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Conrad Murray Trial: Dr. Steven Shafer Takes The Stand

LINDA DEUTSCH   10/19/11 09:43 PM ET   AP

LOS ANGELES — A medical expert looked jurors in the eyes Wednesday and told them that Michael Jackson's doctor committed 17 flagrant violations of the standard of care for his famous patient and was directly responsible for the death of the King of Pop.

Dr. Steven Shafer at one point called the defendant, Dr. Conrad Murray, "clueless" when it came to using the powerful anesthetic propofol and said he didn't know what to do when Jackson stopped breathing.

Prosecutor David Walgren concluded the day's questioning by asking Shafer: "Would it be your opinion that Conrad Murray is directly responsible for the death of Michael Jackson for his egregious violations and abandonment of Michael Jackson?"

Shafer replied, "Absolutely."

Just giving Jackson the anesthetic as a sleep aid was unconscionable, Shafer testified earlier.

"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.

When Murray found Jackson not breathing, there was nothing more important than calling 911, Shafer said.

Asked about Murray's failure to do so, the witness caught his breath and said, "I almost don't know what to say. That is so completely and utterly inexcusable."

In addition, Murray was acting more like Jackson's employee than a physician who should have rejected the singer's requests for propofol as a sleep aid, Shafer said.

"Saying yes is not what doctors do," he testified. "A competent doctor would know you do not do this."

He added, "If a patient requests something frivolous or dangerous, it is the doctor's responsibility to say no."

The Columbia University professor and researcher gave jurors a crash course on propofol, an anesthetic used in hospital settings.

A video shown to jurors detailed numerous safety measures that were not employed by Murray when he administered the drug to Jackson as a sleep aid at the singer's home, according to testimony.

"The worst disasters occur in sedation and they occur when people cut corners," Shafer said. In Jackson's case, "virtually none of the safeguards were in place," he added.

Shafer is expected to be the last prosecution witness in the involuntary manslaughter case against Murray. His testimony will resume Thursday.

He said the fact that Murray was on his cell phone in the hours before Jackson's death was a setup for disaster.

"A patient who is about to die does not look all that different from a patient who is OK," Shafer said, adding that doctors cannot multitask and properly monitor a patient who is sedated.

Shafer, who wrote the package insert that guides doctors in the use of the anesthetic, lectured the jury as if they were in a classroom. He narrated while the silent video took jurors into an operating room to see the specialized equipment and procedures.

The researcher told jurors that it appeared Murray intended to give Jackson large doses of propofol on a nightly basis. He said records showed Murray purchased 130 100ml vials of propofol in the nearly three months before Jackson's death.

Shafer said that is "an extraordinary amount to purchase to administer to a single individual."

He also told jurors that keeping records is essential. While narrating the video, Shafer noted the doctor in the footage was taking copious notes.

"Moment by moment, the anesthesiologist writes down everything that happens, as diligently as you are doing here," he said as jurors scribbled in notebooks.

He said the lack of record-keeping was a violation of Jackson's rights, especially if something went wrong.

"He has a right to know what was done to him," Shafer said. "With no medical record, the family has been denied that right."

Testimony has shown that Murray took no notes on his treatment of Jackson and didn't record his vital signs on June 25, 2009, the day Jackson died.

Shafer said he was testifying for the prosecution without a fee because he wants to restore public confidence in doctors who use propofol, which he called a wonderful drug when properly administered.

"I am asked every day in the operating room, `Are you going to give me the drug that killed Michael Jackson,'" Shafer said. "This is a fear that patients do not need to have."

Shafer, who edits journals on anesthesia and is widely published on the subject, also gave jurors a demonstration from the witness stand of how propofol is drawn into an IV bag with a large syringe. He produced a bottle of the white substance that Jackson referred to as his "milk" and showed the steps involved, which took several minutes.

The explanation by Shafer and the depiction in the video seemed to belie an early defense claim that Jackson could have administered the drug to himself. The process shown Wednesday appeared too complicated for self-administration.

The video also suggested the only place for propofol to be administered properly is in a hospital with medical personnel on hand. The video showed a printed warning if problems arise: "Call for Help!"

Murray, who has pleaded not guilty to involuntary manslaughter, told police he delayed calling 911 because he was giving Jackson CPR.

Murray has acknowledged giving Jackson doses of propofol in the superstar's bedroom as a sleep aid. However, his attorneys have said the amount of propofol given to Jackson on the day he died was too small to cause his sudden death at age 50.

Murray's attorneys will begin calling witnesses Friday. They plan to call 15 people, including police detectives, character witnesses and Randy Phillips, the head of AEG Live, the promoter of Jackson's planned series of comeback concerts.

Chernoff said the defense should rest its case by Wednesday.

Murray's attorneys are also going to call one of Shafer's colleagues, Dr. Paul White, as an expert to try to counter the prosecution case.

___

AP Entertainment Writer Anthony McCartney contributed to this report.

___

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

WHO'S WHO IN THE CONRAD MURRAY TRIAL:
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LOS ANGELES — A medical expert looked jurors in the eyes Wednesday and told them that Michael Jackson's doctor committed 17 flagrant violations of the standard of care for his famous patient and...
LOS ANGELES — A medical expert looked jurors in the eyes Wednesday and told them that Michael Jackson's doctor committed 17 flagrant violations of the standard of care for his famous patient and...
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10:56 AM on 10/23/2011
Poor taste to reprint that photo
As I physician myself I must say there is no excuse for Murray's egregious behavior nor for his attempt to blame his patient for his own death. He's an embarrassment to his profession. Also, it doesn't matter what Jackson did or didn't do that morning or six weeks prior. Murray was the authority in that situation yet financial difficulties, celebrity infatuation and not a little arrogance resulted in an experienced physician sacrificing sound medical judgement that resulted in the death of his ONE patient. And now Murray agrees to blame his patient for his death? Just another example of his lack of moral character.

As a side note, it is common medical practice to refer to propofol as 'milk'.
04:43 AM on 10/21/2011
If Dr Shafer is saying that Propofol can only be administered with an infuser he is wrong.

Propofol is routinly used in the OR as an induction agent administered via a syringe and needle to get people off to sleep (induction dose) It is also not precisely measured during this course of administration. Once the patient is asleep the agent used to maintain anaesthsia may be changed to a volatile agent such as Halothane.
If used not just as a induction agent but one to maintain anaesthesia during the procedure then a syringe driver is to be used ( TIVA ).
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MichaelMcKLA
I'm moving to Pandora.
08:30 PM on 10/20/2011
It will be interesting to see what the defense has to offer. It had better be seriously impressive if Murray wants to get off.
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HUFFPOST SUPER USER
jeromettaylor
The Aliens were here 1st!
06:34 PM on 10/20/2011
****News Update****
Dr. Conrad Murray was convicted on all charges.
He was sentenced to the maximum penalty under California penal code:
He is forbidden to smoke pot in public for 15 years, and his medical practice will be restricted to Lindsey Lohan.
11:43 AM on 10/20/2011
Well, I'm pleased to see this report properly headlined as the DR. CONRAD MURRAY TRIAL. So many other articles have taken the low road to ratings with descriptors like Jackson Doc Trial or worse. Dr. Shafer's striking two-day testimony outlined the many egregious violations committed by Dr Conrad Murray which breached the standard of care his patient had a right to expect. Particularly notable were Shafer's statements on the nature of the Doctor-Patient relationship. He said that Dr. Murray relinquished his authority and responsibility as a doctor -- to put the patient first -- and assumed the role of employee -- putting his own interests first. Shafer made a clear distinction between 'putting the patient first' and 'doing what the patient may want' Dr. Murray forgot or ignored his primary role and duty as a doctor and became, as Shafer described, the same as the employee hired to clean the house according to the employer's wishes. Once Murray voluntarily became another employee, the machinery for his downfall was set in motion -- regardless of how many other doctors before him may have done the same thing.
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HUFFPOST SUPER USER
sparkygirl91
Never apply lipstick while driving on gravel
11:09 PM on 10/19/2011
Dr. Shafer was phenomenal and, while he is the prosecution's witness, the defense will have a tough time - Dr. Shafer will not be intimidated. He's extremely credible and his testimony was such that even a lay-person could understand. We all know MJ was an addict but that is not the issue in this case. The issue is whether Dr. Murray contributed to the death of MJ by providing sub-par care to his patient and not in the expected and required standard. Dr. Murray, or any doctor for that matter, was obligated to say "no" to MJ and he didn't so....here we are. As to the recently released pictures, I'm all for them being shown - and shown to kids old enough - because they're a true reflection of what addiction can and will do to you. It's a tough lesson but it's a good lesson - this is what addiction did to the once fabulous and talented Michael Jackson! Frankly, those young folks who idolized him can now learn from his mistakes, the visual aids they will not find in Health Class.
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Gavin Saunders
we only have each other
09:45 AM on 10/20/2011
Er, if he's addicted to Propofol, why wasn't he just always asleep?
10:35 AM on 10/23/2011
It is important to remember that there was no demerol or it's metabolites (breakdown products), nor any narcotics found in Jackson's system per toxicology reports. Pill bottles on bedside table were inconsistently used with many tablets remaining. Inconsistent with abuse. The drugs present at death were those that Murray administered, in addition to rescue medications given by paramedics.
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10:20 PM on 10/19/2011
Michael did things to his body for years from cosmetic to drugs. He never could live like the establishment and died the same. He wanted and would have got these drugs one way or another to the point I do believe he could have administered one or more drugs to himself not telling his MULTIPLE doctors about each other and hiding staches of who knows what that he combined with
propofil. No one broke in and injected him. he got what he asked for with deciet and his $$$$$ $$$$$.
10:40 AM on 10/23/2011
The issue in court concerns Conrad Murray's behavior, not his patient's. Doesn't matter what
Jackson did or didn't do on the 24th or 6 weeks prior. Dr. Shafer clearly delineated Murray's egregious errors that resulted in the death of his patient. He had a duty to say no and to obtain proper consults/treatment for his ONE patient. He failed to do that. Please remember, Jackson is not on trial here, tho that is what the defense is planning to do. If a patient dies in surgery because the doctor erred, that same doctor just does not blame his/her patient.
Ridiculous.
10:05 PM on 10/19/2011
A doctor should be in control of his patient at all times. There are those patients who demand a drug. This should be discouraged at all times...for if a mishap takes place the physician would be held responsible and not the patient. The tail should never be allowed to wag the dog.
Court is in session. Let us not preempt the trial. Let us follow the proceedings.
09:10 PM on 10/19/2011
Hey Huff Post, why are you quoting TMZ as to Michael's supposed aliases? And why are you publishing that autopsy photo at this time? But on the issue of this witness, Shafer's, testimony today, he obviously feels passionate on the subject, perhaps increased by the recent death of his own father. Everything that Murray did or didn't do was the worst possible choice he could make, and one has to concur with Shafer's testimony that his omissions and commissions are so mind boggling that he really was "clueless" and never thought of his patient, only himself. It is sad to think the lengths the state has to go to prove this involuntary manslaughter case but they seem to cross all the t's and dot all the i's, and I don't believe it's a waste of money to pursue conviction of this sociopath, as finally a message will be sent loud and clear to heartless, soulless white coat drug pushers. Maybe this will be Michael's greatest legacy.
09:01 PM on 10/19/2011
Why isn't the vid working!!!!!!?????? D:
08:20 PM on 10/19/2011
Dr. Shaffer is absolutely terrific!! BUT I have to think Murray is NOTHING BUT ABOUT the money!!!! I have been a nurse for 33 years - from the FIRST day of nursing school DOCUMENTATION was pounded into our heads!!! I don't think a day in 33 years has gone by that I have not heard the word documentation!!! I do think this doctor was undercharged, but at the very least he needs to be sentenced to the full 4 years proposed!
I often wonder about his poor wife!!! I do hope that one of the attorneys does offer his services FREE for the divorce - and if she is not considering divorce that one on the psychologist/pychiatrists we have seen talking of this case offer her FREE counseling!! This is truly a sad case - one of the various reasons I've heard for NOT calling paramedics was he was a private person - AND YOUR POINT IS?? Ya call 911 and worry about stuff like that after the fact!!! Even in the hospitals, the first thing you do if you have a problem with a patient not breathing/no heart beat, ya call for HELP, and start emergency procedures. If it turns out you over reacted oh well... As for the recording - BLACK MAIL - financial security! This guy was not working in the best interest of MJ - it's all about the money!!! And he actually did NOT make a dime!!!
07:21 PM on 10/19/2011
The Doctor did what Jackson was paying him to do, provide him drugs. He screwed up and the freak overdosed, by mistake and with drastic accidental results. Take his license and put him on probation for 10 years. Enough of wasting the taxpayers money over the freaky and disfunctional in this country!
makemesmile
it makes you wonder
10:01 PM on 10/19/2011
Are all drug users and abusers freaks, or just Michael Jackson? Lindsey Lohan looks rather freakish to me with her constant drug abuse.
07:03 PM on 10/19/2011
'''legal Drug Dealer'' ?
05:04 PM on 10/19/2011
All the grandstanding ,the cost, the TV hype. for what. To put a "drug dealer in jail for a very short time. Murray is nothing more than a highly paid drug supplier under the "Dr." name. He should not be allowed to practice in this country,but he will ,not in Calf some other state. So what a waste of time,and money..
GOODDOC1
"civil war" is an oxymoron
01:33 AM on 10/20/2011
Maybe this very public trial will discourage other doctors from doing what Murray did, no matter how much money is offered. I certainly hope so.
05:00 PM on 10/19/2011
Send his sorry _ss to jail for life and nothing less. He deserves more then the california law allows.