclusion of Dr White's testimony; rebuttal for both sides; jury instructions and closing arguments.
Source: ABC7 Murray trialKommentar
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Vielen Dank an bouee von mjjc
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Dr White
Flanagan
Pharmaco dynamic model : variability
Effect site : concentration in the brain, not measurable in living humans; surrogate measures, using EEG.
Bispectral index study graph :
Y axis = vertical : EEG bispectral index 0 = dead , 100 = fully awake.
X axis = horizontal : level of sedation . 5 = fully awake, 1 not arousable.
Line shows a mean, or mathematical average, or model, dots show patients , dots show that patients reaction varies a lot. For a given level of sedation, the EEG bispectral index (effect on the brain) will vary
Shows a paper about a study of propofol and bispetral index, Was Principal Investigator . Shows a diagram , scale for EEG bispectral, is 40 = anethesized to 100 = awake, level of sedation 5 = fully awake to 1 , there is no line , just dots representing individual patients, shows the reaction vary a lot from a patient to another
shows study about relationship between bispectral index and effect site concentration value
shows a study : physilogical endpoints (= physiological changes such as apnea, eyelash reflects, verbal response) compared to EEG bispctral value. Variability 40 to 95 (shows great variability)
Endpoints compared to effect site concentration : 4 to 1 variability
back to dr Shafer's graph about the 2X2 mg lorazepam at 2 and 5am : is an accurate depication of an average patient. MJ had been taking oral lorazepam, you would expect residual levels of lorazepam from prior days. Objection by Walgren about the word «*oral*» , overruled, it's a matter of cross.
CM said he treated MJ with midazolam and lorazeapm : you would expect to find residual levels, but Dr White doesn't know how much given
Another graph from dr Shafer 2X2 mg midazolam 3 am and 7 30 am : same comments as previous graph. Midazolam has a shorter half life , quicker onset, popular for preoperative medication. This graph shows the blood at autopsy for lorazepam, not midazolam. Responsive to pain stimulus line is much higher, but midazolam is not an analgesic.
Actual blood concentration for midazolam in Autopsy Report was close to Shafer's model for midazolam.
Another graph , combining 2 X2mg midazolam and lorazepam , based on CMs interview, showing the concentration CM thought were in MJ's blood. The irrelevent resonsive to pain line is on the graph, much higher than the concentrations levels.
Dr Shafer didn't described the 25mg propofol over 3 to 5 mn in his report , it's the only thing from CMs inerview that Dr Shafer didn't include in his report, but did the simulation for the defense.
Showing the 25mg propofol over 3 to 5 mn simulation
Now showing another graph combining the 25mg propofol and 2 X2 mg lorazepam and midazolam ( still well below the response to pain line). It's a simulation done by dr Shafer , objection by Walgren , Shafer didn't do this one. He did both seperately, dr White combined them, . This doesn't depict a dangerous situation at all.
25 mg propofol over to 3 to 5 mn, would produce anxiety relief, a little sleepiness.
Study : efficacy of propofol compared to midazolam as an intrevenous premedication agent : the dose of propofol used in the study is the equivalent of 24 mg propofol used on MJ, that's minimal sedation.
Continum of depth sedation from minimal sedation (anxiolysis), moderate seation, deep sedation, general anesthesia . Shows relation of level of sedation and physiological effects (responsiveness, airway, obstruction, spontaneous ventiliation, cardio vascular fonction )
Minimal sedation as was provied by CM : would only produce only a little sleepiness, not produce the physiological effects described above.
Gack to graph with the 25mg propofol , midazolam, lorazepam : represents minimal sedation (except for the lorazepam concentration found at autopsy) .
Procedural sedation = conscious sedation = mac sedation = moderate sedation , origin of the terms are different, but they mean the same thing
Moderate sedation : verbal response, airway is unaffected , ventilation ok, cardiovascular function is ok.
Anesthesiolgists are trained in moderate sedation , for other doctors : most hospitals require that doctors who use conscious sedations are trained, in case they inadvertently sedate the patient into a deep sedation, and need to rescue the patient.
CM has a certification from Sunrise Hospital in Las Vegas for moderate sedation.
Shows CM certification for concious sedation : allows him to : evaluate the patient, adminster sedation, manage a compromised airway, provide adequate ventilation in case of apnea, rescue a patient from deeper sedation, monitor the petient to evaluate sedation
Showing Dr Shafer's graph with 40 mg lorazepam starting at midnigt, compared to 2 X 2 mg : simulation was modified cause MJ was still at Staples center at midnight. Shafer corrected it recently. The average patient would be dead, at the very least comatose for several hours, receiving 40mg over 5 hours. Shafer did that simulation because of the 10ml vial found at the house
Showing the modification , 9 doses of 4 mg each, starting at 1 30. Doesn't fit with the vial found. Made to fit with concentration. Last doses would have been given when he would still have been asleep.
Showing the graph with the 40mg lorazepam at midnight , 2X2 midazolam nd lorazepam.
Midazolam given by CM = what was found at autopsy.
Midazolam would have been given when MJ was highly sedated with lorazepam, it doesn't make sense.
Showing a computer model : lorzaepam concentration with a 2 mg lorzaepam bolus at 2 am, another dose at 5 am bolus, followed by an oral larger dose of 20mg (10 pills taken at the same time ) at 7 00. Assumes there was no residual lorazepam, but thinks there was
Showing another graph , same but with a residual level. Residual level for 10mg for 5 days; Same result with 16 mg oral lorazepam (8 pills) at 7 . could do aother simualtion with 3 or 4 pills at 4, other pills at 6
The quantity of lorazepam in stomach content was very low : dissulotion of the pill is 15 mn, then absorbstion halftime is 22 mn (some studies say 40 mn) : especially if MJ was drinking, it's normal that there was very little lorazepam found in the stomach.
This simulation is more reasonable , 40mg simulation is irrational.
The simulation with residual level is more realistic. MJ maybe didnt take the 8 pills all at once, maybe he took a few at one time, then later took more pills. We don't know at what time, how many pills were taken; could be some taken at 6 , some at 8.
it's speculation, but more reasoneble than 4 mg boluses every 30mns
the small amount of lorzaepem in the stomach is explained by absortion halflife
Lorazepam : 93% bioavailability.
Article by greenblack : is the equivalent of 1/300th of a pill in the stomach is consitent with your simulation ? Answer : You would not expect to find free lorazepam in the stomach if it was given IV
break
_________________
Dr White
Flanagan
Free lorazepam in the stomach = oral consumption, it has to be oral consumption. The absortion halflife was taken into account for the simulation.
Dr Shafer's simulation : 50mg propofol, rapid bolus 30s to 60s, iconsitent with CMs iterview, and levels of lidocaine found at autopsy according to Dr Shafer (consistent with 5cc)
Dr Shafer's simulation 100mg , bolus inconsitent with lidocaine , inconsistent with MJ «*anti burn*» request, would burn tremendously in small veins
Multiple self injections 50mg each, inconsistent with lidocaine found at autopsy, would be difficult for MJ, propofol is difficult to draw , Dr White i not sure he would do it himself, defense never claimed that
25mg scenario is less absurd, it's minimal sedation.
25 mg bolus dose over 30 seconds : would a person who is awake be able to do that ? Answer : yes of course.
The blood concentration depends on how fast the injection is done.
Injecting slowly has less effects on cardio vascular and respiratory functions.
Showing the graph with lorazepam, midazolam, 25mg over 3 to 5 mn, and 25mg rapid bolus : 25 bolus concentration goes over the responsive pain lines.
If this bolus was put on tp of the lorazepam femoral blood level : combination could be lethal, would expect to it have very adverse consequences.
Demonstration : fills up a syringe with 5cc saline and 5cc propofol , and demonstrates a 3mn injection.
Dr Shafer's 100ml infusion : inconsistent with CM's interview, you would need an IV system, the handle of the bottle was not used. The bottle in the bag would have been too low, you would have to lower the rate of the saline, it's dangerous. He can't think of a reason not to use the handle, and go to the hassle of cutting the bag with a knife. The bottle could fall if the patients moves, or someone touches the tube. Alberto said there was liquid in the bag, when obviously there was none.
Before pumps became available, you would empty propofol bottle into saline bag. That would be 1mg/ml. 3mg/mil was used in the chinese study. Shows how you do it. If you do that, when the bag is empty you would see the propofol residual on the bag, chamber, Iv tube.
There was no propofol in the bag , no propofol in the long tube.
Thinks there's no evidence that there was an IV, and adds his has other reasons to think that there was no infusion.
Shafer 's simulation of 100ml infusion : coincidence that the patient dies when the bottle runs out. No reason to stop breathing if you breathe during infusion. It would be an incredible coincidence to cough right when the bottle stops (there's a word I didn't understand, I think he meant coughing during anesthesia, and that coughing during anesthesia would cause a problem)
Femoral vein is close to the knee, it's strange to find this concentration so close to injection site, if femoral blood it was taken on the same side as injection site (he doesn't know that, it was not in the coroner's report)
Propofol in the urine do not support 100ml infusion over 3 hours, would expected the urine concentration of unchanged propofol to be much higher (i'm not sure I understood the explanation, I think it was since propofol keeps coming into the system, it goes into the urine), propofol concentration in the urine should have been between 1 to 3, was 0.15
The most consitent scenario is a self injection of 25mg propfol, between 11 30 am and 12 00pm, based on urine levels. (Firefox froze, i didn't see the chart he was showing)
25mg over 3 to 5 mn, sleep would last 10mn , exluding any other medication. Here there was lorazepam and midazolam as well.
Dr Shafer 's scenarios don't reconcile with CM's statement , evidence at the scene, urine concentration
The scenario that was given to dr White reconciles with CM statement (except for self injection, since CM didn't think MJ had self injected), with evidence at the scene, and urine concentration.
Recess until monday morning 9 am
Quelle ; QuelleKommentar
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Zeuge der Verteidigung, Tag 20
Dr. Paul White, Propofol Experte
Kommentar
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Conrad Murray
Narkose-Experte nimmt ihn in Schutz
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Im Prozess gegen Michael Jacksons ehemaligen Leibarzt Conrad Murray meldete sich jetzt ein Betäubungsmittel-Experte zu Wort, der den Doktor gegen Vorwürfe in Schutz nimmt.
Die Verteidigung im Prozess gegen Michael Jacksons (†50) früheren Leibarzt Conrad Murray hat als Hauptzeugen einen Experten befragt. Der Narkosespezialist Paul White sagte vor der Jury, dass der Tod des Sängers nach einer niedrigen Dosis des Betäubungsmittels Propofol nicht zu erwarten gewesen sei.
Der wegen fahrlässiger Tötung angeklagte Herzspezialist Conrad Murray (58) hatte im Juni 2009 bei der Polizei angegeben, dass er seinem Patienten nur eine kleine Menge des starken Mittels verabreicht habe. Die Anklage zeichnete in den vergangenen Wochen ein anderes Bild, wonach Jackson eine große Menge Propofol intravenös erhalten habe. Laut Autopsiebericht war der Sänger an einer Überdosis des Betäubungsmittels gestorben.
Ein weiterer Arzt sagte am Donnerstag in Los Angeles aus, dass Jackson aus seiner Sicht vermutlich von dem Schmerzmittel Demerol abhängig war. Der Sucht-Experte Robert Waldman hatte Unterlagen eines Hautarztes ausgewertet, der Jackson regelmäßig behandelt und bei den Eingriffen große Mengen des Schmerzmittels gespritzt hatte. Waldman legte nahe, dass der Sänger als Folge von Demerol-Entzug unter starker Schlaflosigkeit litt. Drei Tage vor seinem Tod hatte Jackson von dem Hautarzt die letzte Spritze erhalten.
Der Prozess befindet sich in der fünften Woche. Nach der Vernehmung des letzten Zeugen könnte das Verfahren in der kommenden Woche zur Urteilsfindung an die Geschworenen übergeben werden. Es wird nicht erwartet, dass Murray selbst in den Zeugenstand tritt. Im Falle eines Schuldspruchs drohen dem 58-jährigen Mediziner bis zu vier Jahre Haft. (dpa)Kommentar
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Verteidigung zieht neue Karte
Freitag, 28.10.2011, 17:33
Die Verteidigung im Prozess gegen den früheren Arzt von Michael Jackson zieht eine neue Karte. Mit wissenschaftlichen Befunden will sie beweisen, dass Jackson sich selbst die tödliche Dosis des Betäubungsmittels Propofol verabreicht hat.
Mit wissenschaftlichen Befunden zu ihrer Theorie, dass Michael Jackson sich selbst die tödliche Dosis des Betäubungsmittels Propofol verabreicht hat, zieht die Verteidigung im Prozess gegen den früheren Arzt des Popstars eine neue Karte. Bei einer für Freitag angesetzten Anhörung sollte ein Propofol-Experte erklären, wie Jackson sich im Juni 2009 selbst das Mittel gegeben haben könnte, nachdem Arzt Conrad Murray den Raum verlassen hatte.
Die neue Argumentation beruht nach Angaben der Verteidigung auf kürzlich durchgeführten Tests an Proben aus Jacksons Autopsie und der Simulation des Zusammenspiels von Propofol und einem weiteren Beruhigungsmittel. Die Anklage hingegen sieht als einzig mögliches Szenario, dass Murray Jackson das Mittel verabreichte und den Raum verließ, als er glaubte, der Sänger schlafe. Murray ist wegen fahrlässiger Tötung angeklagt. Ihm wird vorgeworfen, durch die Verwendung von Propofol den Tod Jacksons herbeigeführt zu haben. Der Arzt hat sich für nicht schuldig erklärt.
gxb/dapd
Kommentar
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Michael Jackson 'gave himself anaesthetic'
By Anthony Mccartney in Los Angeles
AP
October 29, 2011 7:46AM
AN anaesthesia expert testifying for the doctor charged in Michael Jackson's death has told jurors he believes the pop superstar gave himself a fatal injection of an anesthetic.
Paul White said today the self-injection theory is the only one supported by the physician's statement to police and by evidence found at Jackson's rented mansion.
Mr White said he saw no evidence supporting the prosecution theory that Jackson's doctor was infusing the singer with propofol using an IV.
The researcher said the evidence recovered in Jackson's bedroom was more consistent with the singer receiving the powerful anesthetic through an injection.
A prosecution expert had told jurors he believed Jackson's doctor used an IV drip of propofol and said that was the only way to explain the high levels of the drug found in the singer's body.
Mr White noted there were no IV bags or lines found in Jackson's bedroom that showed propofol residue throughout the lines.
He also said the levels of propofol found in Jackson's urine did not support the IV theory.
Jackson's doctor, Conrad Murray, has pleaded not guilty to involuntary manslaughter.
Mr White's testimony was expected to end Dr Murray's defence case after 16 witnesses. It likely will be vigorously challenged by prosecutors, who spent four weeks laying out their case that Dr Murray was a greedy, inept and reckless doctor who was giving Jackson propofol as a sleep aid in the singer's bedroom.
Propofol is not intended as a sleep aid and, medical groups say, should be administered only in a hospital or surgical setting with advanced monitoring equipment.
Cross-examination of Mr White has been delayed until Monday to give prosecutors more time to review a new analysis prepared by the defence based on recently conducted tests of samples taken during Jackson's autopsy.
The judge hearing the case, which ends its fifth week today, reluctantly agreed to delay the cross examination and said he was concerned about losing jurors.
Superior Court Judge Michael Pastor, however, noted the panel has remained rapt throughout the trial.
"Every single member of that jury and all the alternates are paying extraordinary attention to every witness," Pastor said.
Mr White told jurors he saw no evidence that Murray left Jackson on an IV drip of propofol when he left the room and returned to find the singer unresponsive on June 25, 2009.
Mr White said the singer would have had to lie completely still to keep from disturbing the bottle under that scenario, and he had never heard of anyone using an IV saline bottle to suspend a bottle of propofol for a drip.
Mr White noted all bottles of the drug come with a tab on the side, which could be used to hang them from an IV stand.
Defence lawyer J Michael Flanagan concluded his direct examination of Mr White on Friday morning local time, and the judge recessed the case until Monday.
Mr White performed clinical studies of propofol for years before it was approved for use by the Food and Drug Administration in 1989.
White initially was reluctant to become involved in the Jackson case. But he said after reading more than a dozen expert reports, he couldn't figure out how others came to the conclusion that Murray would have had to leave
Jackson on a propofol IV drip for the singer to die with the anesthetic still coursing through his body.
Kommentar
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La Toya Jackson wrote via her official Twitter account: "@hlntv @justice4michael I'm even more convinced after today that someone intentionally injected Michael. MICHAEL WAS MURDERED!!!!!" She then wrote: "@hlntv @justice4michael #murraytrial MiCHAEL DID NOT KILL HIMSELF!!! HE WOULD NEVER DO THAT!!!!!!"
Kommentar
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Defense witness: Michael Jackson caused own death
APBy LINDA DEUTSCH - AP Special Correspondent | AP – 6 hrs ago
LOS ANGELES (AP) — With dramatic courtroom testimony, attorneys for Michael Jackson's doctor have dropped the bombshell they've been hinting at for months — an expert opinion accusing the singer of causing his own death.
Dr. Paul White said Jackson injected himself with a dose of propofol after an initial dose by Dr. Conrad Murray wore off. He also calculated that Jackson gave himself another sedative, lorazepam, by taking pills after an infusion of that drug and others by Murray failed to put him to sleep.
That combination of drugs could have had "lethal consequences," the defense team's star scientific witness said Friday.
Murray has pleaded not guilty to involuntary manslaughter.
White showed jurors a series of charts and simulations he created in the past two days to support the defense theory. He also did a courtroom demonstration of how the milky white anesthetic propofol could have entered Jackson's veins in the small dose that Murray claimed he gave the insomniac star.
White said he accepted Murray's statement to police that he administered only 25 milligrams of propofol after a night-long struggle to get Jackson to sleep with infusions of other sedatives.
"How long would that (propofol) have had an effect on Mr. Jackson?" asked defense attorney J. Michael Flanagan.
"If you're talking effect on the central nervous system, 10 to 15 minutes max," White said.
He then said Jackson could have injected himself with another 25 milligrams during the time Murray has said he left the singer's room.
"So you think it was self-injected propofol between 11:30 and 12?" asked Flanagan.
"In my opinion, yes," White said.
The witness, one of the early researchers of the anesthetic, contradicted testimony by Dr. Steven Shafer, his longtime colleague and collaborator. Shafer earlier testified Jackson would have been groggy from all the medications he was administered during the night and could not have given himself the drug in the two minutes Murray said he was gone.
"He can't give himself an injection if he's asleep," Shafer told jurors last week. He called the defense theory of self-administration "crazy."
White's testimony belied no animosity between the two experts, who have worked together for 30 years. Although White was called out by the judge one day for making derogatory comments to a TV reporter about the prosecution case, White was respectful and soft spoken on the witness stand.
When Flanagan made a mistake and called him "Dr. Shafer" a few times, White said, "I'm honored."
The prosecution asked for more time to study the computer program White used before cross-examining him. Superior Court Judge Michael Pastor granted the request, saying he too was baffled by the complicated simulations of Jackson's fatal dose. He recessed court early and gave prosecutors the weekend to catch up before questioning White on Monday.
The surprise disclosure of White's new theory caused a disruption of the court schedule, and the judge had worried aloud that jurors, who expected the trial to be over this week, were being inconvenienced. But the seven men and five women appeared engaged in the testimony and offered no complaints when the judge apologized for the delay.
Prosecutors could call Shafer back during their rebuttal case to answer White's assertions.
Among the key issues is how White calculated that a large residue of propofol in Jackson's body could have come from the small dose that Murray says he administered. Shafer assumed Murray had lied, and he estimated Jackson actually was given 1,000 milligrams of the drug by Murray, who he said left the bottle running into an IV tube under the pull of gravity. White disputed that, saying an extra 25 milligrams self-administered by Jackson would be enough to reach the levels found in his blood and urine.
White also said a minuscule residue of the sedative lorazepam in Jackson's stomach convinced him the singer took some pills from a prescription bottle found in his room. He suggested the combination of lorazepam, another sedative, midazolam, plus the propofol could have killed Jackson.
"It potentially could have lethal consequences," said White. "... I think the combination effect would be very, very profound."
White's testimony was expected to end Murray's defense case after 16 witnesses. It likely will be vigorously challenged by prosecutors, who spent four weeks laying out their case that Murray is a greedy, inept and reckless doctor who was giving Jackson propofol as a sleep aid in the singer's bedroom. Experts including Shafer have said propofol is not intended to treat insomnia and should not be given in a home.
White's theory was based on urine and blood levels in Jackson's autopsy, evidence found in Jackson's bedroom and Murray's long interview with police detectives two days after Jackson died while in his care.
While accepting Murray's account of drugs he gave Jackson, the expert's calculations hinged on the invisible quotient: Jackson's possible movements while his doctor was out of the room. With no witnesses and contradictory physical evidence, that has become the key question hanging over the case.
Those who knew the entertainer in his final days offered a portrait of a man gripped by fear that he would not live up to big plans for his comeback concert and worried about his ability to perform if he didn't get sleep. He was plagued by insomnia, and other medical professionals told of his quest for the one drug he believed could help him. He called it his "milk," and it was propofol.
Jurors have now seen it up close as both Shafer and White demonstrated its potential use as an IV infusion.
With White's testimony, the defense sought to answer strong scientific evidence by the prosecution. But they did not address other questions such as allegations that Murray was negligent and acting below the standard of care for a physician.
Flanagan, the defense attorney, produced a certificate from Sunrise Hospital in Las Vegas showing Murray was certified to administer moderate anesthesia, referred to as "conscious sedation." However, the document showed several requirements including that the physician "monitor the patient carefully" and "provide adequate oxygenation and ventilation for a patient that stops breathing."
Medical witnesses noted that Murray left his patient alone under anesthesia and did not have adequate equipment to revive him when he found him not breathing.
The coroner attributed Jackson's June 25, 2009, death to "acute propofol intoxication" complicated by other sedatives.Zuletzt geändert von Lena; 29.10.2011, 15:51.Kommentar
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Murray Trial Day 20 October 28, 2011
Morning Session
Dr White Testimony
Flanagan Direct
They still discuss the variability between people. Propofol’s effect site is the brain and the amounts in the brain are not measurable in living humans so they use alternative measures such as EEG.
Flanagan shows several papers and graphs that show that levels in patients vary a lot.
Flanagan switches to Dr. Shafer’s graph for Lorazepam (2 doses of 2 mg). White says this is accurate for an average patient but not for MJ. White says if MJ was taking oral Lorazepam, you would expect to see residual levels of Lorazepam from previous days. Walgren objects to the use of word “oral”.
White says as CM said he treated MJ with Midazolam and Lorazepam, he would expect to find residual levels but White doesn’t know how much MJ was given to make this determination.
Flanagan shows Shafer’s graph for Midazolam (2 doses of 2 mg given at 3AM and 7:30AM). Actual blood concentration for midazolam in autopsy report was close to Shafer’s model.
Flanagan shows graphs done by Shafer that combines Midazolam and Lorazepam, another graph that shows 25mg Propofol given over 3 to 5 minutes and another graph combining all (25mg Propofol, 2 doses of 2 mg Lorazepam and 2 doses of 2 mg Midazolam).This combination doesn’t show a dangerous situation.
Flanagan and White goes over a study and based on that White says that 25mg of Propofol would provide minimal sedation and help with anxiety relief and bring a little sleepiness. White says that CM gave minimal sedation.
Flanagan asks what is moderate / mac/ conscious/ procedural sedation. White says there’s verbal response, airway is unaffected and cardiovascular functions will be okay.
White says hospitals require doctors that use conscious sedation be trained so that if they mistakenly sedate the patient in a deep sedation they can rescue the patient.
Flanagan shows that CM has a certification from Sunrise Hospital in Las Vegas for moderate sedation. That allows CM to evaluate the patient, administer sedation, manage a compromised airway, provide adequate ventilation in case of apnea, rescue a patient from deeper sedation, and monitor the patient to evaluate sedation.
Flanagan shows Shafer’s graph for 40mg Lorazepam. Initially the doses started around 12:00AM but later Shafer corrected the time. White says the average patient would be dead at the very least comatose for several hours, receiving 40mg over 5 hours. Shafer did that simulation because of the 10ml vial found at the house. For Shafer’s modified simulation ( 9 doses of 4 mg each starting at 1:30AM), White says it doesn’t fit with the vial found in the house. Also last doses would have been given when he was still asleep.
Flanagan shows the graph with 40 mg Lorazepam with 2 doses of midazolam and Lorazepam. White says that it doesn’t make sense when MJ was highly sedated with Lorazepam, Midazolam would be given to him.
Flanagan shows a computer simulation: 2 doses of 2 mg Lorazepam (2AM and 5AM) and an oral dose of 20 mg (10 pills taken at the same time) at 7AM. This graph assumes there was no residual Lorazepam from previous days.
Flanagan shows another graph. It’s the same but assumes a residual level for 10mg for last 5 days. It would achieve the same result with 16 mg oral Lorazepam (8 pills) taken at 7AM.
Flanagan says the amount of Lorazepam in MJ’s stomach was very low. White says the pill will dissolve in 15 minutes and the absorption halftime is 22 minutes. White says that it’s normal that there was a little Lorazepam found in his stomach.
White says that his Lorazepam simulations are more reasonable and that 40 mg simulation of Shafer is irrational. White says the simulation with residual level is more realistic.
White says that maybe MJ didn’t take 8 pills at once. Maybe he took a few at one time and then later took some more such as at 6 AM and 8 AM. White says it’s a speculation but it’s more reasonable than 4mg boluses every 30 minutes.
White explains the small amount of Lorazepam in the stomach by absorption half-life.
Flanagan mentions another article and asks finding equivalent of 1/300th of a pill in stomach is consistent with White’s simulation. White says you would not expect to find free Lorazepam in the stomach if it was given via IV.
Mid morning break.
White says that as there was free Lorazepam in the stomach it has to be oral consumption.
White goes over Dr. Shafer’s simulations. White says Shafer’s simulations have Propofol injections in 30 seconds to 60 seconds and say that it’s inconsistent with CM’s interview. White says Shafer’s simulation of 100mg bolus is inconsistent with lidocaine. White says such injection would burn tremendously in small veins.
White says multiple injections of 50mg is inconsistent with lidocaine levels found at autopsy. White says it would be difficult for MJ to draw Propofol himself. White says he’s not sure if MJ would do it himself and the defense never claimed that.
White says 25mg scenario is less absurd as its minimal sedation. Flanagan asks if a person could be awake to do a 25mg injection over 30 seconds and White answers yes. White adds that the blood concentration depends on how fast the injection is done. Slow injection would have less effect on the heart and respiratory system.
Flanagan shows a graph with Lorazepam and Midazolam and a rapif 25mg bolus Propofol. White says if a fast bolus was put on the Lorazepam levels , the combination could be lethal.
White says Shafer’s 100ml infusion (IV) was inconsistent with CM’s interview. White says that an IV system was needed and the handle of Propofol was not used. White says bottle in the bag would be too low and it would be dangerous. Also White says if the patient moves or someone touches the tube the bottle could fall. White says he can’t think of a reason to not use the handle and go to the hassle of cutting the bag with a knife.
White says before the infusion pumps the practice was to empty the propofol bottle into the saline bag. If you do that when the bag is empty you would see the Propofol residue on the bag and the chamber. There was no propofol in the bag or in the long tube.
White says there’s no evidence that there was an IV and says that he think there was no infusion.
White again mentions Shafer’s simulation of 100ml IV. He says it’s an incredible coincidence that the patient dies when the bottle runs out.
White also says that Propofol in the urine doesn’t support the 100ml IV over 3 hours. White says according to urine levels the most consistent scenario is a self injection of 25mg Propofol between 11:30AM and 12:00PM.
White says that Shafer’s scenarios don’t reconcile with CM's statement, evidence at the scene, urine concentration. White says his scenario with self injection fits fit everything.
Court ends early. Media reports that Prosecutor Walgren asked for time to get ready for cross.Kommentar
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Michael Jackson könnte Todesspritze selbst gesetzt haben
29.10.2011
REUTERS
Sachverständiger Paul White: Jackson könnte selber Betäubungsmittel genommen haben
Wie bekam Michael Jackson die tödliche Dosis an Betäubungsmittel zugeführt? Über diese Frage sind sich Sachverständige im Verfahren gegen Leibarzt Murray uneins. Nach einem neuen Gutachten könnte der Popstar selbst seinen Tod verschuldet haben.
Los Angeles - Der Experte Paul White erklärte am Freitag im Prozess gegen den früheren Leibarzt von Jackson, Conrad Murray, Jackson habe sich vermutlich selbst eine Dosis des Betäubungsmittels Propofol verabreicht, nachdem eine erste, die ihm Murray gegeben habe, abgeklungen sei. Zudem habe Jackson seien Berechnungen zufolge ein weiteres Beruhigungsmittel genommen. Zusammen könne das "tödliche Konsequenzen" haben, sagte White.
Es war die Aussage, auf die die Anwälte Murrays seit Monaten in dem Verfahren hingearbeitet hatten. Die Aussagen von White beruhen nach Angaben der Verteidigung auf kürzlich durchgeführten Tests an Proben aus Jacksons Autopsie und der Simulation des Zusammenspiels von Propofol mit einem weiteren Beruhigungsmittel. White legte dazu im Gericht eine Reihe von Diagrammen vor, die er in den vergangenen Tagen erstellte.
White erklärte, er glaube Murray, wenn dieser ausgesagt habe, dass er Jackson nur 25 Milligramm Propofol gegeben habe. Das hätte aber nur 10 bis 15 Minuten ausgereicht, sagte White auf Nachfrage. Eine weitere Dosis könne sich Jackson dann selbst verabreicht haben. White widersprach damit der Aussage eines anderen Experten, seines früheren Kollegen Steven Shafer, der es ausgeschlossen hatte, dass Jackson selbst die tödliche Dosis genommen haben könnte.
Die Anklage erklärte danach, sie brauche mehr Zeit, um das Computerprogramm zu überprüfen, das White genutzt habe, bevor das Kreuzverhör beginne. Dem stimmte Richter Michael Pastor zu, der sich überrascht von den verschiedenen Angaben der Experten zeigte. Die Verhandlung sollte am Montag fortgesetzt werden.
Die Anklage hielt es bislang nur für möglich, dass Murray Jackson das Mittel verabreichte und den Raum verließ, als er glaubte, der Sänger schlafe. Murray ist wegen fahrlässiger Tötung angeklagt. Ihm wird vorgeworfen, durch die Verwendung von Propofol den Tod Jacksons herbeigeführt zu haben. Der Arzt hat sich für nicht schuldig erklärt. Bei einem Schuldspruch muss er mit vier Jahren Gefängnis rechnen.
Vor White war der Suchtspezialist Robert Waldman zu Wort gekommen, der die Ansicht vertrat, Jackson sei schon Monate vor seinem Tod von dem Schmerzmittel Demerol abhängig gewesen. Dieses Schmerzmittel wurde dem Popstar zwischen April und Juni 2009 verabreicht, weil er an den Folgen von Botox- und anderen schönheitschirurgischen Eingriffen litt.
abl/dapd/AFP
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Katherine Jackson May Not Be In LA For Dr. Conrad Murray Verdict
By Jen Heger
Katherine Jackson probably won't be in Los Angeles when a verdict is announced in the Dr. Conrad Murray case, RadarOnline.com is exclusively reporting.
Michael Jackson's powerhouse attorney, Tom Mesereau told us during Radar Live on Wednesday, that he was going to be with the Jackson family matriarch in London next week for the premiere of a documentary about the King of Pop's life.
"I will be with Katherine in London next week with my law firm partner Susan Yu, Katherine, Tito, Rebbie, we are going to be in London for the premiere of David Gest's brilliant and wonderful documentary about the life of Michael Jackson. It's called Michael Jackson: The Life of An Icon and we will all be there for that premiere, so we will probably be in London when there is a verdict," Mesereau said.
"I went to a private premiere of his film, a private screening, of his film a few months ago in Los Angeles at Universal Studios and it's one of the most brilliant, kindest, most sensitive documentaries about Michael Jackson ever and when I went to see it I was wondering if it was going to be new material or had I seen everything, and I was so moved by this wonderful documentary. It goes through Michael's ups and downs...I'm glad Katherine will be there for the premiere because it's a very positive piece about a brilliant, wonderful, kindhearted human being that all of us loved," Tom asserts.
Mesereau successfully represented Michael Jackson during his 2005 molestation trial in Santa Maria, California. The documentary will cover the ups and downs of the singer’s complex life, and include interviews with Katherine Jackson, Tito and Rebbie.
Dr. Conrad Murray's defense is expected to wrap up it's case by Friday, and final arguments could be heard on Monday.
As RadarOnline.com previously reported, Murray broke down in tears as his best friend and patient testified on his behalf on Wednesday morning.
If convicted of the involuntary manslaughter of Michael Jackson, Dr. Murray could face up to four years in state prison.
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28.10.2011: Prozess: 20. Tag – Zeugen der Verteidigung
Wie angekündigt bezweckte die Verteidigung heute mit Hilfe ihres Hauptzeugen, dem Propofolexperten Dr. White, die Szenarien der Staatsanwalt und ihrem Propofolexperten Dr. Shafer zu widerlegen und aufzuzeigen, dass Michael Jackson selbst für seinen Tod verantwortlich war. Gemäss Dr. White war Conrad Murray gemäss seiner Aussage der Polizei gegenüber sowie gemäss dem Beweismaterial am Tatort nur für eine geringe Dosis an Propofol (25mg) veranwortlich und diese hätte nicht zum Tod von Michael Jackson geführt. Die neue Theorie der Verteidigung besagt, dass sich Michael Jackson zwischen 11:30 und 12 Uhr am 25. Juni 2009 25mg Propofol selbst iniziiert hatte, nachdem er bereits Stunden vorher grosse Mengen an Beruhigungsmitteln (Lorazepam) eingenommen hatte. Dabei soll sich Michael Jackson gemäss Dr. White die 25mg Propofol mittels Spritze in nur 15 bis 30 Sekunden in den Katheter unter dem linken Knie eingespritzt haben.
Gemäss Dr. White ist der Grund, weshalb bei der Autopsie Spuren von Lorazepam im Magen von Michael Jackson gefunden wurden, der, dass Michael Jackson diese oral eingenommen hatte (möglicherweise 4 Tabletten aufs Mal zweimal in der Nacht) und da diese sehr rasch durch das Verdauungssystem aufgenommen werden, nur ein kleiner Rest im Magen aufgefunden wurde. Wäre das Lorazepam, wie Dr. Shafter argumentierte, Michael Jackson mittels Infusion verabreicht worden, hätte man, so Dr. White, im Magen keine Spuren von Lorazepam gefunden. Die Kombination der hohen Dosierung an Lorazepam und der zweiten, selbstiniziierten 25mg Propofoldosis habe sich, so Dr. White, als tödlich erwiesen. In der insgesamt dreistündigen Befragung heute ging es der Verteidigung darum, jedes von Dr. Shafter aufgezeigte Szenario und Argument zu entkräftigen bzw. aufzuzeigen, dass dieses nicht möglich bzw. sehr unwahrscheinlich sei bzw. keinen Sinn mache. Das von Dr. Shafter und der Staatsanwaltschaft am Ende realistische Szenario lautete, dass Conrad Murray Michael Jackson über einen Zeitraum von drei Stunden vor Michaaels Tod 100mg Propofol mittels kontinuierlicher Infusion verabreicht hatte. White argumentierte heute, dass Michael Jackson bei einer solchen Infusion schläfrig gewesen wäre, aber jederzeit hätte aufwachen können.
Aufgrund der gestern neu eingebrachten Theorie der Verteidigung betreffend die Todesursache von Michael Jackson und den damit verbundenen neuen Computersimulationen gestattete Dr. Pastor der Staatsanwaltschaft, sich über das Wochenende auf ihr Kreuzverhör vorzubereiten, indem sie die neuen Unterlagen genau studieren können. Am Montagmorgen um 9 Uhr Ortszeit (18 Uhr Schweizer Zeit) wird David Walgren mit dem Kreuzverhör beginnen und man darf gespannt sein. Es ist nicht auszuschliessen, dass die Staatsanwaltschaft anschliessend ihren Propofolexperten, Dr. Shafer, nochmals in den Zeugenstand rufen wird.
Quellen: jackson.ch, abclocal.go.com (ab Live Stream), cnn.com
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Kathy Hilton: Conray Murray Trial Is a 'Shame'
V I D E O im Link: http://wildfire.gigya.com/facebook
28.10.2011: Hiltons unterstützen die Jacksons
Kathy und Rick Hilton, die Eltern von Paris Hilton, kamen heute zur Gerichtsverhandlung, um ihre Unterstützung für ihren langjährigen Freund Michael und die Jackson Familie zu zeigen. Rick Hilton meinte: “Es gibt viele Fragen, die beantwortet werden müssen.” Kathy Hilton kannte Michael seit sie 13 Jahre alt war und die beiden in die gleiche Schule gingen. Die beiden blieben bis zum Schluss miteiander in Kontakt. Kathy Hilton ging am Todestag auch ins Krankenhaus, um sich persönlich von Michael ein letztes Mal zu verabschieden. Zur Erinnerung bzw. für diejenigen, die es damals verpasst haben, hier nochmals der Link zum bewegenden und herzlichen Interview von Piers Morgen, CNN http://edition.cnn.com/video/?/video...el.jackson.cnn,
mit Kathy Hilton Ende Mai diesen Jahres.
Quellen: jackson.ch, cnn.com
Zuletzt geändert von geli2709; 29.10.2011, 18:55.Kommentar
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