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FACTS revealed during pretrial hearings in Murray’s case. Days 3 and 4

January 9, 2011

Since it is difficult to follow the various media reports covering preliminary hearings of Dr. Murray’s case I’m making a humble attempt to register at least some of the news of Days 3 and 4 of the hearings the way they are reported in the press. The coverage is far from exhaustive (sorry for that) and the news provided here has practically no comment on my part:

Day 3. January 6, 2011

Thursday

Dr. Murray was speaking to his girlfriend Sade Anding when he found that something was wrong with Michael Jackson. He didn’t receive a call from her – it was him who called her at 11.51 am.

According to the prosecution propofol was given to Michael Jackson between 10:40 and 11:00. Dr. Murray earlier said that after administering the medicine he went to the bathroom and when coming back found Michael breathless.

Now we find that Dr. Murray called his girlfriend at 11.51 and after exchanging some small talk with her for five minutes he realised that something was wrong with his patient. Given that 911 was dialled only at 12:21 some 25 minutes or more elapsed between the call to his girl friend and the 911 call.

Instead of calling 911 Dr. Murray placed a call to Michael Jackson’s personal assistant at 12:12 p.m. and sent text messages at 12:03 p.m. and 12:04 p.m. (which still needed to be typed).

“A former girlfriend of the doctor charged in the death of Michael Jackson has testified that he was distracted when he called her on the morning of the singer’s death and she heard commotion in the background.

Sade Anding said she realised at one point that Dr Conrad Murray wasn’t paying attention to her. She heard coughing and mumbling but didn’t recognise the voice as Murray, she said.

“I heard commotion as if the phone was in a pocket or something,” Anding said.

Phone records show Murray called Anding at 11.51am. She said she stayed on the line for five to six minutes, but Murray never got back on the phone.

The records indicate 911 was dialed at 12.21pm.

http://www.stuff.co.nz/entertainment/celebrities/4522097/Michael-Jacksons-doctor-got-distracted-on-call

“… one of Murray’s girlfriends, Sade Anding, gave notable testimony. Anding said she received a five-minute phone call from Murray around 12:30 p.m., during which he abruptly stopped talking after exchanging brief small talk.

Anding said she heard “coughing and voices,” and the line sounded as if he had placed the phone in his pocket. However, according to phone records, the only time Murray called Anding that day was at 11:51 a.m., which would have meant that Murray waited about 25 minutes to call 911 once he recognized Jackson needed emergency assistance. http://www.mtv.com/news/articles/1655551/michael-jacksons-home-contained-dozen-bottles-propofol.jhtml

“Earlier in the day, a former girlfriend of Murray testified that he had been distracted when he called her on the morning of the singer’s death, and she heard commotion in the background.

Witness Sade Anding said she realized at one point that Murray wasn’t paying attention to her. She heard coughing and mumbling but didn’t recognize the voice as Murray, she said.

“I heard commotion as if the phone was in a pocket or something,” Anding said.

The testimony added details to a timeline being developed by prosecutors at the hearing.

Prosecutors said Anding was one of three women whom Murray either called or received a call from around the time Jackson died.

“It shows a distinct pattern by Dr. Murray of whether he is making the phone call or receiving the phone call, that he carries on personal, social business when his attention should be on his patient Michael Jackson,” Deputy District Attorney David Walgren told the judge in a conference, according to a transcript obtained by The Associated Press.

Phone records show Murray called Anding at 11:51 a.m. She said she stayed on the line for five to six minutes, but Murray never got back on the phone.

The records indicate 911 was dialed at 12:21 p.m.

Walgren said Anding’s call was particularly important “because it highlights the priorities Dr. Murray was placing at the time,” according to the transcript. “His focus should have been on his patient when instead at 11:51, the evidence will show he is making a phone call to this cocktail waitress in Houston.”

http://news.yahoo.com/s/ap/20110108/ap_on_en_ot/us_michael_jackson_doctor_122

“Two phone company representatives reported that in the hours before and after Jackson’s death, Murray texted and phoned a number of people, but never dialed 911.

Records read in court show that Murray was sending and receiving multiple texts every few minutes after the discovery, but that he did not inform a Jackson bodyguard to call 911 until after 12:20 p.m.

http://www.mtv.com/news/articles/1655460/michael-jackson-paramedic-recalls-hectic-ride-hospital.jhtml

Detective Dan Myers testified Thursday that Dr. Conrad Murray — who had two cellular phones in his name — had made or received 11 calls totaling just under 90 minutes between 7:01 a.m. and 11:51 a.m. June 25, 2009.

Myers said the doctor’s phone calls that morning included a 32-minute call to his practice in Las Vegas. They also included an 11-minute call made just before the doctor called Jackson’s personal assistant at 12:12 p.m. to report that the singer had a ‘bad reaction,’ according to cellular phone records presented by Myers.

The calls also included one at 1:08 p.m. — when other witnesses testified Murray was making a phone call from the ambulance containing Jackson — to the mother of Murray’s child, Myers said.”

http://www.mtv.com/news/articles/1655460/michael-jackson-paramedic-recalls-hectic-ride-hospital.jhtml

“Dr. Conrad Murray was talking on the phone and texting during the period authorities say he should have been closely monitoring Michael Jackson’s vital signs, according to cellphone records shown in court Thursday.

The records presented by prosecutors indicate that Murray made or received 11 phone calls over five hours while at the singer’s rented Holmby Hills mansion, including a trio of back-to-back conversations that lasted 45 minutes and were interrupted, prosecutors have said, only by Murray’s sudden realization that his famous patient had stopped breathing.

The phone evidence came on the third day of a preliminary hearing to determine whether prosecutors have sufficient evidence to try Murray for involuntary manslaughter in Jackson’s June 25, 2009, death.

The specifics of Murray’s treatment remain something of a mystery because Jackson barred everyone except his children and the doctor from the second floor of his residence. But with the records, prosecutors suggested that Murray was distracted from his medical duties by the calls and other text messages.

Murray told police in an interview that he spent hours that morning trying to get Jackson, a chronic insomniac, to sleep and administered a series of sedatives and propofol.

The records show he also talked to three other patients, another physician, the staff at his practices in Las Vegas and Houston, his teenage daughter and his personal assistant.

A police detective, Dan Myers, testified that the assistant, Stacey Howe, told him she and Murray talked about contacting the medical board in London, where he was to travel in a few weeks for Jackson’s comeback concerts.

Murray ended a call with a female acquaintance at 12:02 p.m. Prosecutors have said he did so abruptly, suggesting that he had just found Jackson stricken.

The phone records show Murray placed a call to Jackson’s personal assistant at 12:12 p.m.

They also show text messages at 12:03 p.m. and 12:04 p.m.

An AT&T representative testified that it is possible to recover the contents of text messages but that he did not know how to do so. There has been no testimony on whether the prosecution has recovered those messages.

http://www.latimes.com/news/local/la-me-conrad-murray-20110107,0,3717159.story?track=rss

Further media reports tell us of Dr.Conrad Murray’s interaction with the paramedics who arrived 4 minutes after the 911 call and doctors at the hospital emergency department.

None of them were informed of the fact that propofol had been given to MJ. When paramedics arrived they asked about the time the patient became unresponsive and Murray replied, “it just happened“. All medical personnel agree that Michael Jackson died in his bedroom at least 20 minutes to one hour before the paramedics arrived:

Paramedic Richard Seneff described Jackson not having a pulse, cold legs and dry eyes and said the paramedics’ heart monitor showed the performer had “flatlined.”

When Murray was asked how long Jackson had been unresponsive, CNN reported that Senneff testified Murray told him it “just happened,” an account the paramedic said “didn’t add up.”

In further damaging testimony, Judge Michael Pastor heard from another paramedic who, like Senneff, said Murray did not initially tell them that he had given Jackson medications.

Paramedic Martin Blount said the denial about what medications he’d given Jackson struck him as strange because he saw hypodermic needles and three bottles of the anesthetic lidocaine in the pop star’s room. Murray, who has pleaded not guilty in the case, “scooped up” the bottles and put them in a bag before leaving for the hospital.

http://www.mtv.com/news/articles/1655460/michael-jackson-paramedic-recalls-hectic-ride-hospital.jhtml

“Thursday, a paramedic who responded to Jackson’s home the day he died testified that the pop superstar looked as if he had not been breathing for at least 20 minutes, despite Murray’s assertion that the singer had stopped breathing only about one minute before paramedics were called.

Citing the temperature of Jackson’s skin and the fact his eyes were fixed and dilated, firefighter/paramedic Martin Blount testified, `It seemed like he (had) been down for a little while.’

Blount’s comments backed up earlier testimony from firefighter/paramedic Richard Senneff, who said the singer appeared to have stopped breathing anywhere from 20 minutes to an hour before paramedics arrived at Jackson’s estate.

Both Blount and Senneff said they believed Jackson was already dead by the time they arrived. Senneff testified Wednesday that paramedics arrived at the home about four minutes after the 911 call. [12:25]

Blount said Murray initially denied giving Jackson any medications. But the paramedic said he saw Murray holding a hypodermic needle and saw three small bottles of the anesthetic medication Lidocaine that the doctor later picked up from the floor.

’He scooped them off the floor and put them into a black bag,’ the paramedic said of Murray.

According to court papers, Murray has admitted giving Jackson propofol, but the doctor insists he did not give anywhere near the amount that would have caused his death.

During a hearing last month, prosecutors indicated the defense was planning to argue that Jackson injected himself with more of the drug, essentially killing himself.

http://bhcourier.com/article/Local_News/Local_News/LA_Police_Detective_To_Continue_Testifying_Against_Michael_Jacksons_Physician/73795

“Two emergency room doctors from Ronald Reagan UCLA Medical Center testified Thursday that Murray never told them he had given the pop superstar a powerful sedative that eventually killed him.

Dr. Richelle Cooper testified that the singer `had no signs of life’ when he was brought to the hospital. She said she asked Murray what medications Jackson was on, and Murray said only the anxiety medication lorazepam. Cooper said Murray did not say he had given Jackson propofol.

Dr. Thao Nguyen, a cardiology fellow at UCLA, testified that she was introduced to Murray at the hospital and asked him what had happened.

Murray told Nguyen that Jackson — who had been rehearsing for a series of concerts in London — was very tired but had difficulty sleeping and required some medications to help him rest, she said.

The doctor said she asked Murray what medications Jackson was given, and Murray mentioned only lorazepam.

Doctors worked on Jackson from the time the ambulance arrived at 1:13 p.m. until 2:26 p.m., when the singer was pronounced dead, Nguyen said.

http://bhcourier.com/article/Local_News/Local_News/LA_Police_Detective_To_Continue_Testifying_Against_Michael_Jacksons_Physician/73795

“Emergency room doctor Dr Richelle Cooper testified yesterday that she believed Jackson died in his bedroom. Still, he was taken to Ronald Reagan UCLA Medical Center, where more than an hour of resuscitation efforts didn’t change her opinion.

Cooper said Murray told her he had seen Jackson stop breathing and immediately started CPR, but prosecutors say that’s not what happened. http://www.stuff.co.nz/entertainment/celebrities/4522097/Michael-Jacksons-doctor-got-distracted-on-call

“Dr. Richelle Cooper, who supervised his treatment, testified that Murray said he had “witnessed the patient arrest,” which she took to mean that he had been in the room when Jackson stopped breathing. She said that when she asked him what had happened, he mentioned the singer’s grueling rehearsal schedule.

“Dr. Murray reported the patient had been in his usual state of health, not ill, but had been working very hard, and he thought he may be dehydrated,” she said.

Dr. Thao Nguyen said Murray appeared “devastated” and “asked me not to give up easily and try my best to save the patient.” Both doctors said that when they asked about what medication he had administered to the singer, Murray mentioned the sedative lorazepam but not propofol.

http://www.latimes.com/news/local/la-me-conrad-murray-20110107,0,3717159.story?track=rss

Full account of Day 3 is at TRIAL & TRIBULATIONS siteDr. Conrad Murray Prelim, Day 3, part 1

After lunch hearings Dr. Conrad Murray Prelim, Day 3, part 2

DAY 4.  January 7, 2011

Friday

The way I understand it Day 4 was devoted mostly to the number of propofol bottles found in the closet of MJ’s home. The media reports the fact in a somewhat sinister tone though it is clear even to a layman that if Michael was given a lethal doze of propofol and was administered this medicine as a sleeping aid 6 days a week for two months – according to the prosecution  – the store of propofol in his home should have been substantial.

The other medicine found were usual over-the-counter anti-anxiety and sleeping drugs prescribed by Dr. Murray to wean him off propofol (as he explained it) and lidocaine which is used for injecting propofol to ease the pain of the injection.

The defense made an attempt to hint at the possibility of Michael Jackson to reach for propofol and syringes himself, which the investigator could not rule out as they were two feet away.

However NONE of the media outlets is reporting the crucial fact about propofol – the very first moment propofol starts dripping into blood the patient falls asleep and is therefore unable to go on with injecting this medicine. Therefore using an ordinary syringe for propofol is impossible as constant pressure is to be exerted there while administering the medicine.

The propofol was sent by a pharmacy to Murray via his girlfriend who received the packages of propofol on April 29th, May 1st and May 13th. The Trial & Tribulations site provides the transcript:

DDA shows Exhibit 23, a FedEx receipt dated April 29, 2009, addressed to her apartment on 6th street. Signed for by a P. Maria.

DDA Q: Do you know a P. Maria that resided at that residence?

Alvarez: No. I’m the only one who resided at that residence.

DDA shows a May 1st, 2009 Fed Ex receipt to Alvarez’ apartment, c/o her from the same pharmacy to Dr. Conrad Murray.

Alvarez: That’s correct.

DDA shows witness a FedEx receipt dated May 13th 2009. Alvarez doesn’t recognize the signature on that receipt. DDA notes same shipper applied Pharmacy Services….

http://sprocket-trials.blogspot.com/2011/01/dr-conrad-murray-prelim-day-4-part-i.html

“The role of propofol has loomed large in Michael Jackson’s 2009 sudden death and according to an investigator, copious amounts of the surgical anesthetic were found in the superstar’s home.

During the latest round of testimony at the preliminary manslaughter hearing for Jackson’s physician, Dr. Conrad Murray, on Friday (January 7), an investigator for the Los Angeles County Coroner’s Office testified that a dozen bottles of propofol were discovered in Jackson’s home, according to TMZ. One of the two bottles found in the singer’s bedroom was empty, and investigators also found a slew of at least 10 other types of medication, including lorazepam, hydrocodone and lidocaine.

The mother of one of Murray’s children, Nicole Alvarez, also testified and said the doctor sent several packages to her home from April to June 2009. While the packages’ contents were not revealed in court, TMZ has reported that the parcels contained propofol and were sent from Murray’s Las Vegas pharmacy.

http://www.mtv.com/news/articles/1655551/michael-jacksons-home-contained-dozen-bottles-propofol.jhtml

“Nicole Alvarez, 29, who said she met Murray in 2005 at a Las Vegas strip club where she worked, testified to receiving at least half a dozen packages from Applied Pharmacy Services, the Las Vegas-based business that, according to court records, sold Murray propofol.

She could not say if the packages she received contained the powerful anesthetic because she had not looked.

“Dr. Murray and I were on a need-to-know basis,” she said. “I just know my place and my position in his life, and that was just not my duty to know the details of his business.”

http://news.yahoo.com/s/nm/20110108/people_nm/us_michaeljackson_6

“Prosecutors also called Murray’s current girlfriend, Nicole Alvarez, and asked about shipments the doctor had sent to her apartment by a Las Vegas pharmacy.

Alvarez acknowledged receiving several packages for Murray but said she never looked inside and didn’t know the contents.

Authorities have said in court documents they believe Murray was having shipments of propofol and other medications used by Jackson sent to Alvarez.

It’s unusual to send propofol to a private residence but not illegal.

The phone records show Murray called Alvarez from the ambulance that transported Jackson to a hospital, but prosecutors did not ask her about the call that lasted two minutes.

Prosecutors said a third woman called Murray but did not speak to him.

http://news.yahoo.com/s/ap/20110108/ap_on_en_ot/us_michael_jackson_doctor_122

“An attorney for Michael Jackson’s doctor on Friday hinted that the pop star may have killed himself with the drug propofol, even as prosecutors tried to bolster their claim the singer’s physician committed manslaughter.

On the fourth day of a hearing Coroner’s investigator Elissa Fleak also testified to finding at jackson’s home 12 bottles of the powerful anesthetic — typically used in hospitals but which Jackson used as a sleep aid.

Fleak said she found most it four days after Jackson died on June 25, 2009 of a drug overdose, and that near his bed were an open box of hypodermic needles and one empty bottle of propofol.

Defense attorney J.  Michael Flanagan seized on her testimony to ask if a man Jackson’s size, from his bed, could reach the needles.

“If a person about 136 pounds and 5’9″ was on the bed, they should be able to reach them, right?” Flanagan asked.

Prosecutors quickly objected and a judge agreed the question was speculation. Still, it pointed to a claim made one week ago in court by prosecutors who warned the defense would offer up a theory Jackson killed himself.

http://news.yahoo.com/s/nm/20110108/people_nm/us_michaeljackson_6

Fleak was the first investigator to describe in detail the items authorities recovered from Jackson’s bedroom.

She took the witness stand on the fourth day of a preliminary hearing to determine if there is enough evidence for Dr. Conrad Murray to stand trial for involuntary manslaughter.

Fleak said she found six vials of the painkiller lidocaine, as well as other prescription medications and syringes, including two found next to Jackson’s bed.

During cross-examination by the defense, Fleak was asked whether some of the items would have been within reach from the bed by someone of Jackson’s height and build.

A judge didn’t allow the investigator to answer that question, but Fleak did say several of the items, including a used bottle of propofol and syringe, were within two feet of the bed.

Murray’s attorney J. Michael Flanagan, asked Fleak whether she checked to see how much liquid remained in each of the vials.

“There were so many vials, I don’t remember which ones were more full or less full,” Fleak said.

http://news.yahoo.com/s/ap/20110108/ap_on_en_ot/us_michael_jackson_doctor_122

The “Independent” makes a summary of what the witnesses said in the first three days:

Saturday, 8 January 2011

Conrad Murray

The irony of this, and so many other criminal trials, is that man at the centre of proceedings will most likely be the one figure whose version of events is not heard by either the public or the eventual jury.

Dr Murray sat silently in court while witness after witness emerged to cast doubt on his professional and personal integrity.

It is rare for a defendant to give evidence in a homicide trial because of the risk that they will incriminate themselves. Instead, his lawyers will seek to create “reasonable doubt” in the minds of jurors by pointing out inconsistencies in the prosecution case.

His only public statement so far has therefore been a YouTube video in which he thanks supporters and insists: “I told the truth and have faith the truth will prevail.”

Richard Senneff, Paramedic

The first paramedic to reach the scene, Mr Senneff accused Dr Murray of giving misleading information about his patient, claiming Jackson was “exhausted from rehearsals” and “dehydrated”. Emergency workers were not told that he had recently taken Propofol and several other powerful drugs.

“It just didn’t add up,” Mr Senneff said, adding that based on his dilated pupils, dry eyes and cold skin, Jackson may have been dead for more than 20 minutes by the time the ambulance arrived at 12.25pm. “My gut feeling was ‘this did not just happen, it’s been a period of time’.”

Asked to describe Dr Murray’s demeanour, Mr Senneff said he was highly agitated: “[He was] spinning … moving around, nervous, sweating, multitasking.”

Martin Blount, Paramedic

Mr Blount was in the first group of paramedics to arrive at Jackson’s rented home in Holmby Hills. He told the court he saw Dr Murray take three bottles of painkillers and secrete them in a bag during efforts to revive the patient.

“I saw three small bottles of lidocaine,” Mr Blount testified. “He scooped them off the floor and put them into a black bag.”

This was a surprise, Mr Blount told the court: Dr Murray (who he said was “frantic” and sweating profusely) had previously insisted to paramedics that he had given Jackson no drugs whatsoever.

Like his colleague Mr Senneff, Mr Blount believes Jackson may have been dead for 20 minutes by the time paramedics arrived, based on the fact that the singer’s hands and feet were already turning blue.

In a final effort to revive Jackson, Dr Murray produced a hypodermic needle and wanted to inject the patient with an unspecified substance. But Mr Blount said he and other paramedics refused to let him.

Michael Amir Williams, Personal Assistant

In a surprising move that the prosecution will claim clearly exposes his efforts to mount a cover-up, Dr Murray reportedly made a telephone call to Michael Amir Williams – who was employed as Michael Jackson’s personal assistant – from the Los Angeles hospital where medical staff had just formally declared the superstar to be dead.

He wanted Mr Williams – who was still at the rented mansion in Holmby Hills – to remove still more pharmaceutical products from the scene of Jackson’s fatal cardiac arrest earlier in the day.

“He (Murray) said: ‘Brother Michael, Mr Jackson has some cream in the house that I know he wouldn’t want the world to know about’,” recalled Mr Williams.

“It was an odd question: to ask to go to the house to get the cream.”

Alberto Alvarez, Bodyguard

The most damning prosecution witness so far, Mr Alvarez provided dramatic testimony about both the first aid Dr Murray performed on Jackson and his alleged efforts to remove evidence from the scene.

The bodyguard arrived in the star’s room as Dr Murray attempted the kiss of life. “After the second time [Murray] gave a breath, he came up and said: ‘You know, this is the first time I’ve given mouth-to-mouth, but I have to do it – he’s my friend’.”

Then Jackson’s two eldest children walked in. “Paris [his daughter] screamed: ‘Daddy!’ and started to cry. Dr Murray said: ‘Get them out. Don’t let them see him like this’… I escorted them out.”

Mr Alvarez told how, before calling an ambulance, Murray told him to remove various items, including an intravenous drip bag apparently containing Propofol, from the scene.

Faheem Muhammad, Guard

There were gasps in court on Wednesday when Mr Muhammad, Jackson’s head of security, described Dr Murray’s response to the discovery that his patient had suddenly stopped breathing.

“I remember him [Dr Murray] asking if anyone in the room knew CPR,” he testified. “It was very frantic.” When no one volunteered, the physician decided to perform the procedure himself.

Dr Murray is supposed to be a trained cardiologist. Yet Mr Muhammad said he appeared not know how to properly administer CPR, a basic and fundamental piece of first aid.

Jackson was given the emergency massage on a soft mattress (rather than a hard surface), and Murray incorrectly used just one hand rather than two to pump his client’s chest.

Ed Chernoff, Defence attorney

Mr Chernoff is a canny defence attorney with a long and successful track record in celebrity trials. He will attempt to convince a jury that Jackson actually gave himself the drugs which caused his cardiac arrest.

Dr Murray’s team say the doctor gave his patient a standard 25ml dose of Propofol at around 11am on the day he died. But blood tests indicate that the fatal dose of the drug, administered at around noon, was as much as 10 times as strong. Dr Murray denies administering this.

Mr Chernoff has already missed few opportunities in cross-examination to portray Jackson as a drug addict who overdosed after waking up to find a supply of Propofol at his bedside. He got medical witnesses to agree that his emaciated physique indicated drug dependency.

Kenny Ortega, Film director

Ortega, the director of Jackson’s comeback show This is It, revealed he had decided to cancel a rehearsal on 19 June, six days before the star’s death, because he looked “lost” and weak.

“It was scary. I didn’t know what was wrong, but I knew there was something going on,” he said of the incident, which occurred at the Staples Centrr in Los Angeles.

The following day, Ortega attended an emergency meeting between singer’s management and the concert’s promoters. Dr Murray insisted Jackson was well enough to carry on and scolded Ortega for sending him home. “Dr Murray told me that this was not my responsibility and asked me not to act like a doctor or psychologist,” Ortega told the court.

Richelle Cooper, ER doctor

When Jackson arrived at the emergency ward of the UCLA medical centre in Westwood, he was treated by Dr Cooper and her colleagueThao Nguyen, who both testified on Thursday.

There were “no signs of life”, Dr Cooper recalled, adding that Dr Murray, who had travelled in the ambulance, was not forthcoming about the drugs he had previously administered: he owned up to giving his patient the benzodiazepine Lorazepam, but made no mention of the fatal Propofol, an intravenous anaesthetic.

Dr Nguyen, in her testimony, revealed that the star was painfully thin, weighing just 136 pounds. She confirmed Dr Cooper’s claim that Dr Murray denied giving the star any sedatives or narcotics, aside from the Lorazepam.

David Walgren, Deputy District Attorney

The prosecutor has by and large been happy to let his witnesses speak for themselves. He has, however, provided context to the events they describe by detailing the selection of drugs Dr Murray gave to Jackson in the 12 hours before his death.

They included Propofol, Valium, Lorazepam and Midazolam. Another 13 other drugs were found at the scene of Jackson’s death (and may have been administered in the previous days and weeks) along with oxygen tanks, needles, catheters and a closed bottle of urine.

Mr Walgren told the court that in the five hours before Jackson died, Dr Murray made 11 telephone calls on two mobile phones. Three of those calls were back-to-back, in the 45 minutes directly before he realised Jackson had stopped breathing.

http://www.independent.co.uk/news/world/americas/the-king-of-pops-final-hours-how-his-last-day-unfolded-2179175.html

The full transcript of the court proceedings of Day 4 is provided by TRIALS & TRIBULATIONS- Dr. Conrad Murray Prelim, Day 4,  part 1

Ater lunch proceedings – Dr. Conrad Murray Prelim, Day 4, part 2

And here is a valuable summary of the medications made at this site: http://www.twitlonger.com/show/808jng by someone very helpful and industrious:

This was posted on TMZ’s site in the comments.

“A pharmacy of drugs” such BS! This is how the media likes to spin everything. So this is what was found at the house:

Propofol
Lidocaine
Lorazepam
Diazepam
Temazepam
Trazodone
Flomax
Clonazepam
Tizanidine
Hydrocodone
Benoquin

Propofol and Lidocaine are used together. Lidocaine is not medication it is used in conjunction with Propofol because Propofol burns when it’s being injected. So right there you can cross Lidocaine off the list. They’re trying to make it sound like it was something separate when it wasn’t.

Then there’s Lorazepam. The Lorazepam was prescribed on April 28, 2009 and contained 30 pills. On June 25, 2009-two months later- there will still 9 pills remaining. So Michael took 21 pills of this in a two month time span.

Then there’s Diazepam. It was issued on June 20, 2009 (the same day Michael was told he was going to lose everything if he backed out of the concerts). One thing Diazepam treats is anxiety. What person wouldn’t have anxiety after being treated the way Michael was at the meeting. I think for someone to tell you they are going to take your children away would cause anyone to have anxiety. Anyway… there were 60 pills of Diazepam prescribed on June 20, 2009 and on June 25, 2009 there were 57 remaining. That means he only took three within the span of 5-6 days.

Then there’s Temazepam. This was prescribed in December of 2008 and on June 25, 2009 there were still 3 pills left. This was something he had stopped taking a while ago and Temazepam did not show up in the toxicology report.

Then there’s Trazodone. This was issued to him in April of 2009. It was a prescription for 60 pills and on June 25 there were still 38 pills left. This was also something he stopped taking quite some time ago. Trazodone did not show up in the toxicology report.

Then there’s Flomax. Flomax has nothing to do with any of this. I don’t even know why they mentioned it.

Then there’s Clonazepam. This was issued in April with 30 pills and on June 25 there were still 8 remaining. Once again, something he was no longer taking. This was not found in his toxicology report either.

Then there’s Tizanidine. A prescription for ten pills was issued on June 7, 2009 and on June 25, 2009 there were 8 left. So in the span of more than two weeks, he took two of these pills. Tizanidine was also not found in the toxicology report.

Last but not least there’s Hydrocodone and Benoquin. I have no idea why these are even listed. They are not medication. They are creams and lotions that Michael used for his skin.

So, out of all of that BS what they found in Michael was: Propofol, Lorazepam, Diazepam, and Tizanidine. And guess who gave him ALL of that in the early morning of June 25, 2009… Dr. Murray.

If you were to go inside a random person’s house and look at the medication they have, I guarantee you that you would find close to the same amount of prescriptions as Michael had. It’s clear to see he was not taking this day in and day out. When people have medication that doesn’t work or that they don’t feel is right for them, they usually stop taking it. Which is EXACTLY what Michael did. My cabinet is full of old prescriptions.

I don’t understand why the general public can’t see the TRUTH here and what the media is trying to do!

The Trials & Tribulations site gives details from the autopsy report.

  • Per autopsy toxicology report:

Found in Jackson’s blood: propofol, lorazepam, midazolam, Lidocaine, diazepam and nordiazepam (nordiazepam is metabolized diazepam)
Found in Jackson’s urine: propofol, midazolam, Lidocaine, ephedrine
Found in Jackson’s vitreous humor (eye): propofol
Found in Jackson’s liver: propofol and Lidocaine
Found in Jackson’s stomach contents: Lidocaine and propofol

http://sprocket-trials.blogspot.com/2011/01/michael-jacksons-drugs-cast-of.html

UPDATED by CO-ED on January 10, 2011

Dr Murray Preliminary: Testimony continued with paramedic Richard Senneff testified on Day 3: Thursday, January 6, 2011:

Context:

By 12:27 paramedics were attempting to resuscitate Michael. These treatments would ultimately fail.

Third day testimony picked up with cross-examination of paramedic Richard Senneff by Defence attorney Low:

Under cross-examination by attorney Low, Senneff was asked why UCLA were already advising at 12:57 pm that a decision be made to ” call it ” i.e pronounce a time of death, Senneff testified that:

“When we give our third round of meds we update vital signs for any changes. There was no change in the patient. ”

But Senneff testified that Murray ” didn’t want to make the call.”

After relaying this information to the UCLA staff on the telephone (the connection remained unbroken after the initial 911 call was made), staff at UCLA asked to speak to Dr Murray. A decision was made in those brief moments to take Michael to the UCLA hospital. After Dr. Murray came off the phone with UCLA — obstensibly at least — Seneff said Murray resumed the resuscitation effort on his patient.

Senneff told attorney Low that Murray suggested they “.. insert a central line. ”

Senneff also stated on the stand that he and his team were ” not trained in central line ” and that it was ” out of our scope of training. ”

ER Doc says:

A Central Line is a catheter is placed in a large vessel closer to the heart for faster medication delivery. It is not typically a procedure performed by paramedics although they do place a Jugular, or neck IV, sometimes if they are unable to locate a smaller, peripheral vessel for IV access.

Co-Ed Note:

Further information on Central Lines:

Central lines, also called Central venous lines or central venous catheter’s, are typically used to allow for the feeding of concentrated solutions into a patients system with less complications. A central line saves having to administer frequent small injections or drips placed in the arm. It also allows medics to:

1) Draw blood

2) Give concentrated fluids

3) monitor Central Venous Blood Pressure.

It is a risky procedure, as while inserting the line it is possible to puncture the lung. The catheter may irritate the heart and cause irregular heart beats called arrhythmias. Other complications include:

a) air embolism – pneumothorax

b) bleeding – hemothorax

c) blood clot in the tubing

d) and /or infection

If a central line becomes disconnected air may enter the blood and cause problems with breathing and/or lead to a stroke.

Back to Senneff testimony:

Attorney Low told the court that Dr. Murray’s other idea for treating Michael ” …was to administer magnesium. ”

Senneff reply to this statement by attorney Low was ” Yes. ”

ER Doc says:

Magnesium in Advanced Life Support:

Sometimes a lack of magnesium in the body can affect heart activity.It is low on the list of medications used in the case of Cardiac Arrest, especially outside the hospital. It is typically used for one particular abnormal heart rhythm and as a last resort in an Arrest situation.

Co-Ed Note:

Further information on why Magnesium is used in a medical scenario:

Magnesium is typically used in a medical situation to detect ‘ Ventricular Tachycardia ‘ ( VT), which is a heart rhythm faster than 100 or 120 beats per minute and originates in the ventricles. Essentially it is a very rapid heart beat and a potentially fatal form of arrythmia. The reason why it is potentially fatal is because eventually it may lead to ventricular fibrillation, asystole and sudden death.

This was an unusual suggestion for Dr. Murray to have made here because all the paramedics called to testify agreed that there was no evidence in Michael’s body to indicate a heart rhythm of this kind existing.

Furthermore the paramedics do NOT carry magnesium as part of their arsenal, and Senneff would also subsequently testify that Dr. Murray did not offer them any magnesium ( even if this was actually necessary,) in reality, such a treatment would have had to wait until they had taken [Michael] to UCLA.

Back to Senneff testimony:

Attorney Low continued his cross by asking Senneff, ” Was there at some point [that you heard] Dr Murray say that he found a pulse ”

Senneff replied ” Yes he did. ”

Murray, in fact, claimed that he felt a pulse in Michael in the femoral artery, this is the large artery in the leg close to the groin area. Senneff said that as soon as Murray said that, the first thing he did was look at the EKG monitor.

Attorney Low’s next question to Senneff which was, in actuality, half rhetoric was, ” When you do good CPR, it’s common to get a pulse. ”

To this, Senneff replied: “I believe what I said was, stop compressions, continue ventilations.”

Elaborating, Senneff explained, ” If you stop compressions, then you feel a pulse then obviously it’s not the compressions. Stop for a few seconds. check the monitor. It also gives you a clear opportunity [to read] the EKG machine.”

At this juncture in Senneff’s testimony, mention was made in court of the paramedic’s awareness of the presence of increasing numbers of bystanders and, more worryingly, paparazzi gathering outside Michael’s home. It does not take much imagination to estimate that the thoughts of the paramedics were uneasy about the crowd outside and concerned about how they could get their critical patient to UCLA without hindrance.

When asked by attorney Low whether Dr. Murray made any further suggestions for the treatment of the patient he was at that time assuming responsibility for, Senneff said,

” Dr. Murray asked us to give another round of Ephinephrine. [We] did this through saline line.”

Co-Ed Note:

Ephinephrine, also known as Adrenalin, is an naturally occurring hormone. During the ‘fight or flight’ response in a living being, the adrenal gland releases Ephinephrine into the blood stream along with other hormones like Cortisol, signalling the heart to pump harder, increasing blood pressure, opening airways in the lungs, narrowing blood vessels in the skin and intestine to increase blood flow to major muscle groups, and performing other functions to enable the body to fight or run when facing a perceived threat. Unfortunately, for Michael, this treatment would have been after the fact.

At this point, all present then prepared to take their patient to UCLA the major hospital in Downtown LA. Dr. Murray’s request that Michael’s face be covered with a towel, as the ‘higher medical authority’ present was obeyed and while dodging one persistent paparazzi who attempted to take pictures of the party — as well as fans and passing strangers — the medical team carried Michael to the ambulance outside on a gurney.

It has been reported that the time that they ( the paramedics) did this was at around 1:07 pm. Arriving at UCLA at approximately 1:13 pm, care of Michael was then handed over from Dr . Murray to Doctor’s Cooper and Dr. Winn.

Both of the Doctors asked Dr. Murray what Michael Jackson was being treated with. They were told by Dr Murray that he had given his patient Lorezepam, a Valium, and also flomax. Again, crucially, Dr Murray did not mention anything about the propofol treatment. I will now hand over to the ER Doc to elaborate on Dr. Murray’s deliberate omission:

ER Doc says:

Lifesaving and and Providing the Correct Treatment in an Emergency requires accurate information and an accurate history:

An Emergency Department, particularly a Level I Trauma Center, is an extremely busy, and at times, chaotic environment. Patient presentations can vary from the common cold to major trauma cases; motor vehicle accidents, gun shot wounds, suicide attempts by various means, fire victims, overdoses as well as major medical emergencies. Paramedic ambulances arrive 24/7 with or without advance notification to medical personnel. Law enforcement presence is common; escorting victims of sexual or physical abuse, detainees who have a medical complaint that must be checked before the person is taken to jail.

When a patient presents with a medical complaint, a history of the problem is immediately obtained. In most cases, the patients background and medical history is an important aspect directing proper care. The medical professional, whether an RN, Nurse Practitioner, Physician Assistant or Physician, must have this information in order to best determine what is or could possibly be the cause of the patient’s illness.

Medical history is of utmost importance when the patient is injured, unresponsive or near death. A ‘differential’ is a list of potential diagnosis that a medical provider will begin to consider. If a comatose patient arrives by ambulance or is brought to the ED by an acquaintenance, one might think of a drug overdose, poisoning, stroke, cardiac event and other possible reasons for a patient to be unresponsive. A clear history is essential and will help guide the provider to order pertinent diagnostic tests, blood work, x-rays, etc.

Full Cardiac Arrest or a ‘Code Blue’ means a person has stopped breathing and there is no discernable heart rhythm. If a patient arrives in this dire circumstance, the medical provider will obtain available information and pertinent history from the paramedics and/or friends or family present. Again, this information is used to evaluate and decide what may have happened to the patient and suggests what procedures might be of value to save the patient’s life.

It is very important and life saving at times for people familiar with that patient to be straightforward, clear and truthful about the circumstances of the patients life and recent medical history, including medications taken and/or recent physical complaints or a change in behavior. Moments of stress and high anxiety may inhibit detailed memory; that happens. However, there is no place and certainly no excuse for knowingly concealing information.

Someone’s life may be lost.

Co-Ed Note:

DDA David Walgren said in his opening statement on January 4, that Dr. Cooper pronounced the official time of death as 2:26 pm.

Dr. Murray then left the UCLA hospital, destination unknown. It was later revealed that when the LAPD tried to contact Dr. Murray; they were not able to reach him. Two days later he was interviewed by LAPD with his attorney. It was at that interview that Dr. Murray revealed that Michael had been given a lethal cocktail of benzodiazepines and propofol.

In subsequent redirect (by DDA Walgren) paramedic Senneff’s testimony revealed further anomalies in Dr Murray’s behavior on the morning of June 25.

When Senneff was asked by DDA Walgren why Senneff had cause to doubt that Dr. Murray had actually detected an active pulse in Michael’s femoral artery, Senneff stated,

” When Dr. Murray said he felt a pulse, not one of the other paramedics had felt a pulse. There can be a “false” pulse during CPR compressions. [We] stopped compressions for a few seconds. and then resumed. [We ] did not feel a pulse.”

In obvious reference to attorney Low’s attempts to paint a picture of Dr. Murray as helpful and vigorous during the resuscitation effort, DDA Walgren took Senneff through the treatment steps Low had outlined revealing, in the process, that most of Dr Murray’s suggestions were not backed up by actual action by him or within the capabilites of the paramedics — something Dr. Murray should have known.

For instance, Walgren asked Senneff, ” Did Dr. Murray offer to insert a central line from his equipment?”

Senneff’s reply, “No. ”

Walgren’s next question was, ” Did Dr.Murray offer magnesium from his equipment? ”

Senneff’s reply, ” No.”

Walgren then introduced a line of questioning designed to show there was room to doubt Dr. Murray’s on-site claim to the paramedics that Michael had ” gone down” – i.e become critical, within a short period before the 911 call. Walgren, clearly trying to establish that Michael was either critical or dead long before that call, asked Senneff to recall what his determination of Michael’s physical condition was from his perspective, asked,

” …Your opinion of this patient was based on the surroundings, the IV, the look of the patient, quite thin and pale, the doctor being there. In fact, it was your opinion that the patient was dead. No other indication of other type of illness or drug use, other than your observations and the defendant telling you he gave him Lorazepam?”

Senneff replied, ” No, it was just unusual to see a doctor in a patient’s home, the IV and the oxygen bottle.”

Walgren, at this point, seeking to underline the Prosecution’s core contention that Michael had been dead for a longer period than that implied by Dr. Murray’s version of the timeline of events on the morning in question, then asked Senneff if he thought,

” .. it was inaccurate that the doctor said the patient had just gone down with the call ”

Senneff replied, ” Yes sir. ”

When Senneff was asked by Walgren to estimate a time that he thought [Michael] had ” gone down,”

Senneff replied, ” 20 minutes to an hour. ”

Although approximate, Senneff’s answer postulates a possible time of death period at somewhere between 11:26 am and 12:06 pm.

The next witness to testify was paramedic Martin Blount:

Walgren established in the preamble questioning that the next paramedic to take the stand was an experienced firefighter of 20 years and had been working as a paramedic for 11 years. He was the driver on the emergency call out to 100 North Carolwood on the morning of June 25, 2009.

Blount testified that he had carried the gurney up to [Michael’s] bedroom and that the once in the bedroom he had positioned himself by the head of the patient [Michael] who was at that point lying on the floor. Blount further testified that his observation of the patient’s condition was that,

” It seemed like he [ Michael] had been down for a little while. ”

Blount testified that Dr. Murray stated that the reason for the presence of an IV in the room was because the patient ( by now identifed to the paramedics as being Michael Jackson) had been rehearsing for 16 hours and was being treated for dehydration. Blount also testified that he heard Dr. Murray deny to Senneff that recreational drugs were being used by the patient or that he had given him any drugs.

Blount corroborated parts of Senneff’s earlier testimony when he said that he did not see a heart monitor [Michael’s] bedroom. As already explained by ER Doc above, part of the procedure of advanced cardiac life support (ACLS) is to get air going into a patient by way of an endotracheal tube (ET). It was Blount who inserted the ET. A hand pump device (ambu bag) was then used to facilitate and regulate the movement of air into the patient’s lungs.

Blount said the team noticed that the IV (at that time attempting to run Ephinephrine through a saline line) was not working properly. The team at that point began looking for a new site to insert a new IV.

On feeling Jackson’s skin, ” To me, the temperature of Jackson’s skin was cool.”

Blount also observed that [Michael’s] eyes were, ” blown.” The term ” blown ” means large and unresponsive to light. In Blount’s professional opinion, he thought Michael was dead.

That morning, paramedic Blount was also the one observing the capnometer and the capnography readings. These readings give an immediate picture of the patient’s condition by tracking the carbon dioxide in a patient’s exhaled breath, unlike readings from a pulse oximeter which are delayed. Capnography readings enable paramedics to objectively evaluate and assess a patient’s ventilatory status (and indirectly circulatory and metabolic status) — in particular the End Tidal C02 is a way of gauging the level of carbon dioxide released at the end of expiration.

So, we have ACLS in full progress at this point: with intubation, EKG monitoring, ephinephrine solution though an IV, and CO2 monitoring all being applied to the patient. Blunt testified that it was at this point that Dr. Murray held up a large 24 gauge hypodermic needle with a blue liquid in it and said words to the effect of) — ” we could use this. ” Blount recalled the size of the needle as being larger than normal.

Blount also testified that he noticed three bottles of Lidocaine lying on the bedrrom floor. On the stand, Blount testified that at the time this odd because he had heard Dr Murray tell Richard Senneff that he had not given Michael any drugs. His actual words were,

” He scooped them off the floor and put them into a black bag. ”

There is one further point: Due to Dr. Murray’s incomplete, and in fact, dishonest disclosure of the medications taken by his patient, and his earlier explanation to the paramedics that the patient was simply dehydrated; the paramedics were working on the assumption that the cause of death/ arrest or physical distress was unknown.

Please note: Lidocaine is a local anesthetic and antiarrythmic drug. It’s particular quality is that it allows for rapid onset of action.

In Blunt’s stated opinion there was no viable heart rhythm to be found, despite Dr Murray telling them he had found one in Michael’s femoral artery, directly corroborating Senneff’s earlier testimony.

On cross-examination by attorney Low, Blount revealed that his team had tried at least three times to find a vein in Michael’s hands, arm and wrist.

Low’s next question advances the Defence’s core contention — and one they undoubtedly are hoping will ‘play’ in the minds of the, as yet, unselected jury — that Michael was a long-term addict; thus undermining his right to be defined a victim of what so far presents as a case of incompetent medical care given by Dr Murray.

Low proceeded next to ask Blount if there was ” … any reason why they [the paramedic team] could not find a vein? Is it your experience [that with people as skinny as the Michael Jackson was] that with drug addicts it’s difficult to find a vein? ”

Blount’s response to Low was to example the case of a drug addict he had treated who was still able to accept medication via the vein.

The purpose of Low’s question was to counter the main theme of the paramedics’ testimony: that known and established ACLS treatment failed because the patient [ Michael ] was already dead. By establishing a counter-proposition that the paramedics were unable to find a vein or that any treatment given by them — or for that matter Dr. Murray — was doomed because Michael was an addict, shows one thing:

The Defense strategy is weak. Any legal argument, and in particular defense tactic, that bases itself on a negative portrayal of the victim or plaintiff rather than an affirmative statement of exculpatory facts clearly shows that the defense cannot defend Dr Murray’s actions. That is not to say the prosecution have the advantage, it is merely a statement of known fact in criminal jurisprudence.

Attorney’s Low’s cross of Blount continued with Low pushing the point that, ” even so, at the same time, it can be difficult?”

Blount agreed.

On redirect, Walgren, seeking quickly to re-establish Dr Murray as the causal link between death and Michael Jackson came back hard with this question to Blount; ” If someone has no viable heart rhythm, then blood cannot be circulating through the body. One of the things that happen is the veins collapse and they can be difficult to access. ”

Blount, answering unequivocally, replied ” yes. ”

The next witness called to the stand on Day 3 was Harry Daliwal – an AT &T Area Retail Sales Manager:

DDA Deborah Brazil established in introductory questions that Daliwal had been an AT & T specialist for over 15 years and an expert in the field of analysing data communication by phone and mobile hardware.

Daliwal was shown a collection of bindered documents numbering 72 pages. Exhibit 19. Cell phone records. The cell phone that Dr Murray used was an AT & T iPhone.

Through Daliwal’s analysis of the records, it is apparent that on June 25, in a critical time period period while his patient (according to Dr Murray’s own words ) had only just ” gone down,” that he was as the LA Times wrote  —

“… talking on the phone and texting during the period authorities say he should have been closely monitoring Michael Jackson’s vital sighs.”

From 06:45 am the first of text messages which could definitively be determined as non-automatic were read out in the court. They numbered over 20, and they continued throughout the key period when Dr Murray’s attention would have been required by his patient.

Actual phone activity from and to Dr Murray’s phone on June 25 began at 09:23 am. The LA Times wrote,

“In the approximately five hours before Murray discovered that his famous patient had stopped breathing, he had 11 phone conversations on two different phones. A trio of back-to-back calls lasting 45 minutes led directly to the moment when prosectors say the physician realized Jackson was in cardiac arrest.”

In total, Murray sent or received 5 text messages on his iPhone. His phone conversations on that phone and a spirit cellphone included calls with his practice in Las Vegas, a clinic he runs in Houston, three patients, an employee and another doctor. The records show that in the five hours before Dr Murray discovered that his famous patient had stopped breathing, he had 11 phone conversations on 2 different phones. A trio of calls totalling 45 minutes led directly to the moment when prosecutors say Dr Murray realized Jackson was in cardiac arrest.

If we accept the paramedics experienced testimony that the critical period when Michael arrested could be placed somewhere between 11:26 am 12:06 pm, then it’s alarming that before a 911 call was made 3 calls were made in that period up until the 12:12 pm from Dr Murray to Michael Amir Williams.

There has been speculation that the critical period could possibly stretch beyond the hour speculated by the paramedics.

On cross, Defense attorney Ed Chernoff kept it brief asking if the content of voicemail and text messages could be retrieved. Dawali replied that it could be done.

Please note: Dramatic new evidence consisting of voicemail and text message content retrieved from Dr Murray’s phone was submitted — and accepted by Judge Pastor by the Prosecution on January 10 (Day 5 of the prelims) — suggesting that the Prosecution spent the weekend of January 8 and 9 tracking down that content. This will be instrumental in confirming contested events in the timeline leading to Michael’s death.

The next witness called to the stand on Day 3 was Jeff Strohm, an employee at Sprint Nextel, known as a Custodian of Records.

Strohm’s testimony essentially consisted of more detailed information about the phone records.

The next witness called to the stand on Day 3: Dr Richelle Cooper ~ UCLA Emergency Medicine physician.

This is the Doctor that pronounced Michael’s time of the death at 2:26 pm on June 25. Introductory questions established Cooper’s credentials. Practising as an attending since 2008.

Dr. Cooper testified that that her initial understanding was that Michael arrested on June 25 at 12:18 pm. This time is only estimated.

Dr. Cooper also testified that she met the ambulance when Michael arrived at UCLA. She stated Dr Murray told her he witnessed the arrest.

When she asked Dr Murray for details: Murray told her Michael had been having trouble sleeping and was dehydrated. Murray declared that he gave Michael 2mg of Lorazepam ( Atvian) and then another similar dose.

There was no mention of propofol being adminstered in that conversation between Dr. Murray and Dr. Cooper.

Dr. Cooper said Dr Murray confirmed that Michael was also taking Valium and flomax.

Flomax is typically used to improve urination in men with benign prostatic hyperplasia (enlarged prostrate). Flomax, a drug belonging to the family of drugs called alpha-adrenergic blockers. Flomax relazes the muscles in the prostrate and bladder making it easier to urinate.

Dr Cooper testified that Dr Murray said there had been no seizure activity before Michael arrested and no complaints of chest pains from Michael to him either.

Dr Cooper confirmed there were no signs of life present in the patient when she examined him on June 25. She stated that his pupils were fixed and dilated. Despite this, work continued on Michael at UCLA. Ventilation continued, along with CPR and constant monitoring.

Dr Cooper confirmed that a total of one hour and 26 minutes was spent working on Michael and that not once was a pulse detected.

On cross, Defences Att. Flannagan attempted to get Dr Cooper to confirm that the 25mg of Propofol Dr Murray would admit to (on June 27, 2009 with his lawayer present at an inteview with thE LAPD) having administered, could not be a causal factor in the death of [Michael.]

Dr Cooper’s reply was, ” If you’re not giving continual medication, then the meds clear within 10 to 20 minutes. ” But she added that,

” If there is more than one sedative, there is an additive effect. ”

This point which came towards the end of Dr Cooper’s testimony is crucial as we know Dr Murray administered a variety of benzodiazephines to Michael as well as propofol. An exponential effect of these drugs may have been set off by this and this will be fully explained by the ER Doc at the end of the # Day 3 post.

When DDA Walgren stepped up to redirect he threw doubt on the amount of propofol Dr Murray could have given his patient. He also drew attention to the phenomenon of ‘potentiation’ — the process whereby a cumulative presence of drugs in the system leads to a greater, possibly unforseen effect of medications results from their combined usage.

Dr Cooper confimed that when administering propofol,constant monitoring with appropriate equipment was required — in particular of the airway and the heart.

On cross by the Defense, Dr Cooper was asked whether knowing that Michael had been given propofol would have made any difference to the treatment Michael recieved at UCLA.

Dr Cooper’s response was ” No.”

However, on redirection by the prosecution, Dr Cooper said accurate history ” would have been helpful. It would have given [me a better] interpretation as to what had occurred. ”

The next witness called to the stand on Day 3: Dr Thao Nguyen~ a cardiologist at UCLA.

Dr Nguyen testifed that she as called to the ER by Dr Cooper. She corroborated Dr Cooper’s and the paramedics testimony that on June 25 Dr Murray told anyone who questioned him that he had only given his patient lorazepam otherwise known as Atvian via IV. The amount he said he gave was 4 milligrams. Dr Nguyen said Dr Murray made no mention of any further medication.

Critically, Dr Nguyen said when she asked Dr Murray if he had tried to reverse the effects of the Atvian ( a logical question since that was what Dr Murray told her he gave Michael), Dr Nguyen told the court Dr Murray told her he had not.

Dr.Nguyen also testified that Dr Murray told her he did not know what time the patient had stopped breathing.

This is a crucial piece of testimony: If Dr Murray truly did witness Michael arresting, how would not know when his patient stopped breathing? If Murray was monitoring his patient adequately and saw him in distress, surely he cannot have left his patient at that point? That would amount to clear and undeniable neglect.

Dr Nguyen said Dr Murray told her he did not have a watch, and could not give her information about when he administered the Atvian, when the patient went “down ” or when he stopped breathing.

The question at the crux of this case will therefore be: Why not? Why was a doctor being paid $150,000 a month to monitor and care for a patient unable to answer simple questions about when that patient experienced serious physical distress and died?

On cross by Defense attorney Flannagan, Dr Nguyen was asked how long 4 milligrams of Lorazepam would keep a 136 pound patient sedated?

Dr Nguyen later testifed after briefly explaining about the use of Atvian for anxiety that such an amount would typically induce sleep lasting,

” …about 14 hours ”

The last witness called to the stand on Day 3: Dan Myers ~ a Detective with the LAPD.

Detective Myers testified about the cell phone records of the two cellular phones belonging to Dr Murray. After briefing the court on a number of calls made to and from Dr Murray’s from different sources such as his clinic, three patienst, a doctor at the Acres Home and Cardiology clinic in Texas, his personal assistant took the timeline up to 11:26 am on June 25. The last call made by Dr Murray before he called Michael Amir Williams at 12;12 pm was to a mistress of Dr Murray’s — Sade Adling. Detective Myers also testified that at 1: 08 pm Dr Murray called Nicole Alvarez — the mother of his child.

The testimonies of these women were heard on Day 4.

Co-Ed Summation # Day 3:

Clearly there is much information to come in these hearings, and with Day 5 revealing that the Defense are suggesting to the court that Michael could possibly have overdosed himself by drinking fruit juice laced with propofol, it is clear they are prepared to contemplate anything rather than the more feasible explanation that a mixture of complacent, grossly inadequate, absenteeist medical care by Dr Murray led to the death of Michael Jackson.

The question of whether Michael asked for propofol, or whether he was addicted to prescription drugs are irrelevant to the central truth that Dr Murray repeatedly stated he could not account for how, when, or why Michael began to die. If he cannot do this, he wasn’t watching his patient.

The co-eds at VMJ will now hand over to ER Doc who will discuss the ramifications of the prescription medication we know Michael was taking. Included are helpful links for those who wish to continue their research.

ER Doc says:

Drugs and Drug Combinations: Benzodiazepines: Valium, Ativan, Versed

Benzodiazepines are not narcotics. They are a distinct chemical class of drugs used to treat anxiety, insomnia and seizures, among other conditions. Both narcotics and benzodiazepines may become addictive. Benzodiazepines are also referred to as sedatives, minor tranquilizers and anti-anxiety medications. Ativan and Valium can be taken orally and are longer acting than others; which means they stay in the body longer than other medications in the same class.

Versed is typically delivered via IV when used along with an anesthetic in surgery or for
surgical procedures. Valium and Ativan are widely prescribed in oral form and recent studies have found that they are minor euphoriants (do not produce a high feeling) as opposed to cocaine or quaaludes.

Benzodiazepines are not typically used as recreational or ‘party’ type drugs. Very often, dependency on narcotics such as Vicodin, Codeine, Diluadid and others may be associated with the same dependancy on benzodiazepines. Resuscitative equipment should be available when benzodiazepines are administered by injection, particularly by IV. These agents should not be administered via IV to patients in shock, coma, acute alcohol intoxication, or to patients who have recently received other respiratory depressant drugs. Patients should be warned about the potential impairment of mental alertness or physical coordination.

Recommended dosing:

VALIUM: IV, 2-10mg and repeat in 3 to 4 hours if necessary.

ATIVAN: IV, 2 mg total dose…

must never be used without individualization (for one person) of dosage particularly when used with other medications capable of producing central-nervous-system depression.

Equipment necessary to maintain a patient airway should be immediately available prior to intravenous administration of Ativan.

VERSED IV: 1 mg and not to exceed 2.5 mg.

Intravenous VERSED has been associated with respiratory depression and respiratory arrest, especially when used for sedation in noncritical care settings. In some cases, where this was not recognized promptly and treated effectively, death has resulted. Intravenous VERSED should be used only in hospital or ambulatory care settings, including physicians’ and dental offices, that provide for continuous monitoring of respiratory and cardiac function, ie, pulse oximetry. Immediate availability of resuscitative drugs and age- and size-appropriate equipment for bag/valve/mask ventilation and intubation, and personnel trained in their use and skilled in airway management should be assured.

Drug Potentiation

Note: These drugs ‘potentiate’ each other which means the enhancement of one medication by another giving a greater effect when they are combined than the effect of one medication alone.

REFERENCES:

http://www.myaddiction.com/prescription_drugs3.html
http://www.a1b2c3.com/drugs/benz01.htm description of benzo properties, uses and effects
http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20B)/BENZODIAZEPINES.html
http://psyweb.com/Drughtm/jsp/versed.jsp
http://rx-s.net/weblog/more/diazepam-valium-indications-and-dosage/
http://www.druglib.com/druginfo/ativan/indications_dosage/


8 Comments leave one →
  1. Alison permalink
    January 12, 2011 10:38 pm

    Yay!

    however its going to be very nasty, like you said.

    The CNN report below that says prosecution expert witness said he miscalculated the amount of propofol in Michael’s stomach – how is that possible for an expert to do? i don’t believe it, if it was ME trying to calculate something then thats entirely possible but not someone who’s a) had good enough maths to get into medical school, b) practised as a doctor and c) is an expert witness. no way could he have made a mistake, certainly not one so big and so high profile. he would have double checked it. why is he changing his story?

    and saying he COULD have put it in his juice bottle – didn’t they test the juice bottle as routine? they would have already known if he’d done that before signing the autopsy report surely.

    murray has lied about everything, and would the claimed 25 mg have done anything much at all? from the sounds of Helena’s notes, after 25 mg Michael would have woken up before murray had chance to leave the room?

    Like

  2. SandyK permalink
    January 12, 2011 11:39 am

    Dr. Murray to stand trial!!!

    Source:
    http://www.contactmusic.com/news.nsf/story/dr-conrad-murray-to-face-trial_1194846

    Source AP Video:

    Like

  3. Suzy permalink
    January 12, 2011 6:36 am

    Murray ordered to stand trial: http://edition.cnn.com/2011/CRIME/01/11/california.conrad.murray.hearing/index.html?hpt=T2

    Like

  4. Suzy permalink
    January 11, 2011 8:10 pm

    Good testimony for the prosecution today from the coroner: http://latimesblogs.latimes.com/lanow/2011/01/michael-jackson-hearing-coroner-says-drug-dose-amounted-to-homicide.html

    Michael Jackson hearing: Coroner says drug dose amounted to ‘homicide’
    January 11, 2011 | 11:16 am

    The medical examiner who ruled Michael Jackson’s death a homicide testified Tuesday he would stand by the classification even if it turned out the pop star gave himself the fatal dose of anesthetic.

    Dr. Christopher Rogers made the statement as a lawyer for Jackson’s personal physician questioned him about the possibility the singer administered the anesthetic propofol when Dr. Conrad Murray wasn’t looking.

    “Based on the quality of the medical care, I would still call this a homicide even if the doctor did not administer the propofol to Mr. Jackson,” said Rogers, chief of forensic medication at the Los Angeles County Coroner’s office.

    He said Murray had endangered Jackson by using the drug in a home setting without proper monitoring, regardless of who gave the final dose. The testimony was a blow to the defense.

    Over the course of the six-day hearing to determine whether there is enough evidence to try Murray for involuntary manslaughter, his lawyers have hinted they may argue for acquittal at trial by blaming Jackson for the fatal dose.

    Rogers testified the pop star was in “excellent” health for a middle-aged man and died because of “substandard” medical care. The pathologist said Murray violated treatment norms with his use of propofol.

    The drug, he said, is not indicated for insomnia and requires constant patient monitoring, which Murray did not provide.

    “The information we received indicates that the doctor left Mr. Jackson while he was anesthetized and this is something you would not do,” Roger said.

    Despite testimony from a paramedic that the singer was so underweight as to resemble a hospice patient, Rogers said Jackson was “normal weight” at 5 feet 9 and 136 pounds.

    — Harriet Ryan at Los Angeles County Superior Court

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  5. Dialdancer permalink
    January 11, 2011 12:58 am

    I’ve read the “no watch” excuse. Sounds like a Arvizo kind of lie. Were there no clocks in Michael’s bedroom, did Michael not have a watch on or lying on the nightstand where most take theirs off when going to bed? Is Murray such a nitwit that he could not think on his feet? Most cell phones, iPhones have a clock with a minutes and seconds indicator? Did not know the address so he could immediately call 911, did not know CPR, didn’t own a watch and supposedly falls apart in an emergency. This man is suppose to be a heart specialist one of those who is culled out of the herd for mental agility, judgment and skill. This man should not be allowed a tongue depressor.

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  6. Alison permalink
    January 11, 2011 12:18 am

    and murray says he only gave 25mg of propofol – not enough to do anything much according to the info you just posted so its amazing he thinks anyone could believe him, he obviously hasn’t a clue. i also read somewhere ages ago that one doctor said 25mg wouldn’t be enough to flow out of an IV bag.

    could one of the doctors here explain how his eyes would have been open, if he was sedated asleep surely he would just have not woken up, eyes shut.??

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  7. January 10, 2011 4:23 pm

    “On day 3 of the Preliminary Hearing, Witness No. 11, Dr. Thao Nguyen, testtified: “He (Murray) said he did not have a watch and he did not have the time.” http://sprocket-trials.blogspot.com/2011/01/dr-conrad-murray-prelim-day-3-part-ii.html
    So how was he able to give the exact times of the cocktail of drugs he administered to Michael in the early morning hours of June 25, 2009? Did his misplace his watch along with his ethics and morals?”

    Susan, thank you for this great link. It has been added now to the blog roll as TRIALS & TRIBULATIONS. It is the best and most accurate source of information about the hearings at the moment. I will try to use it for a more thorough analysis of the situation.

    The fact that he didn’t have a watch also struck me but I regarded it as a result of his frantic efforts to save the situation. He could have taken it off to make CPR, for example. In general propofol cannot be given without watching time – it is simply impossible! One of the articles I am reading now says:

    Induction of General Anesthesia:

    Healthy Adults Less Than 55 Years of Age:
    40 mg every 10 seconds until induction onset (2 to 2.5 mg/kg).

    Elderly, Debilitated, or ASA-PS III or IV Patients:
    20 mg every 10 seconds until induction onset (1 to 1.5 mg/kg).

    Maintenance of General Anesthesia:
    Infusion
    Healthy Adults Less Than 55 Years of Age:
    100 to 200 mcg/kg/min (6 to 12 mg/kg/h).

    Elderly, Debilitated, ASA-PS III or IV Patients:
    50 to 100 mcg/kg/min (3 to 6 mg/kg/h).

    For maintenance of sedation, a variable rate infusion method is preferable over an intermittent bolus dose method. With the variable rate infusion method, patients will generally require maintenance rates of 25 to 75 mcg/kg/min (1.5 to 4.5 mg/kg/h) during the first 10 to 15 minutes of sedation maintenance. Infusion rates should subsequently be decreased over time to 25 to 50 mcg/kg/min and adjusted to clinical responses.”

    It is still necessary to calculate the amount of propofol required for Michael’s weight BUT what is already clear is that once the initial doze was given it should have been closely maintained to keep the patient sleeping and then gradually decreased not to produce a kind of a shock.

    Watching the patient was a must!

    Whatever happened there Murray’s negligence in “providing care” for MJ is simply unheard of. This alone is crime enough to put his behind bars.

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  8. Susan permalink
    January 10, 2011 2:44 pm

    Hi everyone;

    On day 3 of the Preliminary Hearing, Witness No. 11, Dr. Thao Nguyen, testtified: “He (Murray) said he did not have a watch and he did not have the time.”

    http://sprocket-trials.blogspot.com/2011/01/dr-conrad-murray-prelim-day-3-part-ii.html

    So how was he able to give the exact times of the cocktail of drugs he administered to Michael in the early morning hours of June 25, 2009? Did his misplace his watch along with his ethics and morals?

    Like

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