Conrad Murray Trial, Day 13: Doctor Hammered by Expert Witness

Anesthesiology expert says Murray bought an “extraordinary” amount of propofol

After a hiatus of several days, the involuntary manslaughter trial of Dr. Conrad Murray resumed Wednesday, and Michael Jackson's former physician took it in the shorts big-time.

Anesthesiology expert Dr. Steven Shafer re-took the stand and eviscerated Murray for his treatment of Jackson, rattling off 17 separate egregious violations that, in Shafer's opinion, directly contributed to the death of the "Thriller" singer.

The prosecution is expected to wrap up its case with the conclusion of Shafer's testimony Thursday. Until then, catch up on the case with a thorough rundown of the day's proceedings below.

Update, 4:00 p.m. PT

On the stand during Dr. Conrad Murray's involuntary manslaughter trial Wednesday, anesthesiology expert Dr. Steven Shafer rattled off a 17-item list of "egregious violations" that Murray committed while treating Michael Jackson.

 Shafer also called the amount of propofol ordered over the months  he treated Jackson — an amount that Shafer worked out to be just  over four gallons — was "an extraordinary amount to administer to one  individual."

Among the egregious violations — that is to say, "something that  should never happen" and could have led to Jackson's death — Shafer noted:

— A lack of emergency airway equipment, which "should be there  without exception … no competent doctor would administer propofol  without emergency airway equipment."

— A lack of more advanced airway equipment, such as a laryngeal mask, laryngoscope or endotracheal tube — which Shafer says Murray should have had on hand since he had no backup  personnel.

— A lack of an infusion pump, to monitor how much propofol was being administered.

— Using a model of a "pulse oximeter" that didn't have an alarm, which was  "completely inappropriate for use in this setting."

— Failure to establish a doctor/patient relationship. According to Shafer, Murray and Jackson had more of an employee/employer relationship, where Murray honored Jackson's every request no  matter how dangerous.

— Lack of documentation and medical records, which Shafer actually  called "unconscionable." Shafer marveled, "It is unbelievable that with  80 days of treatment there is not a single record showing the  treatment of any given night."

— No electrocardiogram equipment or no blood-pressure monitoring devices were on hand.

— Murray's delay in calling 911 when Jackson was unresponsive. "Nothing is a higher priority than calling for help at the moment of disaster," Shafer testified. The fact that Murray first called Jackson's assistant, Michael Amir Williams, and left a voicemail for him instead of calling 911 is "so egregious that I find it difficult to comprehend," he added. "It's just inconceivable to me … that is so completely and utterly inexcusable."

— Not informing paramedics that he had given Jackson propofol. "When a person's life hangs in the balance, to withhold information is inexcusable," Shafer said.

 Shafer (pictured) also criticized Murray's emergency treatment of Jackson, saying that performing one-handed chest compressions on a patient in bed is useless, and that chest compressions were completely unnecessary in Jackson's case, because the real problem was that he needed oxygen in his lungs.

Asked by the prosecution team whether the dosage that Murray was giving to Jackson was safe in the setting it was administered, Shafer  shot back, "Not at all."

Noting the number of variables and the lack of precedent in treating insomnia with propofol, Shafer said, "We are in pharmacological never-never land here; something that's only been  done to Michael Jackson … so any dose is a dangerous dose."

Shafer opined that, even in the event that Jackson had self-administered drugs when Murray left his side for a two-minute bathroom break — as Murray's defense team contends — the doctor is still directly responsible for Jackson's death.

"Absolutely," Shafer asserted.

Update, 12:26 p.m. PT

During the involuntary manslaughter trial of Dr. Conrad Murray on Wednesday, anesthesiology expert Dr. Steven Shafer showed a video in court that showed the proper administration of propofol, and the possible complications that can arise from its use.

In the video, Shafer walked the courtroom through the many safeguards that need to be in place before administering the anesthetic, which was found by coroners to have killed Michael Jackson.

Shafer detailed the many devices needed on hand to ensure that air and oxygen flow to the patient's lungs and brain, which he testified is of primary importance when anesthetizing a patient. Shafer also stressed that the room should be prepped with the devices immediately available in case they're needed.

"When there are problems, you have to respond to anesthesia in a matter of seconds," Shafer told the court. "If you have to walk a few feet, it's a few feet too far."

Also critical when anesthetizing a patient, according to Shafer: Making absolutely sure that the contents of the stomach, such as vomit and bile, don't enter the lungs.
Shafer also stressed the importance of providing informed consent to the patient, making him aware of the possible complications from the procedure. Shafer stressed that the consent must be confirmed in written form.

"Verbal informed consent is not recognized; it does not exist," Shafer asserted.

The need for constant note-taking on the patient's condition and what drugs have been administered during the procedure is also critical, Shafer attested.

While on the stand, Shafer — who will serve as the prosecution's final witness — also detailed the various complications that can occur, such as hypotension, a common occurrence during propofol use, airway obstruction, apnea and aspiration.

Should a patient go into arrest, Shafer testified, physicians should first assess the patient to make sure that an arrest actually had occurred, call for help, administer CPR, and deliver emergency resuscitation drugs.

Court is currently in recess for lunch.


Update 10:30 a.m.

The courtroom is currently on a break while the prosecution re-edits a video, reportedly a dramatization of what could happen when a propofol-related medical emergency occurs, and how it should be treated.

CNN's Alan Duke has seen the video, and calls it a "dramatic" film that includes a re-enactment of a propofol-related cardiac arrest.

Anesthesiology expert Steven Shafer, who's known as the "godfather of propofol," is the prosecution's witness in today's proceedings. Prosecutor David Walgren has spent most of the morning so far establishing Shafer's credentials, and when court resumes, the video will be played for the jury.

Previously …

Anesthesiology expert Steven Shafer is expected to be the final prosecution team witness when the Conrad Murray involuntary manslaughter trial resumes today after a three-day break.

Read more: Conrad Murray Trial Delayed (Again) Because of New MJ Drug Test Results reports the prosecution is likely to rest its case today. If so, Judge Michael Pastor will call for another break on Thursday, before Murray's defense team begins its presentation on Friday.

Proceedings were postponed for three days to allow Shafer (pictured) to attend a medical conference, and then deal with the death of his father. Pastor called for another delay to allow the defense attorneys to examine new evidence after the prosecution ordered new lab tests on the contents of Michael Jackson's stomach.

The tests were requested last week by the prosecution after Murray's defense team contended Jackson had swallowed eight lorazepam pills on the day he died. Prosecutor David Walgren said on Monday the lab results showed "a much smaller amount of lorazepam in the stomach that is totally inconsistent with oral consumption of lorazepam tablets."

Read more: Michael Jackson, Conrad Murray and the Stripper

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 June 25, 2009 death because he recklessly administered the propofol, a potent surgical anesthetic drug, and was negligent in properly monitoring Jackson.

Shafer's testimony is considered key to the prosecution's case.

Despite the many delays, the trial is still expected to go to the jury next week.

Murray faces up to four years in prison and loss of his medical license if convicted, though reports a new California law could mean his sentence would be reduced to two years and be served in a county jail.

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