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Witness: Jackson's doctor didn't follow protocol
Dr. Paul White acknowledges that pulse monitor Murray used wasn't adequate
Paul Buck / AP
Dr. Conrad Murray could lose his medical license and face four years in jail.By ANTHONY McCARTNEY
updated 7 minutes ago 2011-10-31T18:49:29
LOS ANGELES — A prosecutor grilling a defense expert got the veteran anesthesiologist to acknowledge Monday that Michael Jackson's doctor deviated from the standard of care.
Dr. Paul White was repeatedly questioned about the ways in which Dr. Conrad Murray had broken guidelines and rules in his treatment of Jackson.
White acknowledged that the type of pulse monitor that Murray was using on Jackson's finger was inadequate to properly monitor the singer when the physician left the room.
Murray, who has pleaded not guilty to involuntary manslaughter, has acknowledged he was giving Jackson doses of the anesthetic propofol in the singer's bedroom as a sleep aid. He told police that he left Jackson's room for two minutes on June 25, 2009, and returned to find the pop superstar unresponsive.
White also said he would not leave the room if he were treating a patient who had indicated he liked to inject propofol into himself, as Murray claims that Jackson had told him.
Superior Court Judge Michael Pastor had to interrupt testimony and admonish White after the researcher repeatedly referenced conversations he had with Murray. The judge has excluded testimony about those discussions.
"Dr. White is trying to offer a response he thinks is helpful," Pastor said of White's comments. At one point Monday, White said he had been told that Jackson had his own stash of propofol beyond the hundreds of doses of the drug that Murray had purchased and shipped to his girlfriend's apartment.
Pastor warned White not to try to bring up the conversations or other excluded information again.
"It's deliberate and I don't like it," Pastor said. "It's not going to happen again."
Deputy District Attorney David Walgren pointedly questioned White, a retired professor and clinical researcher, about the circumstances of Murray's care based on his interview with police two days after Jackson's death. White told jurors last week that he believes all the evidence in the case shows that Jackson must have self-administered propofol when Murray left the room.
Walgren and White noted the unique circumstances of the case.
"Have you ever administered propofol in someone's bedroom?" Walgren asked.
"No, I have not," White replied.
"Have you ever heard of someone doing that prior to this case?" the prosecutor asked.
"No, I have not," White responded.
Later, White said Murray's treatment of Jackson was different from how propofol is supposed to be used — as an anesthetic used in hospital or clinical settings.
"This was an unusual case because the doctor was trying to allow the patient to achieve a sleep state," White said.
White retired last year after conducting research on propofol before it was approved for use in the United States. He told jurors that he has been paid $11,000 for his work on the case so far.
White's testimony has put him at odds with his colleague and longtime friend, Dr. Steven Shafer, who testified for the prosecutor. Shafer said White's self-administration theory
is not supported by the evidence in the case, in his view, and he called the theory "crazy" during his testimony earlier this month.
White and Shafer were colleagues at Stanford University and conducted research on propofol before it was approved for use in U.S. operating rooms in 1989. Both help edit a leading anesthesia journal. Until White's retirement last year, both were practicing anesthesiologists.
Shafer said Murray committed 17 egregious violations of the standard of care and should never have been giving the singer propofol as a sleep aid.
"We are in pharmacological never-never land here, something that was done to Michael Jackson and no one else in history to my knowledge," he told jurors.
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Key Conrad Murray witness faces new contempt of court charge
October 31, 2011 | 1:05 pm
Conrad Murray in court Oct 31 2011
The judge overseeing the trial of Michael Jackson’s personal physician said Monday he was considering finding a key defense witness in contempt of court and fining him $1,000 for violating an order.
Superior Court Judge Michael Pastor said the witness, an anesthesiologist who is the main medical expert for Dr. Conrad Murray’s defense, violated a court order by mentioning in his testimony conversations he had with Murray.
Pastor had earlier warned Dr. Paul White to keep from mentioning the “two extensive conversations” he said he had with Murray, information the judge had previously ruled was inadmissible evidence in the case.
Minutes after the judge’s admonishment, White again brought up the conversation before jurors, the judge said.
“That is a direct violation of my order and quite frankly constitutes direct contempt,” Pastor said.
In his testimony earlier Monday, White hinted at information from those conversations -- that the pop star had his “own supply” of propofol, that Murray left a half-filled syringe at Jackson’s bedside -– to a prosecutor’s repeated objections.
Deputy Dist. Atty. David Walgren protested to the judge outside the jury’s presence that White was intentionally dropping mentions of information from his conversations with Murray.
Defense attorney Michael Flanagan said White could not be expected to specifically recall what information he got from Murray’s police interview and what information he got from his meetings with the physician.
Pastor said he didn’t buy that explanation.
“Nice try,” Pastor said. "This is so obvious .... He’s trying at every juncture to add in other material. It’s deliberate, I don’t like it, it’s not going to happen again.”
Pastor said when White once again referred to the conversation despite his admonishment, it was a direct violation of his order.
The contempt of court charge is the second for White, who was also chided by the judge earlier this month for making comments about a prosecution witness reported on a website.
Pastor said he would hold a hearing on both contempt charges Nov. 16.
In his testimony Monday, White, an expert on the anesthetic propofol, elaborated on the theory he first gave last week.
Jackson, he testified, probably injected himself with a syringe Murray had filled with 25 milligrams of propofol and laid near his bedside.
He said that when Murray was distracted by a series of phone calls, Jackson woke up and got the syringe.
“It was some time during that 40-minute period where I believe Mr. Jackson had the opportunity and likely self-administrated the final fatal dose of propofol,” he said.
Walgren noted that Jackson was attached to an IV stand and a urinary catheter and suggested it was more plausible for Murray to have injected the propofol and then lied about the amount he gave.
“It’s possible if he wanted to potentially harm Michael Jackson,” White replied.
“If Michael Jackson did it, was he doing it to harm himself?” Walgren asked.
“I don’t think he realized the potential danger,” the witness answered.
The exchanges between the witness and prosecutor were testy at times, with Walgren remarking: “You keep throwing out these kind of rehearsed lines.”
A defense attorney objected, and the comment was stricken.Kommentar
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Neue Vorwürfe gegen Jackson-Arzt Murray
Im Prozess um den Tod von Michael Jackson ist ein Zeuge der Verteidigung heute zum Zeugen der Anklage geworden. Der Sachverständige Paul White sagte vor Gericht in Los Angeles aus, der angeklagte Arzt Conrad Murray sei fahrlässig bei der Pflege seines berühmten Patienten gewesen. Jackson war im Juni 2009 an einer Überdosis Propofol gestorben. Die Anklage wirft Murray vor, Jackson zu viel von dem Narkosemittel verabreicht zu haben.
„Ohne sorgfältige Überwachung am Bett des Patienten könnte es gefährlich sein“, sagte der Narkosespezialist der „Los Angeles Times“ zufolge zum Einsatz von Propofol bei Jackson. Die Verabreichung außerhalb eines Krankenhauses widerspreche allen ärztlichen Standards. Am Freitag hatte seine Aussage die Position der Verteidigung gestützt. Demnach könnte sich Jackson das letztlich tödliche Anästhetikum Propofol selbst gespritzt haben.
White ist laut Terminrolle der letzte Zeuge. Wenn nicht noch Anklage oder Verteidigung mit Überraschungszeugen aufwarten, wäre dann die Beweisaufnahme abgeschlossen und nach den Plädoyers von Anklage und Verteidigung könnte der Fall an die Geschworenen gehen.
http://orf.at/stories/2087159/Kommentar
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31.10.2011/ 21. Prozesstag / Fakten / Presse / KEINE DISKUSSION
Conrad Murray-Trial - Day 21-October 31, 2011:
"Day 21, Session 1 (TMZ-stream)"
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"Day 21, Session 2 (TMZ-stream)"
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"Day 21, Session 3 (TMZ-stream)"
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"Day 21, Session 4 (KABC-stream)"
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"Day 21, Session 5 (KABC-stream)"
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+ YouTube Video Kommentar
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Experte kritisiert Vorgehen von Michael Jacksons Arzt
Der Sachverständige Paul White sagte vor Gericht in Los Angeles aus, der angeklagte Arzt Conrad Murray sei fahrlässig bei der Pflege seines berühmten Patienten gewesen. Jackson war im Juni 2009 an einer Überdosis Propofol gestorben. Die Anklage wirft Murray vor, Jackson zu viel von dem Narkosemittel gespritzt zu haben.
„Ohne sorgfältige Überwachung am Bett des Patienten könnte es gefährlich sein“, sagte der Narkosespezialist zum Einsatz von Propofol bei Jackson. Die Verabreichung außerhalb eines Krankenhauses widerspreche allen ärztlichen Standards. „Man kann dieses Mittel einsetzen, ich würde es auch tun. Ich würde es aber nie bei einem Patienten zu Hause machen.“
Am Freitag hatte seine Aussage die Position der Verteidigung gestützt. Demnach könnte sich Jackson das letztlich tödliche Anästhetikum Propofol selbst gespritzt haben. Im Kreuzverhör der Anklage wurde White am Montag immer einsilbiger. Der Sachverständige sah sich sogar einer Strafandrohung vom Richter über 1000 Dollar (720 Euro) gegenüber, weil er trotz Verwarnung aus einer Unterhaltung mit Murray zitiert hatte. Er hatte sich schon Anfang des Monats den Unmut des Richters zugezogen, als er den Prozess im Internet kommentierte.
White ist der letzte Zeuge. Wenn nicht noch Anklage oder Verteidigung mit Überraschungszeugen aufwarten, wäre dann die Beweisaufnahme abgeschlossen. Nach den Plädoyers von Anklage und Verteidigung könnte der Fall an die Geschworenen gehen. Es wird nicht erwartet, dass Murray selbst in den Zeugenstand tritt. Im Falle eines Schuldspruchs drohen dem 58-jährigen Mediziner vier Jahre Haft.
http://www.focus.de/kultur/musik/kri...id_679647.htmlKommentar
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Witness: Jackson's doctor didn't follow protocol
APBy LINDA DEUTSCH - AP Special Correspondent | AP – 46 mins ago
LOS ANGELES (AP) — Dr. Conrad Murray heard his own expert witness testify Monday that he wouldn't have accepted payment to do what Murray did for Michael Jackson — administering a hospital anesthetic in the star's bedroom.
"I wouldn't even consider it," Dr. Paul White said. "It's something no amount of money could convince me to take on."
The use of the drug propofol to treat Jackson's insomnia was "a complete off-label use of the drug," he said.White also acknowledged that the drug should never be given outside a medical facility because of the need for proper lifesaving equipment.
White, a highly regarded and now-retired anesthesiologist, is sometimes referred to as "the father of propofol" for his early research on the drug. But on Monday he was a less than respected figure, drawing criticism from the prosecutor and censure from the judge who threatened to fine him $1,000 for contempt of court.
White came under a bruising cross-examination by prosecutor David Walgren who attacked the expert's recent claim that Jackson caused his own death. Walgren questioned White's scientific calculations and noted he once led the defense to think Jackson drank an extra dose of propofol.
White acknowledged he had done no research on that theory when he posed it. A study later showed the theory to be unsupportable, he said.
While stopping short of blaming Murray for the singer's death, White blurted out during cross-examination that he believed Murray had loaded a syringe with the drug propofol and left it where Jackson could have gained access to it.
That scenario had not been offered before and it could explain how a groggy Jackson could have awakened from sedation, grabbed the syringe and injected the drug into his IV line.
Superior Court Judge Michael Pastor told White outside the jury's presence to stop trying to sneak in references to private conversations he had with Murray. The witness had suggested his opinions were partially based on what Murray told him, but those talks are not in evidence.
At one point Monday, White said he had been told by Murray that Jackson had his own stash of propofol beyond the hundreds of bottles of the drug that Murray had purchased and shipped to his girlfriend's apartment. Pastor warned White not to try to bring up the conversations or other excluded information again.
"It's deliberate and I don't like it," Pastor said. "It's not going to happen again."
But by the end of the morning the judge said White had violated his order. Outside the jury's presence, he chastised the witness for telling the jurors at one point: "I'd like to talk to you about this but the judge told me I couldn't."
He said he considered that remark direct contempt of court but would allow White to explain at a contempt hearing on Nov. 16 before he imposes the $1,000 fine.
White was repeatedly questioned about the ways in which Murray had broken guidelines and rules governing the use of propofol. Walgren confronted the witness with excerpts from his own writings in textbooks which set down rules that Murray broke by administering the drug in Jackson's bedroom.
Murray, who has pleaded not guilty to involuntary manslaughter, has acknowledged he was giving Jackson doses of the anesthetic propofol in the singer's bedroom as a sleep aid. He told police that he left Jackson's room for two minutes on June 25, 2009, and returned to find the pop superstar unresponsive.
White said in forming his opinions, he assumed Murray was out of the room much longer, making phone calls.
The retired anesthesiologist also said he would not leave the room if he were treating a patient who had indicated he liked to inject propofol into himself, as Murray claims that Jackson had told him.
White said he has been paid $11,000 for his work for the defense so far.
White's testimony has put him at odds with his colleague and longtime friend, Dr. Steven Shafer, who testified for the prosecutor. Shafer said White's self-administration theory is not supported by the evidence in the case, in his view, and he called the theory "crazy" during his testimony earlier this month.
White and Shafer were colleagues at Stanford University and conducted research on propofol before it was approved for use in U.S. operating rooms in 1989. Both help edit a leading anesthesia journal. Until White's retirement last year, both were practicing anesthesiologists.
Shafer may be called as a rebuttal witness later in the trial, which is now in its sixth week.
___Zuletzt geändert von Lena; 01.11.2011, 01:50.Kommentar
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Verteidigung im Jackson-Prozess erleidet Rückschlag
(AFP) – Vor 7 Stunden*
Los Angeles — Im Prozess um den Tod von Michael Jackson hat die Verteidigung einen Rückschlag erlitten: Im Kreuzverhör mit der Staatsanwaltschaft belastete ihr Hauptzeuge selbst den Angeklagten. Auf Nachfrage räumte der medizinische Sachverständige Paul White eine Reihe von Versäumnissen von Jacksons Leibarzt Conrad Murray ein.
Unter anderem sagte er aus, er selbst hätte nach Jacksons Zusammenbruch rascher den Notruf gewählt und Hilfe gerufen. Auch hätte er selbst niemals "in Betracht gezogen", Jackson das Narkosemittel Propofol als Einschlafhilfe zu verabreichen, wie Murray dies auf Verlangen des Popstars jede Nacht getan habe.
Auf die Frage von Staatsanwalt David Walgren, ob es an Jacksons Todestag "Momente" gegeben habe, an denen Murrays Pflege nicht den ärztlichen Standards entsprochen habe, antwortete der renommierte Narkosespezialist mit "Ja". Am vergangenen Freitag hatte White die These der Verteidigung unterstützt, wonach sich Jackson die Überdosis Propofol selbst gespritzt haben könnte.
Im Kreuzverhör räumte der Propofol-Spezialist zudem ein, für seine Aussage vor Gericht von der Verteidigung bisher 11.000 Dollar (7857 Euro) erhalten zu haben und noch mehr Geld zu erwarten. Er erinnerte daran, dass sein Tarif als Sachverständiger bei 3500 Dollar pro Tag liege. Der Sachverständige der Anklage, Steven Shafer, hatte nach eigenen Angaben für seine Aussage kein Geld genommen.
White war laut Planung der letzte Zeuge. Vor der Entscheidung der Geschworenen stehen jetzt nur noch die Schlussplädoyers von Anklage und Verteidigung aus. Die Anklage wirft Murray fahrlässige Tötung vor, im Fall eines Schuldspruchs drohen ihm bis zu vier Jahre Haft.Kommentar
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31. Oktober 2011, 21:53 Uhr
Hauptzeuge der Verteidigung im Jackson-Prozess belastet Angeklagten
Im Prozess um den Tod von Michael Jackson hat die Verteidigung einen Rückschlag erlitten: Im Kreuzverhör mit der Staatsanwaltschaft belastete ihr Hauptzeuge am Montag selbst den Angeklagten.
Im Prozess um den Tod von Michael Jackson hat die Verteidigung einen Rückschlag erlitten: Im Kreuzverhör mit der Staatsanwaltschaft belastete ihr Hauptzeuge am Montag selbst den Angeklagten. Auf Nachfrage räumte der medizinische Sachverständige Paul White eine Reihe von Versäumnissen von Jacksons Leibarzt Conrad Murray ein. Unter anderem sagte er aus, er selbst hätte nach Jacksons Zusammenbruch rascher den Notruf gewählt und Hilfe gerufen. Auch hätte er selbst niemals "in Betracht gezogen", Jackson das Narkosemittel Propofol als Einschlafhilfe zu verabreichen, wie Murray dies auf Verlangen des Popstars jede Nacht getan habe.Kommentar
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Prosecutors ridicule Jackson self-injection scenario
By Alex Dobuzinskis
LOS ANGELES | Mon Oct 31, 2011 8:21pm EDT
(Reuters) - An expert defense witness suggested on Monday that Michael Jackson could have risen from his bed, picked up a syringe left by his doctor and given himself a fatal dose of a powerful anesthetic in 2009.
But the testimony by Dr. Paul White in the trial of Dr. Conrad Murray was ridiculed by prosecutors in an aggressive cross-examination of the final witness for the defense.
In a damaging day for Murray, who has pleaded not guilty to the involuntary manslaughter of Jackson, White was forced to acknowledge he would never agree to give propofol to a patient in a bedroom to treat insomnia, as Murray has admitted doing.
Propofol, normally used to sedate patients before surgery, was ruled the chief cause of Jackson's death.
"It's something that no amount of money would convince me to accept or take on as a responsibility," White said.
Administering propofol for insomnia is "a complete off-label use" of the drug that "had not been studied," White said.
White, an expert on propofol, said that after Murray gave Jackson a relatively small dose of 25 milligrams of the drug, he might have walked out of the room and left a syringe with another 25 milligrams of the agent that Jackson called his "milk." Neither side in the case has said where a syringe might have been located.
Murray's attorneys have argued during the five-week-old trial that Jackson may have "self-administered" propofol, but they have until now provided few details.
But an incredulous prosecutor cited prior testimony about how Jackson was lying in bed on June 25, 2009, wearing a urine-collecting device called a "condom catheter" and having taken several sedatives.
"And so Michael Jackson is walking around, wheeling an IV stand, attached to a condom catheter and Conrad Murray is somewhere else on the phone?" prosecutor David Walgren asked White. "It's a possible scenario," White responded.
The singer might have self-injected through a port on an IV line that Murray had installed for him, White said.
LEAVING JACKSON'S BEDSIDE
Prosecution witnesses last week presented a scenario under which Murray placed Jackson on an intravenous drip of propofol after the initial injection, as he had done in about two months of prior nightly propofol treatments.
White also cited phone records that show Murray was on the phone for about 45 minutes after the time he told police he gave Jackson propofol. Murray told police he was only out of the room for two minutes.
Prosecution witnesses have testified that Murray was not properly monitoring Jackson, in a bid to bolster the charge of involuntary manslaughter, or gross negligence, against the physician.
White himself admitted on Monday that he would have not left Jackson's bedside since, as Walgren said, the singer had confessed he liked to "push the propofol" into himself.
In a further blow for White, Los Angeles Superior Court Judge Michael Pastor fined him $1,000 on Monday for violating an order not to mention his discussions with Murray, which were not entered as evidence in the case.
White also told the court that he had been paid over $11,000 for his testimony by the defense team.
Murray faces up to four years in prison if convicted. The defense is expected to wrap up its case later on Monday, or on TuesdayKommentar
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PEOPLE VS. DR. CONRAD MURRAY
Propofol Expert:
Michael Jackson Killed Himself
Propofol Expert -- Dr. Paul White Testifies
Updated 10/31/11 at 8:45 AM
Anesthesiologist and Propofol expert* Dr. Paul White -- the defense team's final witness -- told the jury today, he believes Michael Jackson killed himself by self-injecting Propofol.
The prosecution has argued ... Murray had MJ on a Propofol IV drip the day he died, resulting in an accidental overdose that killed the singer.
But Dr. White testified, there was no evidence -- either on the scene or in Murray's police interview -- that Murray hooked MJ up to a Propofol IV drip the day he died.
It's worth noting -- Murray admitted during his police interview that he had previously administered Propofol to Michael using an IV drip in the weeks before the singer's death.
According to White, the evidence on scene suggests Murray was only responsible for a small, non-fatal Propofol injection -- and he believes MJ was the one who injected the final and fatal dose.
Other highlights:
* Yesterday, defense attorney J. Michael Flanagan addressed what he called the "elephant in room," asking Dr. White whether he could justify administering Propofol, and then leaving the patient. White answered, "Absolutely not."
* White told jurors the amount of Propofol that Murray said he gave MJ the day he died was barely enough to reduce anxiety and cause a bit of sleepiness.
* Not to be upstaged by the prosecution ... White did his own Propofol demonstration, showing it was not only easy but "perfectly safe" to administer Propofol via injection.
* White said he believed Jackson gave himself a dose of Propofol around 11:30 am -- and that, combined with the Lorazepam and the 25 mg Murray gave him earlier, is what killed him.
* During an aggressive cross examination, prosecutor David Walgren got Dr. White to acknowledge that Murray deviated from the standard of care when he gave MJ Propofol.
* White told Walgren he's been paid $11,000 for his testimony so far. He said his usual fee is $3,500 a day.
* White also said it's acceptable for a doctor to leave his patient's bedside after 15 to 30 minutes when administering a "small dose" of 25 mg of Propofol.
* During a particularly contentious moment, Walgren asked White whether Murray had an obligation to report all the drugs he administered to MJ. White said sometimes, in cases of emergency, details are "overlooked." Walgren then asked whether Propofol was "a detail that was overlooked?" White answered, "Obviously it was overlooked"...* Walgren shot back, "Not obviously... It could also be a lie." White acknowledged that yes, It's was possible.
* White acknowledged he would have never agreed to administer Propofol as a sleeping aid ... saying, "no amount of money" could persuade him to do it.
* Judge Michael Pastor warned White to stop mentioning personal conversations he had with Murray ...* which could allow the defense to introduce statements by Murray without subjecting him to cross examination. At one point, White suggested Jackson had his own private stash of Propofol... Finally Pastor lost his patience, and excused the jury so he could read White the riot act.
* After the trial resumed, White told jurors it's possible MJ climbed out of bed, found a syringe containing Propofol that Murray left behind and injected himself with the fatal dose.Kommentar
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mjchris danke für's einstellen der videos vom gestrigen prozesstag.
Bin immer froh, wenn ich diesen service prompt vorfinde, denn selten konnte ich das prozessgeschehen von anfang bis ende live verfolgen.
Vielleicht ist es möglich, die beiden fakten-threads von tag 21 zusammenzuführen ... es gab schon einen vor deinem .. sry
Unsere mods machen das sicher ...
In ergänzug zu info Tag 21:
Quelle hier und f.Murray Trial day 21 October 31, 2011
Morning Session
Dr White Testimony
Walgren cross
Dr White is retired after 30 years of clinical care, teaching and research. White says he’s an expert in the use of Propofol, not expert in pharmacokinetics and dynamics modeling. He asks other people to do that such as Dr Shafer.
Walgren asks if there were instances Dr Murray deviated from standards of care on June 25th and the preceding 2 months. Dr White agrees.
Walgren asks what did Dr. White understood from CM’s police interview. White says he understood CM gave 25mg to 50 mg Propofol with 5 CC of lidocaine. Based on interview, could not say how CM administered the drip. White says there could be a number of possibilities about the drip and multiple IV tubes as described by Dr. Shafer is one of the possibilities.
White agrees and says that giving Propofol without proper monitoring could be dangerous and could result in cardio-respiratory depression. White says at the minimum he would want to have an ambu bag.
Walgren asks White if he has given Propofol in a bedroom. White says he has never heard of it. White says that he knows Propofol being given in medical offices and clinics.
Walgren asks about the suctioning equipment. White says it’s desirable to have it but vomiting is fairly rare. White says pulse oximeter is essential and blood pressure cuff is important. White says for an infusion you measure blood pressure every 5 minutes and for minimal sedation you measure it every 5 minutes. Capnography is not utilized everywhere, White finds it useful but not very precise.
Walgren asks if failing to maintain medical records is egregious deviation from standard of care. White says charts are needed but in this case it didn’t contribute to death. White also classifies it as minor to moderate deviation from standard of cares.
Walgren asks about pre procedural assessment. It’s when the patients overall condition is evaluated to see if there are any factors that can increase cardio respiratory depression. Respiratory depression from Propofol is mentioned to be rare and generally happens when narcotics are present.
Walgren asks how much Dr. White has been paid by the defense. White says that he was paid $11,000 so far. White says he also charges $3,500 a day for court appearances but he didn’t ask that because defense doesn’t have the resources.
Walgren asks if White ever had a patient that stopped breathing after Propofol. White says he did (after general anesthesia) and he assited them with an ambu bag and mask or other ventilation techniques such as endotracheal intubation or laryngeal mask.
Walgren mentions doctor’s oath of “do no harm” and asks if CM violated this by giving Propofol. White says CM did not harm.
Walgren asks who makes the final decision – the doctor or the patient. White says both share the responsibility but the doctor have the option to walk away. White says he would never administer something he considers inappropriate, he would walk away.
Walgren asks if it is easy to go from a level of sedation to the other. White agrees that the monitoring is required but 25 mg dose is a very minimal dose that would wear off after 15 minutes. He says monitoring a patient for that dose for around 15-30 minutes would be enough and then it’s okay to leave the patient.
Walgren asks about pulse oximeter without an alarm. White says it has no value when you are out of the room. White also states that 25 mg propofol wouldn’t have effects after 25-30 minutes. Walgren asks if benzodiazepines would have an effect, White says if they have been given hours before they would have little effect.
White tries to justify CM’s treatment saying that this was an unusual case with the goal being sleep and what CM leaving MJ was acceptable.
Walgren asks what if the patient liked to push Propofol. White says he would not left the room.
White asks about failure to call 911. White says he cannot justify it but also adds the situation was different, CM didn’t know the address and the house was not easily accessible. Walgren pushes White. White says CM should have called 911 sooner but it wouldn’t have made a difference in this case. White says he would have started resuscitation and call 911 within 3 to 5 minutes.
White say he doesn’t think everything CM said to the police is true. White says in emergency situations it’s hard to remember the details and CM could have overlooked to mention Propofol and didn’t do it in a devious way. Walgren suggests that the other alternative is that CM lied. White reluctantly agrees.
Walgren does over the letter White gave to the defense. In the letter it’s written that sedatives, analgesic and benzos may increase the risk of Propofol. White says high concentration of lorazepam and 25mg propofol given too fast causes arrhythmia, and a rapid demise.
White mentions although CM bought Propofol MJ had his own stocks of Propofol. Walgren asks where he saw this information. White says CM told that to Dr. White.
Walgren shows the IV tubing found in the scene and asks if it is easily concealable and fits in the hand or in the pocket. Dr White admits to that.
Walgren mentions how White speculated that MJ drank propofol and now White rejects that's the cause of death. White says Dr Shafer explained why there could be propofol in the stomach and why it would not cause death.
White says he did his 3 page letter in a very short time as Flanagan needed something from him. White says he did not write any other report. In the letter White wrote MJ self administered either by injecting or orally. Flanagan had mentioned oral Propofol before he wrote the letter and White say he did a search but did not find anything about it.
Walgren asks if according to White the only option was to blame the victim. White says if CM only given what he said he did, there was to be something else. Walgren asks if White now blames MJ for Lorazepam as well. White says yes. Walgren asks if White took everything CM said to be the truth. White says yes. White says what CM said in regards to drug administration is consistent with the autopsy report.
Walgren goes over the report and point outs that White now says MJ died of a rapid bolus but he never wrote that in his report / letter. Walgren asks if he came up with any other theory that does not attribute the drug taking to MJ. White says no.
Walgren asks who Dr. Gabriella Ornelas is. White says she’s a PhD in biomedical engineering. White met her for the first time last week and asked is she could calculate the amount of free propofol you would expect to see in the urine after a 3 hour 100mk infusion.
Mid morning break
Walgren mentions that Dr. Shafer provided software for the models to the defense and White only provided computer codes on paper.
Walgren goes over the 10 AM Lorazepam theory. As the peak effect will be in 2 hours it first nicely with 12 AM. Last week when Dr. Shafer testified that Lorazepam had to be taken at least 4 hour prior to death that’s when White met with Ornelas. She created several scenarios. White says he was not aware of the 10 AM Lorazepam theory.
Walgren asks if MJ came and asked him to work for him to give Propofol , if he would accepted the job. White says absolutely not. He says no amount of money could convince him to do it because of time required, the responsibility and off label use of propofol.
Walgren asks if White’s 11:40AM self administration theory is based on a lot of assumptions for the lack of medical records. White agrees.
Walgren asks if for his theory he used CM leaving the room for 2 minutes. White says no.
Walgren asks about the beagle Propofol study. White says that Flanagan knew a veterinarian that could do the study and he had no part in it. White says he only got a report from Flanagan that oral propofol had no effect on beagles.
Walgren asks when White assumes that MJ took Lorazepam was CM out of the room as well. White says MJ was walking around. Walgren objects as White is telling what CM told him. White says he understood that CM was in the another part of the room (adjacent bedroom etc) or not watching. White says CM wasn’t aware that MJ took Lorazepam.
Walgren asks White if he’s aware that CM left the room only once. White says yes. He also says that he believes CM was away around 7 AM. Dr. White says when CM was on the phone he was presumably away from MJ because he was sleeping.
White’s theory is that CM drew 50 mg Propofol and lidocaine and gave half of it to MJ and left the half full syringe. White then says CM was in the corridor, Walgren objects as he is once again telling what CM told White. White thinks after CM gave MJ the half the syringe and observed him left him to talk on the phone and went to the bathroom. White thinks MJ could have injected in that 40 minutes.
Walgren asks if MJ injected through the IV port and the syringe was originally on the chair. Walgren asks if wouldn’t it raise an alarm when CM found the syringe in the injection port. Walgren also asks if according to his theory MJ fell back to bed in the same position.
Walgren asks if it’s White’s understanding that MJ moved around the house wheeling an IV stand with a condom catheter on him and a urine bag attached to his leg.
Walgren asks if isn’t it a possibility that CM injected the additional Propofol. White answers yes if he wanted to harm MJ.
Walgren asks if putting MJ to sleep was mild/ minimal sedation which means response to verbal stimuli. Walgren asks if it makes sense to him. White says providing sleep doesn’t need a higher level of sedation.
White says he believes that MJ didn’t receive Propofol on the 23rd and 24th based on the urine levels.
White says during the 6 weeks prior CM gave MJ 1 or 2 boluses of Propofol (25 to 50 mg) and followed it with an infusion with the Propofol bottle. Walgren again objects as White is once again telling what CM told him. White speculates that it was minimal to moderate sedation.
Walgren cites several articles written by Dr White. One article says that MAC (moderate sedation) requires the same level of standard of care as general anesthesia.
Guidelines for Office based anesthesia (written by Dr White) :
1-appropriately trained personnel
2-anesthesia equipment
3-complete documentation of care provided
4-monitoring equipment
5-recovery area with appropriate staff
6-availability of emergency equipment
7-plan for emergency transport of patients to a site that provides more comprehensive care, should a complication occur
8-documention on a quality assurance program
9-continuous training of physician
10- safety standards that can't be jeopardized for patients' comfort or cost
Walgren asks if these standards should apply if Propofol is administered in a bedroom ? White says that he wouldn’t give it in a bedroom and White eventually agrees that giving Propofol in a home requires the minimum requirements of office based anesthesia
Lunch break
Murray Trial Day 21 October 31, 2011
Afternoon Session
Dr White Testimony
Walgren cross
Walgren continues with quotes from Dr. White's books/articles: "because of the profound risk of cardio respiratory depression, propofol should always be administered by anesthesiologists, not by gastroenterologists, etc (other doctors)". White states that the book was published in 1996, things have evolved since then. White states that he would agree that propofol has profound a risk of cardio respiratory depression, but it can be administered by trained doctors other than anesthesiologists, in a proper setting.
White states that the guidelines for sedation, for non anesthesiologists are: "even if moderate sedation is intended, the same standard of care should be applied as for deep sedation" and that "because it's not always possible to predict how a patient will react, the caregiver needs to prepared to rescue a patient from deep sedation."
Dr White agrees that for moderate sedation (when an infusion is used), the patient should receive the same care as for deep sedation.
For mild sedation, Dr. White states that the doctor should be prepared in the event that the patient goes into moderate sedation, not deep sedation.
Dr. White states that he wouldn't administer propofol in a home, but thinks that these guidelines should be followed with an infusion. White states that he doesn't know if a second person is necessary, assuming the doctor is monitoring the patient, while the propofol is being administered.
Walgren asks what about administering benzodiazepines and a propofol bolus? Dr. White states that in an ideal situation, it would be great to follow the guidelines.
Walgren shows Ornelas model with 25mg propofol infused over 3 to 5 minutes versus a 25mg fast injection and the differences in blood concentration and free propofol in urine levels. Her model is based on a 1998 article.
Dr White has not read the article in detail. Dr White had a conversation with Ornelas at the Flanagan’s house for a few hours at the end of last week. The models Dr White testified to, were not done by him, he is not an expert in models.
Walgren again shows the model with Murray infusing 25mg at 10:40 am versus MJ self injecting at 11:40 am. Before the self injection, blood level was near 0.
Walgren shows a zoom of the same graph, zooming on the self injection. Dr White believes that self injection occurred later than 11:40.
Dr White thinks this scenario is the most likely as it’s consistent with Murray's interview with LAPD, not recovering the tubing, matches the concentration of free propofol in the urine, matches blood concentration.
Walgren shows another zoom of the same graph, over 10 minutes, showing only blood concentration. The circulation stops almost immediately. Dr White says it could have been arrhythmia, the cause is unclear.
Walgren brings up the autopsy report: MJ had no heart problems. Dr White says that doesn't preclude an arrhythmia.
Murray told LAPD that when he returned to the room, MJ's heart rate was 122. Dr White said it's unclear what 122 was and it could have been the saturation. Walgren reads the police interview; Murray also reported that he felt a thready pulse. Dr White says that Murray might have felt his own pulse, he was under stress. He might not have felt a perfusing pulse. Walgren: "This fits with you new theory that MJ died instantly"
Dr White states he doesn't see any evidence of respiratory arrest, or cardiac arrest, or both combined.
Walgren goes back to March 8th letter White sent to the defense. First cause of death Dr. White thought of is respiratory depression. Dr White corrects "cardio pulmonary depression" among other things. Walgren mentions the oral consumption is one of the other things.
Walgren shows models of lorazeapm (multiple 4 mg injection, 2 X 2 mg IV +16mg oral).
The graph shows 0.0013 mg in the stomach, Dr White doesn't know where this number comes from, but it is smaller than the 0.006mg.
White states that the fact that there is free lorazepam in the stomach suggests oral ingestion.
White states that residual lorazepam is an assumption of 10mg for the past 5 nights.
Walgren shows the graph where Murray would have injected 25mg of propofol, and where MJ would have self injected. When MJ self injected, the lorazepam was a little lower.
Walgren again goes back to Ornelas model with 25mg propofol over 3 to 5 minutes, 25mg fast injection blood concentration and free propofol in urine levels. Walgren asks why it doesn’t show the effect site (brain). White says it’s because she was only asked about the free propofol in the urine.
Graph by Dr Shafer added effect site concentration to Onnelis' graph: the levels at effect site are the same in both Murray's injection, or the supposed MJ's self injection. Dr White says these numbers are meaningless, because of variability. Dr White would be more interested in the heart concentration.
Afternoon break
Walgren asks White if he did any research to make sure that the 0.3% used by Ornelas (0.3% of the propofol is excreted unchanged) was accurate. White says it’s his feeling that it was the most conservative number.
Walgren shows an article used by Dr Ornelas as a basis for her analysis. It was published in 1988. It indicated that less than 0.3% of propofol is excreted unchanged, but the model uses 0.3%. Dr White recalls a paper that said 1% .
Walgren asks based on this paper (less than 0.3%), could it be 0? Dr White doesn't agree.
Walgren says that the article says that 0.3 could be an overestimate. Dr White says that the difference with a 3 hour infusion would still be huge.
Walgren shows a 1991 article about animals (dogs, rat). There was no unchanged propofol at all whether it was bolus or infusion. Dr White says he doesn't rely on articles about animals, he would prefer to rely on articles about humans.
Walgren shows a 1999 article: they found no free propofol in the urine. Dr White indicates he did not search the subject
Walgren shows a 2002 article in which the levels found were much smaller. Objection, sustained. The judge asks Walgren to change the subject.
Flanagan redirect
Flanagan talks about 911 not being called for 20 minutes. Flanagan says mentions that it was a large house, fenced, gate closed that can only be opened by security, guards were just outside the kitchen, incident happens upstairs , there are no landlines. Flanagan asks would it be unreasonable to ask a person in the kitchen for help.
White says he would resuscitate the patient and ask the person in the kitchen, it sounds more reasonable than going to security.White says that CPR should be given within 1 to 2 minutes, and sustained for at least 3 minutes, before leaving the patient.
Flanagan asks what kind of CPR should be given. White says mouth to mouth and adds that an ambu bag would be better but mouth to mouth is a possibility.
Flanagan asks Dr. White what would be his assessment if the patient was not breathing and his eyes and mouth were open. White says he would assess the patient to see if they are alive as they are often a sign of death.
Flanagan asks if the patient was dead at 12:00PM, could anything be done. White says if the patient was dead, not keeping a chart would not have changed anything.
Flanagan asks White if he would suspect Propofol to have anything with the death. White says if the propofol was given at 10:40 and the patient was dead at 12:00 he wouldn’t suspect propofol.
Flanagan asks after the EMT’s received the authorization to declare the patient dead if the further attempts was realistic and had a chance of saving the patient. White says no.
White says even if the ER doctors had known about propofol, it would not change the outcome.
Flanagan and White talk about 25 mg Propofol bolus over 3 to 5 minutes. White says if it had any negative effects it would be apparent by the end of the bolus and there would have been no reason to suspect anything at a later time.
Flanagan asks about concelling the IV tube and White says it’s easier to conceal an IV tube than an IV bag but if the IV tube was in a pocket there would be liquid in the pocket.
Flanagan mentions that at preliminary hearing 2 witnesses indicated the possibility of oral consumption of propofol.
Flanagan asks if Walgren has contacted Dr. White. White says Walgren called him and they talked. White said that he was contacted by the defense. Walgren asked him if he was paid and White said he was. White says this is his only source of income.
With L.O.V.E. and respect
Lg rip.michaelKommentar
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Murray hat dem Gericht wohl gesagt, dass er noch nicht entschieden hat, ob er aussagt. Es hängt vom Prozesslauf ab. Die Verteidigung möchte nun noch die Doktorin als Zeugin vorladen, die die Diagramme machte, die White in seiner Zeugenaussage verwendete. Die Staatsanwaltschaft wird noch Shaffer ins Rebuttal nehmen.
Prosecutors ridicule Jackson self-injection scenario
By Alex Dobuzinskis
LOS ANGELES | Tue Nov 1, 2011 6:53am IST
(Reuters) - An expert defence witness suggested on Monday that Michael Jackson could have risen from his bed, picked up a syringe left by his doctor and given himself a fatal dose of a powerful anaesthetic in 2009.
But the testimony by Dr. Paul White in the trial of Dr. Conrad Murray was ridiculed by prosecutors in an aggressive cross-examination of the key witness for the defence.
As the trial, now in its sixth week, began drawing to a close, Murray told the judge he was still considering testifying in his own defence, despite previous assurances by his lawyers that they did not plan to call him.
"I have not made a decision," Murray said. "... It depends on how the case progresses."
In a damaging day for Murray, who has pleaded not guilty to the involuntary manslaughter of Jackson, White was forced to acknowledge he would never agree to give propofol to a patient in a bedroom to treat insomnia, as Murray has admitted doing.
Propofol, normally used to sedate patients before surgery, was ruled the chief cause of Jackson's death.
"It's something that no amount of money would convince me to accept or take on as a responsibility," White said.
Administering propofol for insomnia is an "off-label use" of the drug that "had not been studied," White said.
White, an expert on propofol, said that after Murray gave Jackson a relatively small dose of 25 milligrams of the drug, he might have walked out of the room and left a syringe with another 25 milligrams of the agent that Jackson called his "milk." Neither side in the case has said where a syringe might have been located.
Murray's attorneys have argued during the trial that Jackson may have "self-administered" propofol, but they have until now provided few details.
But an incredulous prosecutor cited prior testimony about how Jackson was lying in bed on June 25, 2009, wearing a urine-collecting device called a "condom catheter" and having taken several sedatives.
"And so Michael Jackson is walking around, wheeling an IV stand, attached to a condom catheter and Conrad Murray is somewhere else on the phone?" prosecutor David Walgren asked White. "It's a possible scenario," White responded.
LEAVING JACKSON'S BEDSIDE
The singer might have self-injected through a port on an IV line that Murray had installed for him, White said.
Prosecution witnesses have presented a scenario under which Murray placed Jackson on an intravenous drip of propofol after the initial injection, as he had done in about two months of prior nightly propofol treatments.
Prosecution witnesses have testified Murray was not properly monitoring Jackson, in a bid to bolster the charge of involuntary manslaughter, or gross negligence, against him.
White himself admitted that he would have not left Jackson's bedside since, as Walgren said, the singer had confessed he liked to "push the propofol" into himself.
White also told the court that he had been paid over $11,000 for his testimony by the defence team.
Murray faces up to four years in prison if convicted. Defense attorneys said they will call a researcher on Tuesday who prepared mathematical models White used to analyse the case, and that she would be their final witness.
Prosecutors said they plan to call back their propofol expert, Dr. Steven Shafer, to rebut defence testimony before both sides make closing arguments and hand the case to the jury.
(Editing by Jill Serjeant)
Edit: Sehe gerade es gibt einen 2. Info-Thread. Kann ein Mod die zusammenführen. Zudem ist dieser hier falsch im Memorial-Bereich.Zuletzt geändert von Lena; 01.11.2011, 12:41.Kommentar
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Live-Übertragung vom Murray Prozess: Auf ABC7.com, auf TMZ.com oder auf OTRC.com
31.10.2011: Prozess: 21. Tag – Zeugen der Verteidigung
Heute wurde der Propofol Experte der Verteidigung, Dr. Paul White, von Staatsanwalt David Walgren ins Kreuzverhör genommen. Walgren versuchte immer wieder die Zustimmung von White zu erhalten, dass Murray diverse Pflegestandards missachtete. Teilweise gab Dr. White zu Protokoll, dass der genaue Pflegestandard nicht definiert werden könne, sagte aber, dass er an Murrays Stelle sofort den Notruf 911 gewählt hätte, als dieser realisierte, dass Michael Jackson in Schwierigkeiten war. White stimmte ausserdem zu, dass der von Murray verwendete Pulsmesser nicht geeignet war. David Walgern fragte weiter: “Haben sie jemals Popofol verabreicht im Schlafzimmer von Jemandem?” White antwortete: “Nein, habe ich nicht.” Er habe vor dem Prozess auch noch nie davon gehört.
Im Kreuzverhör mutmasste Dr. White, dass Michael Jackson die selbe Spritze benutzte, die Murray schon benutzte, um ihm eine Stunde zuvor eine 25 Milligram Injektion zu geben. Seiner Tehorie nach, könnte Murray sie mit 50 Milligram gefüllt haben und dann halb gefüllt in Michaels Schlafzimmer liegen gelassen haben. White kann sich nicht vorstellen, dass Murray die fatale Dosis injiziert habe, ausser dieser wollte “Mr. Jackson potenziell etwas anhaben.” Walgern fragte darauf, ob er denke, dass sich Michael Jackson selbst etwas anhaben wollte. “Ich denke nicht, dass er die potenzielle Gefahr erkannte”, erwiderte White. David Walgern fragte White auch zu seiner Meinung über Murrays Entscheidung, das Schlafzimmer zu verlassen und so Jackson alleine mit der Spritze zurück zu lassen. “Nein, ich würde den Raum nicht verlassen”, antwortete White, sagte aber auch, dass Murray Michael Jackson 30 Minuten nach der Propofol Injektion verlassen konnte, da dann die Gefahr von Nebenwirkungen vorbei sei.
White anerkennte, dass der vermisste Infusionsschlauch genug klein wäre, um ihn in eine Jackentasche zu stecken. Walgren erinnerte damit an das mögliche Szenario, dass Murray den Infusionsschlauch verschwinden liess, als Michael ins Spital gebracht wurde. Die 100 Milliliter Propofol Ampulle, von der die Staatsanwaltschaft glaubt, dass sie Murray bentutzt hatte, war leer, als sie die Detektive fanden. Dr. Steven Shafer, der Propofol Experte der Anklage, erwähnte die Theorie, dass als Murray aus dem Schlafzimmer war, selbst als Michaels Herz aufhörte zu schlagen, noch Propofol von einer Infusion in seinen Körper lief. White nannte dies einen “unglaublichen Zufall von Umständen”, dass die Flasche genau dann zu Ende geht, wenn Michael Jackson stirbt. Ein deartiger Fluss von Propofol hätte Michael Jackson nicht töten können. Dr. White bezweifelt die Annahme der Anklage, dass Murray die Propofol Ampulle in einem aufgeschnittenen leeren Beutel tat, um diese an den Infusionsständer zu hängen. Es wäre logischer gewesen, dass Murray einen Plastik-Aufhänger um die Flasche getan hätte, eine Routine-Praxis. Die Propofol Ampulle hätte zudem rausfallen können, wenn Michael Jackson sein Bein bewegt hätte. Die Ermittler, die die Ampulle und den offenen Beutel entdeckten, sagten aus, diese beisammen gefunden, aber nicht fotografiert zu haben.
Quelle : jackson.ch, cnn.com, usatoday.com, hlntv.com
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Justice 4 MJ - Twitter Event & Gerichtsaktion
Globale Veranstaltung, bitte helft mit, das Wort zu verbreiten!
Datum: Jeden 25. des aktuellen Monats!
Zeit:--UPDATE-- 19:00 Uhr - 22:00 Uhr (PST Time) - CET 04 - 07 Uhr
Ort: www.twitter.com
Wir wollen der Welt die Wahrheit über den Mord an Michael Jackson wissen lassen und wir wollen Gerechtigkeit. Der Plan ist Twitter als Werkzeug zu verwenden, um das Wort zu ergreifen und die Ungerechtigkeit gegenüber Michael Jackson zu betonen. Die Welt muss wissen, warum wir in voller Empörung uns befinden und wegen Dr.Murray 's fahrlässiger Tötung, die völlig absurd und ungerecht in ihrer Anklage steht, erschrocken sind! Die Strafe trifft eindeutig nicht das Verbrechen!
Michael Jackson ist ein Mann, der so viel für die ganze Menschheit getan hat, als er Rassenschranken brach und als gemeinnützigster Künstler in die Geschichte einging!
Wenn die Bürger von Los Angeles die LAPD nicht akzeptieren und sich von der Brutalität der Polizei an einem Mann im Jahr 1992, den wir bis dahin nicht kannten, distanzieren, warum ist es so mit uns als Gesellschaft, daß die Menschen dieser Erde die Tatsachen, daß Dr Murray Michael Jackson tötete, ignorieren sollte? Warum sollten wir Murray mit Mord davonkommen lassen und uns an die Staatsanwaltschaft hängen, um jede Gerechtigkeit zu bekommen! Wie wir alle sehen können ist der Mord 2. Grades nicht in der Anklage vertreten und Dr Murray wird wahrscheinlich am Ende ohne Gerichtsverfahren, mit einer Bewährungs - und Zivilstrafe als Strafe weggehen.
Kann man das glauben, wenn es den berühmtesten Mann in der Welt passiert, dem besten Unterhaltungskünstler aller Zeiten? Was sagt das über unser zukünftiges Schicksal, wenn wir das zulassen? Kann man nicht sehen, daß sie sich nicht um uns kümmern?
Helft uns, um eine Wende herbeizuführen! Geht bitte auf TWITTER und tippt "#JUSTICE4MJ" ein. Wiederholt dies bis "#JUSTICE4MJ" eine der führendsten Themen bei Twitter ist. Dies ist die einzige Chance, die wir haben, um die Welt für den nächsten Gerichstermin für Murray zu sensibilisieren.
Wir haben noch eine Stimme und man kann die Änderung vornehmen, durch die Staatsanwaltschaft, Murray eine stärkere Anklage zu geben! Es ist noch nicht zu spät, bitte handelt JETZT!
Zum selben Zeitpunkt, an dem bei TWITTER die Aktion läuft, wird ein Usteam Live Video geschalten, um Fragen zu beantworten. Jeder Fan kann an diesem Usteam Video teilnehmen! Usteam und Twitter arbeiten prima miteinander und die Tweets werden dadurch noch viel effektiver.
Für diejenigen unter Euch, die nicht wissen, warum das getan wird oder nicht wissen wie man TWITTER nutzt, schaut bitte das folgende Video an:.
Dies kann dazu beitragen Michael die Gerechtigkeit zurückzugeben, die er verdient. Laßt uns um unseren fallen gelassenen Idol und Freund kümmern.
Quelle: justice4mj & JAM-FC
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