Conrad Murray took a beating from his fellow physicians during his involuntary manslaughter trial Wednesday.
As the prosecution began to draw its case to a close (after today, only one witness for the people remains), the court heard testimony from two doctors who criticized pretty much every aspect of Murray's treatment of Michael Jackson, from his initial decision to treat Jackson's insomnia with the sedative propofol to his crucial delay in calling 911.
During their testimony, Dr. Alon Steinbeg and Dr. Nader Kamanger -- both of whom reviewed Murray's case for the California Medical Board -- said that Murray's actions played a direct part in Jackson's death.
Also a roadblock for Murray's defense: His attorneys' decision, announced early this morning, to drop the argument that Jackson had orally administered the fatal dose of propofol to himself.
Read on for a full rundown of the day's court proceedings.
Update, 4:22 p.m. PT
A second expert witness for the prosecution in the involuntary manslaughter trial of Dr. Conrad Murray testified Wednesday, tearing into Murray's treatment of Michael Jackson and calling Murray's failure to disclose the use of propofol "unconscionable."
By withholding the fact that he had administered propofol to Jackson on the morning of his death from EMTs and emergency room personnel, Dr. Nader Kamangar said, Murray was "really doing wrong by one of the basic principles of medicine, which is putting your patients first."
Earlier in the trial, paramedics responding to the 911 call from Jackson's house on June 25, 2009, as well as the attending physician at UCLA Medical Center's emergency room on the day Jackson was brought in, told the court that Murray declined to tell them he had given the singer propofol when they asked what medications he was on. In a police interview two days after the singer's death, however, Murray recalled how he had administered the sedative to the singer in the hours before his death.
That was far from the only criticism that Kamangar (pictured) leveled at Murray. The sleep expert, who reviewed Murray's treatment of Jackson for the California Medical Board, slammed the use of propofol as an insomnia treatment in the first place; condemned the setting that Murray administered the propofol in; maintained that Murray's method of CPR was grossly inadequate; and asserted that Murray fatally delayed calling 911 in the "golden minutes" when Jackson's life might have been saved by emergency personnel.
Kamangar characterized Murray's use of propofol to treat Jackson's insomnia "frankly disturbing," and opined that Murray's actions -- and in some cases, inactions -- played a causal role in Jackson's death.
Update, 10:10 a.m. PT
Dr. Alon Steinberg, an expert reviewer for the California Medical Board who reviewed Dr. Conrad Murray's treatment of Michael Jackson, took the stand in Murray's involuntary manslaughter trial Wednesday and detailed numerous ways in which Murray improperly treated Jackson in the time leading up to his death.
In all, Steinberg (pictured) detailed six extreme deviations from standard care on Murray's part -- each of which, according to Steinberg, amount to gross negligence.
Steinberg testified that Murray's negligence included:
--The use of the sedative propofol, when it isn't medically indicated for insomnia
-- Administering propofol in someone's home without the proper equipment, such as an EKG monitor
-- Administering propofol without the proper backup personnel in attendance.
--Administering propofol with inadequate preparation in case of emergency.
--Improper care during Jackson's respiratory arrest. ("When he was trying to resuscitate Mr. Jackson, he didn't follow proper protocol," Steinberg testified, adding that performing chest compressions on a patient in respiratory arrest is "inexcusable," as it's not necessary in that situation. Instead, Steinberg said, he should have tilted Jackson's head back and put a bag mask over his face in an effort to get his oxygen level back up, and administered the benzodiazapene antidote flumazenil.)
--Failure to call 911 in a timely manner. (Noting that Murray first called Jackson's assistant, Michael Amir Williams, when he first noticed that the singer wasn't breathing, Steinberg said, "It's basic knowledge, you don't have to be a health-care professional -- when you see someone down, you have to call 911.")
--Failure to maintain proper medical records that could have been handed over to emergency-room personnel when Jackson arrived at UCLA Medical Center.
The deviations in standard care, Steinberg concluded, directly impacted Jackson's death.
"If these deviations hadn't happened, Mr. Jackson would be alive," Steinberg told the court.
Steinberg also criticized Murray's decision to leave Jackson's side while he was under the influence of propofol -- which he likened to "leaving a baby who's sleeping on your kitchen countertop" -- and not keeping the medications properly locked up so that Jackson couldn't get to them, which is what Murray's defense team contends what happened on the day of his death.
On cross-examination, defense attorney J. Michael Flanagan tried to shake Steinberg from his testimony, arguing with him over whether Murray told police that he had placed Jackson on a propofol drip, in addition to an initial dose. (After an extensive period of back-and-forth, Steinberg cracked, "Can we agree to disagree?")
Flanagan also cited a study indicating that, contrary to Steinberg's testimony, propofol had been effectively used to treat insomnia. Steinberg countered that the study was published in 2010, a year after Jackson's death, and that in any case the findings were still experimental and it would be unethical for a doctor to treat a patient based off of them.
Flanagan further suggested that Murray might have been off in his time estimates due to the hectic nature of the situation.
"You know for a fact, don't you, that Dr. Murray was gone for more than two minutes?" Flanagan asked, referring to the bathroom break Murray took prior to finding Jackson unconscious.
Steinberg replied that he could only base his review on Murray's own account in his interview with police.
TMZ reports that, earlier in the morning, Jackson's defense team stated that it would no longer be pursuing the argument that Jackson had orally ingested the propofol dose that killed him -- this, after an independent study by the defense team found that orally ingesting propofol would not be fatal. (It probably also didn't help that, Tuesday, deputy medical examiner Christopher Rogers testified that there was no propofol found in Jackson's esophagus or stomach.) However, that doesn't prevent defense from contending that Jackson ingested the propofol via other means.
The prosecution in the Conrad Murray involuntary manslaughter trial has just three witnesses left to call to the stand before resting its case.
CNN.com reports a sleep expert, a cardiologist and an anesthesiologist are in the prosecution's line-up for Wednesday's court proceedings. The three medical experts are expected to give specific and scientific testimony about Murray's treatment of Michael Jackson leading up to and including his June 25, 2009 death.
The Los Angeles County coroner ruled Jackson died of "acute propofol intoxication," and that sedatives were also a factor. Prosecutors contend Murray is criminally liable for Jackson's death because he recklessly administered the propofol, a potent surgical anesthetic drug, and was negligent in properly monitoring Jackson.
Tuesday's courtroom action included the conclusion of the playback of Murray's interview with police two days after Jackson died. During the interview, Murray revealed several details about Jackson's other medical conditions -- including serious problems with his feet and eyes.
Murray also told police about his suspicions that Jackson had been receiving powerful medication from Beverly Hills dermatologist Arnold Klein. Murray said he was told Jackson visited Klein three times a week and returned "basically wasted."
Also on Tuesday, jurors heard the testimony of Dr. Christopher Rogers, the medical examiner who conducted the autopsy on Jackson and ruled his death a homicide.
Rogers testified that it was physically possible that Jackson administered a fatal dose of propofol to himself, which the defense claims caused the singer's death.
But Rogers also said it was unlikely that's how events occurred, and said that even if the fatal dose was self-administered, Murray is still responsible for Jackson's death because he provided his client with access to the drug and failed to properly monitor its usage.
"Essentially, (Murray) would be estimating how much propofol he would be giving," Rogers said. "I think it would be easy under those circumstances for the doctor to estimate wrong and give too much propofol."
CNN.com reports the trial could go to the jury as early as next week. Murray faces up to four years in prison and loss of his medical license if convicted.
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