Conrad Murray Trial: Battle of the Propofol, Experts

The defense in the trial of Dr. Conrad Murray called its final witness today, propfol expert Dr. Paul White, who challenges the findings of the state's expert, Dr. Steven Shafer, as to the cause of Michael Jackson's death.

White is not finished testifying, but today he expressed perplexity at the findings by prosecution experts that propofol caused Jackson's death. The defense also called an addiction specialist today who had examined Dermatologist Arnie Klein's treatment records of Jackson. He testified Jackson was dependent on, and possibly withdrawing from from Demerol when he died. (Apparently, Jackson was getting the Demerol to help with pain from Botox and Restalyne.)He said one of the symptoms of Demerol withdrawal is insomnia. Jackson was getting shots of Demerol, and the last one was three days before he died. Murray was not aware Jackson was receiving Demerol. Klein has not been charged with wrong doing. [More..]

Shafer conceded that it was possible that Jackson, not Murray, could have been the one to open the drip to a fatal pace, but prosecutors contend it would make no difference in Murray's guilt.

Dr. White is the Director of research at Cedars-Sinai Medical Center and has authored journals and textbooks on anesthesiology. He's been researching propofol since 1983, 6 years before it was approved. Dr. Shafer is editor-in-chief of the journal Anesthesia and Analgesia and a professor of anesthesiology at Columbia University. Both received awards this month from the American Society of Anesthesiologists.

Murray is charged with involuntary manslaughter. According to California jury instructions, available on Lexis, the jury has to find beyond a reasonable doubt that:

1. The defendant had a legal duty to Jackson

2. The defendant failed to perform that legal duty;

3. The defendant's failure was criminally negligent;

4. The defendant's failure caused Jackson's death.

To prove Dr. Murray's failure was criminally negligent, the jury must find beyond a reasonable doubt that Murray acted in a reckless way that created a high risk of death or great bodily injury and a reasonable person would have known that acting in that way would create such a risk.

Criminal negligence involves more than ordinary carelessness, inattention, or mistake in judgment.... In other words, a person acts with criminal negligence when the way he or she acts is so different from how an ordinarily careful person would act in the same situation that his or her act amounts to disregard for human life or indifference to the consequences of that act.

On cause of death for involuntary manslaughter:

An act causes death if the death is the direct, natural, and probable consequence of the act and the death would not have happened without the act. A natural and probable consequence is one that a reasonable person would know is likely to happen if nothing unusual intervenes. In deciding whether a consequence is natural and probable, consider all of the circumstances established by the evidence.

There may be more than one cause of death. An act causes death, only if it is a substantial factor in causing the death. A substantial factor is more than a trivial or remote factor. However, it does not need to be the only factor that causes the death.

The crime of involuntary manslaughter in Cal Pen Code § 192(b):

Manslaughter is the unlawful killing of a human being without malice.

Involuntary--in the commission of an unlawful act, not amounting to felony; or in the commission of a lawful act which might produce death, in an unlawful manner, or without due caution and circumspection. This subdivision shall not apply to acts committed in the driving of a vehicle.

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  • Display: Sort:
    It is astounding, (5.00 / 2) (#2)
    by lentinel on Fri Oct 28, 2011 at 05:38:02 AM EST
    if true, that "Murray was not aware Jackson was receiving Demerol".

    Not exactly my kind of Doctor.

    I don't remember any visit I have made to any doctor, in which I was not asked what other medications I was taking. I have even been asked this when purchasing over the counter medicines in a local drugstore.

    The other issue for me is that whoever put whatever in Jackson's veins, Jackson was clearly going through severe distress for quite awhile before Murray called 9/11.

    The chilling testimony for me was from the emergency responders who said that if they had been called 45 minutes earlier, they might have been able to save Jackson.

    So the testimony about what Murray was doing during that 45 minutes, making phone calls to his friend for example, made quite an impression on me.

    Not astounding (5.00 / 1) (#6)
    by BackFromOhio on Fri Oct 28, 2011 at 12:17:20 PM EST
    IMO - Depak Chopra indicated in interview after the death, I believe, that Jackson would constantly ask him for prescriptions; Chopra's refusal severed their close friendship.  I believe I've read that Jackson went from Dr to Dr asking for RX.

    If Jackson did not tell Murray that Jackson was taking various things, even though Murray had told Jackson he needed to know anything Jackson was taking, I doubt there's culpability, unless there's something in the law that requires Murray to get and update annually or whatever, and Murray did not ask.  


    Sad story (none / 0) (#11)
    by Militarytracy on Fri Oct 28, 2011 at 06:15:32 PM EST
    Agree with (5.00 / 2) (#7)
    by BackFromOhio on Fri Oct 28, 2011 at 12:18:16 PM EST
    you as to Murray's negligence in responding -- if that's the case

    The physician would rely on your information (none / 0) (#3)
    by sj on Fri Oct 28, 2011 at 11:35:42 AM EST
    If you forgot or deliberately omitted mentioning a particular medication it doesn't constitute negligence on the part of the physician.

    Just playing devil's advocate (none / 0) (#4)
    by nyjets on Fri Oct 28, 2011 at 11:42:18 AM EST
    I would imagine that there are some things that a doctor should know or at least suspect despite what the patient says.

    Oh, no question (none / 0) (#5)
    by sj on Fri Oct 28, 2011 at 11:57:59 AM EST
    But suspicions aren't medical facts.  And I'll stipulate that the physician had the option of declining the patient.  

    But there is no way to do contraindication analysis without knowing the drug.  A suspicion doesn't cut it.  A doctor can know that a patient is abusing medications.  It is much harder to know which ones.  And, hypothetically, if a patient says I have a problem with drug X, and drug X exhibits the symptoms that I'm seeing, there isn't necessarily a reason to also go looking for drug Y.

    Now, as anyone reading this can tell, I am clearly not a doctor.  I'm just saying that I don't think it's that cut and dried.


    I agree (5.00 / 1) (#8)
    by nyjets on Fri Oct 28, 2011 at 12:45:05 PM EST
    I did not mean to imply that doctors HAVE to know. Suspicions are not medical fact and it is not cut and dried as you said. Espically for some drugs.
    That is why I am unsure about this case.

    How can they be negligent (none / 0) (#10)
    by Militarytracy on Fri Oct 28, 2011 at 06:15:05 PM EST
    If their patients aren't telling them things and withholding certain things?

    It depends (none / 0) (#12)
    by nyjets on Fri Oct 28, 2011 at 09:09:20 PM EST
    You are right, for some things, if a patient tells a doctor A, the doctor may have no reason to doubt the patient word. Then it becomes at most a civil matter.
    However, there are somethings that a doctor should suspect or question. And it is those area where criminal negligence comes into play.
    As someone said earlier, it is not cut and dry.

    Seems like a double bind to me (none / 0) (#13)
    by Militarytracy on Sat Oct 29, 2011 at 01:15:15 AM EST
    If doctors must be so fear ridden and unbelieving of their patients won't that affect their ability to be expedient successful healers.  Developing paranoia hasn't made too many people wildly successful.

    I just can't put a doctor in such a position.  If I'm on a jury and something like this comes up and the patient lied to the doctor and that led to the failure of their treatment....it is highly unlikely I'm holding that doctor accountable.

    The only way I could is if the doctor used a dangerous drug in an unorthodox and extremely dangerous fashion, then maybe I could.


    As I said (none / 0) (#14)
    by nyjets on Sat Oct 29, 2011 at 07:29:14 AM EST
    As I said, it all depends. In many ways and in many/most circumstances, you are correct and the doctor should not be charge with any criminal offenses.
    That being said, I can imagine there are some instances where a doctor shold know, or verifiy what the doctor says.
    THis is a classic example of how every case is different and needs to be treated differently.

    Propofol v. Demerol (none / 0) (#1)
    by Mr Natural on Thu Oct 27, 2011 at 11:39:56 PM EST
    - battle of the Jesus Juices.

    Dr. White (none / 0) (#9)
    by jbindc on Fri Oct 28, 2011 at 04:58:46 PM EST
    Also testified that he could not justify a doctor giving a patient propofol and leaving his patient.

    The star medical expert for Michael Jackson's physician began his testimony Thursday with the acknowledgment that not even he could explain the doctor's treatment of the pop star.

    "Let's deal with the elephant in the room here," a defense attorney said to Dr. Paul White, the most important and probably final witness for the physician. "Conrad Murray has been accused of infusing a dose of propofol and leaving his patient. Can you justify that?"

    "Absolutely not," White replied.

    The exchange was a strong indication the defense planned to concede that Murray provided substandard care to Jackson but argue that his conduct did not rise to the level of involuntary manslaughter.

    red herring (none / 0) (#15)
    by diogenes on Sat Oct 29, 2011 at 06:47:56 PM EST
    No one dies of opiate withdrawal.  And if Jackson's last shot of Demerol was THREE days before his death, then whatever alleged withdrawal was present would be post-acute, probably mainly consisting of insomnia.
    Of course, inappropriate use of propofol to treat insomnia of ANY cause CAN lead to death.  The use of IV propofol in an outpatient setting to treat insomnia is negligent, and the only question is whether it is civil negligence (i.e. malpractice) or criminal (i.e. criminal negligence).

    For me, (none / 0) (#17)
    by Makarov on Sun Oct 30, 2011 at 02:57:47 AM EST
    it all comes down to propofol being contraindicated outside a surgical center or hospital setting, where a patient who stopped breathing could immediately be intubated.

    I had occasion to accompany a parent to a number of doctor appointments in the last month, and every one said the same thing - there is no reason, whatsoever, to administer or allow to be administered propofol outside of an operating room or ICU. That comes from a neurosurgeon, a general surgeon, and an internal medicine specialist.

    MJ was taking that drug before (none / 0) (#18)
    by Jeralyn on Sun Oct 30, 2011 at 03:51:19 AM EST
    Murray got there. Murray was trying to wean him off of it.

    Indeed (none / 0) (#19)
    by Abdul Abulbul Amir on Mon Oct 31, 2011 at 08:11:37 AM EST

    MJ was well on the road to this tragic end.  The doctor of the moment is just a detail, IMHO.