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Drug 'Cocktail' Killed Michael Jackson, Says Doctor

LINDA DEUTSCH   10/13/11 10:16 PM ET   AP

LOS ANGELES — Dr. Conrad Murray's use of a cocktail of drugs on Michael Jackson as he struggled to fall asleep on the day he died was a "recipe for disaster" and ultimately caused his death, a UCLA sleep therapy expert testified Thursday.

Dr. Nader Kamangar described Murray's treatment as "unethical, disturbing and beyond comprehension."

Under questioning by Murray's attorney, J. Michael Flanagan, the witness was asked to tell jurors what he knew about the events of June 25, 2009, the day of Jackson's death.

"To summarize, Mr. Jackson was receiving very inappropriate therapy in a home setting, receiving very potent therapies without monitoring," Kamangar said.

He said diazepam (Valium), lorazepam (Ativan) and midazolam (Versed) were given to the sleepless star during a 10-hour period throughout the night and morning.

"This cocktail was a recipe for disaster," Kamangar said.

Noting the addition of propofol (Dipravan), a powerful anesthetic used in surgeries, Flanagan asked: "Could this have caused death?'

"Absolutely," Kamangar said. "Absolutely."

Authorities say Murray gave Jackson a fatal dose of propofol. Murray has pleaded not guilty to involuntary manslaughter.

The witness, one of the experts who evaluated Murray's actions for the California Medical Board, expressed dismay about the drugs Murray gave the pop star, his failure to immediately call 911 for help, and his lack of monitoring and record-keeping.

Murray was unable to produce any written records on his treatment of Jackson, Kamangar noted.

"There were no records whatsoever," he said. "It's very easy to forget details. We do not rely on memory."

"So it's your opinion that there's no way he could have remembered what he did if he didn't write it down?" Flanagan asked.

"It is an egregious violation of the standard of care when you are using sedatives like propofol and you are not writing it down," Kamangar answered.

The defense lawyer pressed on, asking, "Because he didn't write down the pulse rate, oxygen saturation, heart rate ... that didn't kill Michael Jackson, did it?'

"It's a combination of factors," said Kamangar.

"But not the cause of death?" asked Flanagan.

"It's a contributing factor," said the witness.

Kamangar was the third prosecution expert to criticize the conduct of Murray. He said his first mistake was using propofol to treat insomnia, calling it an unacceptable application of the drug.

He said Jackson's demand for the drug – the subject of previous testimony – was not a sufficient reason to give it. He also suggested Murray should have done a physical examination, taken a history from his patient about his insomnia, and called in other medical experts if necessary to evaluate the problem.

"The most important thing he should have done is call for help," Kamangar said.

He said Murray's interview with police made it clear that he waited too long to call 911 when he found Jackson not breathing.

Flanagan suggested at one point that doctors sometimes practice "bad medicine," but their patients are unharmed. Kamangar agreed.

On redirect questioning, Deputy District Attorney David Walgren asked: "Mr. Flanagan asked if a doctor could be grossly negligent and the patient could survive?"

"Yes," said Kamangar.

"Conrad Murray was grossly negligent in many areas and he caused Michael Jackson's death, is that correct?"

"Yes," said the witness.

On Wednesday, Murray's defense team announced they were dropping a claim that was the centerpiece of their case – that Jackson swallowed additional propofol when Murray was out of the room. Flanagan did not bring up self-dosing on Thursday.

Before court recessed, the prosecution called to the stand Dr. Steven Shafer, one of the nation's leading experts on propofol. However, he did not get into his substantive testimony before trial recessed until Monday because Shafer had a schedule conflict.

Shafer was expected to be the final prosecution witness in the case. The defense has a colleague of Shafer's waiting to take the stand.

Shafer helped craft guidelines for appropriate propofol dosing for sedation that is included in the packaging of every bottle that is sold.

Murray could face up to four years behind bars and the loss of his medical license if convicted.

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AP Entertainment Writer Anthony McCartney contributed to this report.

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McCartney can be reached at http://twitter.com/mccartneyAP

For The Huffington Post's slideshow of who is who of the Courtoom Characters, see below. All images courtesy of Getty.
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  • The Victim

    <strong>The Victim: </strong>Michael Jackson (shown here on March 5, 2009) <strong>Known Aliases:</strong> The King of Pop, Omar Arnold, Josephine Baker, Paul Farance, Bryan Singleton, and Prince - to name a few, reports <a href="http://www.tmz.com/2009/07/24/michael-jackson-alias-doctor-arnold-klein-la-county-coroner-omar-arnold-drugs/" target="_hplink">TMZ</a>.

  • The Accused

    <strong>The Accused:</strong> Dr. Conrad Murray Dr. Murray was hired as Michael Jackson's personal physician for the 2009 <em>This Is It</em> concert tour. On June 25, 2009, Michael Jackson died of "acute propofol intoxication" in his Bel-Air home. Jackson was officially pronounced dead at UCLA Medical Center. Dr. Murray was at his side in the ambulance. Last year, Dr. Conrad Murray was charged with "involuntary manslaughter by the Los Angeles District Attorney's office," as reported by <a href="http://www.cnn.com/2010/CRIME/02/08/michael.jackson.charges/index.html?hpt=T2" target="_hplink">CNN</a>. The trial began on September 27, and is expected to last 5-6 weeks.

  • The Judge

    <strong>The Judge:</strong> Michael Pastor, Los Angeles Superior Court Judge Michael Pastor was named Judge of the Year in 2007 by the LA County Bar Association, reports <a href="http://www.radaronline.com/category/tags/judge-michael-pastor" target="_hplink">Radar Online</a>.

  • The Prosecution

    <strong>The Prosecution:</strong> David Walgren, Deputy District Attorney In his opening statement David Walgren stated, "It will be clear that Conrad Murray abandoned Michael when he needed help." Walgren is also known for writing the argument <em>against</em> Roman Polanski's effort to seek dismissal of the pending child-sex case against him, reports <a href="http://www.myfoxla.com/dpp/jackson_dr_trial/whos_who/david-walgren-v2" target="_hplink">Fox</a>.

  • The Co-Counsel

    <strong>The Co-Counsel to the Prosecution:</strong> Deborah Brazil, Deputy District Attorney The fifteen-year veteran is an Adjunct Associate Professor of Law at <a href="http://swlaw.edu/faculty/adjunctfaculty/facultybio/340658" target="_hplink">Southwestern Law</a>, her alma mater.

  • The Defense

    <strong>The Defense:</strong> Ed Chernoff In the Texas-based Attorney's opening statements he asserted, "While Michael Jackson was frustrated because he could not sleep, frustrated because his doctor refused to give him a drug that he preferred, that he wanted, he did an act without his doctor's knowledge, without his doctor's permission."

  • The Co-Counsel

    <strong>The Co-Counsel to the Defense:</strong> J. Michael Flanagan and Nareg Gourjian (seen here with The Accused: Dr. Conrad Murray). Nareg Gourjian and J. Michael Flanagan defended Britney Spears in her 2007 hit-and-run case, reports ABC.

  • The Head Of Security

    <strong>The Head Of Security:</strong> Faheem Muhammad Muhammad witnessed Michael Jackson's children enter the bedroom crime scene. He testified that Paris Jackson was "on the ground, balled up crying," and Prince Jackson "was shocked," at the sight of his father.

  • The Security

    <strong>The Security:</strong> Alberto Alvarez Alvarez was the first staff member to enter Jackson's bedroom after Conrad Murray called for help. He testified to the series of events that took place in the bedroom, prior to the 911 call, reports <a href="http://www.ontheredcarpet.com/Conrad-Murray-trial:-Michael-Jacksons-bodyguard--Alberto-Alvarez--says-doctor-told-him-to-grab-vials/8372734" target="_hplink">OTRC</a>.

  • The Personal Assistant

    <strong>The Personal Assistant:</strong> Michael Amir Williams Michael Amir Williams alleges that Dr. Murray asked to return to the Jackson residence post-mordem to retrieve "some cream Michael wouldn't want the world to know about," reports ABC.

  • The Personal Chef

    <strong>The Personal Chef:</strong> Kai Chase Chase claims Dr. Murray ran to get her in the kitchen around lunch time, yelling "Get Prince, get help, get security." Dr. Murray didn't ask Chase to dial 911, according to her testimony.

  • The #1 Paramedic

    <strong>The #1 Paramedic:</strong> Richard Senneff Senneff testified that Michael Jackson could have been saved, but the paramedic claims he was given false information upon arriving at the scene. "When I first moved the patient, his skin was very cool to the touch. When I took a first glance at him, his eyes were open, they were dry and his pupils were dilated. When I hooked up the EKG machine, there was a flatline," which wouldn't have been the case if 911 has been called immediately upon finding Jackson, as reported by The BH Courier.

  • The #2 Paramedic

    <strong>The #2 Paramedic:</strong> Martin Blount Blount testified that Dr. Murray claimed Jackson was "dehydrated," reports <a href="http://www.tmz.com/2011/09/30/people-vs-dr-conrad-murray-trial-testimony-dr-richelle-cooper-ucla-medical-center/" target="_hplink">TMZ</a>.

  • The Coroner Investigator

    <strong>The Coroner Investigator:</strong> Elissa Fleak, Los Angeles County Coroner's Office (seen in the background) Fleak testified that she found a "nearly-empty 20-milligram vial of propofol on the floor, as well as an empty bottle of flumazenil, which is used to treat benzodiazepine overdoses," at the crime scene, reports <a href="http://www.thewrap.com/music/column-post/conrad-murray-trial-day-7-prosecution-expected-play-audio-murrays-police-interview-live-" target="_hplink">The Wrap</a>. Elissa Fleak also testified that she accidentally <em>touched</em> a syringe in Jackson's bedroom- leaving a thumbprint.

  • The ER Doctor

    <strong>The ER Doctor:</strong> Dr. Richelle Cooper Dr. Cooper testified that "Mr. Jackson died long before he became a patient." The <a href="http://latimesblogs.latimes.com/lanow/2011/10/er-doctor-says-she-never-had-chance-to-save-michael-jackson.html" target="_hplink"><em>LA Times</em></a> reports that Dr. Cooper pronounced Jackson dead twice -- once on the phone (while Jackson was at home) and later at the hospital.

  • The Second ER Doctor

    <strong>The ER Doctor:</strong> Dr. Thao Nguyen, Cardiologist Dr. Nguyen testified that "when she pressed him for the time he had given the drug, he said he didn't know," reports the <a href="http://latimesblogs.latimes.com/lanow/2011/10/conrad-murray-talking-texting-before-jacksons-cardiac-arrest.html" target="_hplink"><em>LA Times</em></a>. "He said he did not have a watch," Dr. Nguyen said.

  • The Pharmacist

    <strong>The Pharmacist:</strong> Tim Lopez The Las Vegas pharmacist testified that he sent seven FedEx packages containing Propofol to an address in Santa Monica (belonging to Nicole Alvarez).

  • The Mistress

    <strong>The Mistress:</strong> Nicole Alvarez Alvarez is the mother's of Dr. Conrad Murray's son. She testified to receiving FedEx packages (containing Propofol, the prosecution argues) but was unaware of the contents and did not open them. She stated that she spoke to Dr. Murray the day Michael Jackson died -- she remembers Dr. Murray telling her "that he was on the way to the hospital in the ambulance with Mr. Jackson, and for me not to be alarmed."

  • The Houston Waitress

    <strong>The Houston Waitress:</strong> Sade Anding Sade spoke with Dr. Murray the morning of Michael's death. The waitress was on the phone with Dr. Murray for about five minutes before the line went silent. The <a href="http://latimesblogs.latimes.com/lanow/2011/10/conrad-murray-talking-texting-before-jacksons-cardiac-arrest.html" target="_hplink"><em>LA Times</em></a> reports, "I started telling him about my day, and that's when I realized he was no longer on the phone," Anding testified. "I was just talking, and the next thing, I said 'Hello hello,' and then I didn't hear anything."

  • The Nightclub Dancer

    <strong>The Nightclub Dancer:</strong> Michelle Bella Michelle Bella stated that she received a text (unrelated to Michael Jackson) from Dr. Murray the morning of Jackson's death, reports <a href="http://www.thehollywoodgossip.com/2011/10/sade-anding-nicole-alvarez-michelle-bella-and-stacey-ruggles-the/#ixzz1a1fmsybj" target="_hplink">Hollywood Gossip</a>.

  • The Pursuer

    <strong>The Pursuer:</strong> Bridgette Morgan The <a href="http://latimesblogs.latimes.com/lanow/2011/10/conrad-murray-talking-texting-before-jacksons-cardiac-arrest.html" target="_hplink"><em>LA Times</em></a> reports that Morgan met Dr. Murray at a Las Vegas nightclub. She called Murray the morning of Jackson's death, but Dr. Murray didn't answer.

  • The Estate Attorney

    <strong>The Estate Attorney:</strong> Howard Weitzman Weitzman previously told <a href="http://www.tmz.com/2011/04/12/michael-jackson-katherine-jacksno-pathetic-john-branca-howard-weitzman/#.To1Ehpz6bzA" target="_hplink">TMZ</a>, "The Jackson family has NO rights to determine what charities receive money from Michael's Estate but Mrs. Jackson will certainly have input." Weitzman has represented John DeLorean, Marlon Brando, and Arnold Schwarzenegger.

  • The Co-Executor

    <strong>The Co-Executor:</strong> John Branca, Entertainment Lawyer In December 2010, the Jackson Estate was worth $310 million in gross revenues and it is Branca's responsibility to distribute and manage this sum. Branca has represented Elvis, The Rolling Stones, and The Beach Boys.

  • The CEO

    <strong>The CEO:</strong> Paul Gongaware, Co-CEO of AEG Live Gongaware claims Dr. Murray demanded $5 million for his medical services, reports <a href="http://www.tmz.com/2011/09/27/michael-jackson-doctor-conrad-murray-opening-statements-involuntary-manslaughter-trial-propofol-aeg-live-co-ceo-paul-gongaware/#.To50N5z6bzA" target="_hplink">TMZ</a>. Gongaware did say that Jackson once returned from a visit to Dr. Arnold Klein "with a slower, slurred speech pattern," reports<a href="http://nancygrace.blogs.cnn.com/2011/09/28/michael-jackson%E2%80%99s-personal-assistant-testifies-about-the-day-he-died/" target="_hplink"> CNN</a>. AEG is being sued by Katherine Jackson, Michael's mother, for negligent supervision of defendant Murray while he was tending to Michael.

  • The AEG Live Attorney

    <strong>The Attorney, AEG Live:</strong> Kathy Jorrie In her testimony, Jorrie said that Dr. Conrad Murray assured her, in two separate conversations, that Michael Jackson was, "perfectly healthy" and in "excellent condition."

  • The Former Manager

    <strong>The Former Manager:</strong> Frank DiLeo Five days before Jackson's death DiLeo suggests to Dr. Murray he "get a blood test from Jackson" because they had "to see what he's doing," reports CNN.

  • The Producer/ Director

    <strong>The Producer/ Director:</strong> Kenny Ortega The Producer/ Director of <em>This Is It</em> and the Staples Center Michael Jackson Public Memorial. One week before Jackson's death, Ortega testified "My friend wasn't right. There was something going on that was deeply troubling..." as reported by the <a href="http://latimesblogs.latimes.com/movies/2011/09/michael-jackson-conrad-murray-kenny-ortega-tesimony-this-is-it-movie.html" target="_hplink"><em>LA Times</em></a>.

  • The Former Patient

    <strong>The Former Patient:</strong> Robert Russell Russell, a sales manager for an electrical distribution firm, stated that as a patient of Dr. Murray's he "was getting the best care in the world."

  • The Dermatologist

    <strong>The Dermatologist:</strong> Dr. Arnold Klein Dr. Klein was once thought to be the biological father of Jackson's children (Klein <a href="http://abcnews.go.com/GMA/MichaelJackson/story?id=8030165&page=1" target="_hplink">denied this</a> to Diane Sawyer). The defense <a href="http://www.tmz.com/2011/03/22/dr-arnold-klein-dr-conrad-murray-michael-jackson-demerol-drugs-addict-addition-manslaughter-trial-discovery-witness/#.To3XxJz6ayg" target="_hplink">argues</a> that Klein is responsible for Jackson's addiction to Demerol injections - and hence Klein is responsible for Jackson's dependency on powerful narcotics (such as propofol).

  • The Sleep Specialist

    <strong>The Sleep Specialist:</strong> Dr. Nader Kamangar In Dr. Kamanger's testimony he asserted that Dr. Conrad Murray was to blame for Jackson's death, whether he administered the Propofol or if he left Jackson unattended with the sedative, the <em><a href="http://www.latimes.com/news/local/la-me-conrad-murray-20111013,0,3651620.story" target="_hplink">LA Times</a></em> reports. Photo: Getty

  • The Cardiologist

    <strong>The Cardiologist:</strong> Dr. Alon Steinberg Dr. Steinberg expressed that "When [doctors] monitor a patient, you never leave their side, especially after giving propofol. It's like leaving a baby that's sleeping on your kitchen countertop," reports the <a href="http://www.latimes.com/news/local/la-me-conrad-murray-20111013,0,3651620.story" target="_hplink"><em>LA Times</em></a>. Steinberg is one of the witnesses expected to dissolve the defense's medical arguments. Photo: Getty

  • The Autopsy Doctor

    <strong>The Autopsy Doctor:</strong> Dr. Christopher Rogers Dr. Rogers was the autopsy doctor that ruled Michael Jackson's death a homicide. Dr. Christopher Rogers claims that the scenario presented by the defense is nearly impossible, reports <a href="http://www.tmz.com/videos/0_6axh334q" target="_hplink">TMZ</a>. Photo: Getty

  • The Toxicologist

    <strong>The Toxicologist:</strong> Dan Anderson During Anderson's time on the witness stand, the defense bombarded the Toxicologist. Flanagan and Anderson were debating what a theraputic level of a sedative was before Flanagan asked, "Well, the propofol is within therapeutic range also, isn't it?" To which Anderson replied, "I said it's within a therapeutic range in a proper setting. This is not a proper setting," reports <a href=" http://www.myfoxla.com/dpp/jackson_dr_trial/case_file/criminalist-dan-anderson-conrad-murray-trial-20111007#ixzz1agOaXgcV" target="_hplink">Fox LA</a>. Photo: Getty

  • The LAPD Detective

    <strong>The LAPD Detective:</strong> Scott Smith Smith and Detective Orlando Martinez interviewed Dr. Conrad Murray two days after Jackson's death at the Ritz Carlton Hotel in Marina Del Rey, reports The Daily Beast. At this point, the death had not yet been labeled a homicide. The defense argues that Smith took inadequate notes during this interview. Photo: Getty

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