Someone to Monitor Me

Less than a week after Michael Jackson died, after allegedly suffering “cardiac arrest,” CNN’s Drew Griffin interviewed Nurse Practitioner Cherilyn Lee.  The world was still reeling and Michael’s family and investigators in LA were still sleeping when, at 7:15 a.m., the public first heard the word Propofol.  Nurse Lee identified Propofol and speculated it may have caused Michael’s death.

Michael met Nurse Lee and had her recommend vitamins and nutritional supplements.  She was familiar with his insomnia and had once assessed his bedroom for levels of stimuli and sleep patterns.  But in April 2009, Michael asked her to help him find an anesthesiologist to monitor him.  He then told her about Propofol, which he claimed was the only thing that ever worked to provide instantaneous sleep.  He described the drug as being administered intravenously and said that he would fall asleep as soon as he received the first drop.  When she asked him who administered the drug, he said that a doctor gave it to him “a long time ago.”  After consulting with her Physician’s Desk Reference – a comprehensive volume that provides a detailed description of drugs, their side effects, and contraindications – she warned Michael that the drug was dangerous and that she feared if he took it he would not wake up.  Michael’s response, after she voiced her concerns, demonstrates why Dr. Conrad Murray’s conduct in monitoring his patient was reckless and, at the least, constitutes manslaughter.

Michael told Lee, “I need to have somebody here to just monitor me.  If somebody stay (sic) here and monitor me with this IV then I would be okay.  I would be okay because they’re gonna be here twenty-four hours or twelve hours to monitor me so I could sleep eight hours.”  Drew Griffin aptly predicted, “Half the people watching this are not going to believe you.  They are going to think this woman is just seeking fame.”  When asked why she was speaking out now, she responded, “I’m coming forward because the more I watch the news and the more they kept saying drugs and I’m thinking, ‘This is not drugs.’  It wasn’t the drugs they’re saying; the Demerol, it wasn’t that.  He kept saying he wanted to have somebody there that could watch him and medically supervise him.  That’s what [Michael] said.”

Nurse Lee’s reiteration of Michael’s words show (1) he had not taken Propofol in many years and (2) he understood that when given the drug, he needed to be monitored.  With that as a background, Murray’s defense that Michael was a drug addict who, in the absence of his physician, self-administered the fatal dose, is quite thin.

On June 27, 2009, robbery-homicide police officers Orlando Martinez and Scott Smith interviewed Dr. Conrad Murray in the presence of his attorneys, Michael Peña and Ed Chernoff.  Since Dr. Murray failed to keep any records of his treatment of Mr. Jackson, unless he testifies at trial, his statement to these police officers may be the only evidence giving insight into that treatment.

According to the recorded conversation, Murray first met Mr. Jackson in 2006 through a patient’s son.  He was referred not as a cardiologist, but merely because Jackson needed a physician.  Murray subsequently treated Jackson’s children for flu while they lived in Las Vegas.  Dr. Murray told Martinez that he received a phone call from Michael’s personal assistant, Michael Amir Williams, requesting that he treat Mr. Jackson for the upcoming concerts in London.  Mr. Jackson then personally called Murray and asked that he join the tour.  Murray was elated.

Dr. Murray said that for a little over two months before June 2009, he had been treating Mr. Jackson, assisting him to sleep by administering Propofol every night.  Murray would first give an injection to get Mr. Jackson to sleep and, with an IV drip of 50 milligrams of Propofol, keep him under.  According to Murray, fifty milligrams per night was the maximum dosage Murray administered.

At various points throughout the interview, Dr. Murray told Martinez that Mr. Jackson had developed a dependency on Propofol.  As a result, Murray decided to try to wean him off, and introduce other agents.  Beginning three days before Mr. Jackson died, Murray administered Lorazepam and Midazolam instead of Propofol.

A common side effect of Midazolam is a change in respiration.  On autopsy, doctors discovered that Michael Jackson had an undiagnosed reduced lung capacity.  Before changing Michael’s medical regimen, Dr. Murray should have, at the very least, conducted a physical to determine if the medications he was first prescribing were appropriate for his patient.

On June 25th, Murray arrived at the Carolwood residence around 12:50 a.m. and went to Mr. Jackson’s bedroom.  Mr. Jackson arrived around 1:00 a.m.  They had a brief discussion as to how rehearsals went that night.  Mr. Jackson then took a shower.

Dr. Murray then began using an IV for hydration.  He administered Valium orally.  Using a syringe through the IV port, at 2:00 am he administered two milligrams of Lorazepam, diluted with saline, over the course of two to three minutes.

Mr. Jackson remained awake for another hour, so at 3:00 a.m., Dr. Murray introduced two mgs. of Diazepam in the same manner he administered the Midazolam.

Around 3:20 a.m., Mr. Jackson fell asleep for – according to Murray’s watch – 10 to 12 minutes.  Dr. Murray turned down the lights, turned on the music, and suggested that Mr. Jackson meditate.  Mr. Jackson said he would have to cancel his rehearsal because he could not sleep.  Dr. Murray then administered Midazolam; it did not work.

At 5:00 a.m. Murray administered two milligrams of Lorazepam.  Still unable to sleep, Mr. Jackson again complained that he would have to cancel rehearsal. Mr. Jackson confided that he was under a great deal of pressure about cancellations.  Dr. Murray administered two milligrams of diazepam at 7:30 a.m., but Mr. Jackson remained awake.

Still awake at 10:00 a.m., Mr. Jackson began asking for “milk,” allegedly his name for Propofol.  Doctors have nicknamed the drug, “Milk of Amnesia.”  According to Dr. Murray, he relented and administered Propofol at 10:40 or 10:50 a.m.  Murray gave half the normal dose, saying he administered only 25 milligrams over 25 minutes.  It was simply an injection to put Mr. Jackson to sleep, and then a slow drip to keep him asleep.  According to Murray, he was looking at his watch and Mr. Jackson fell asleep around 11:00 am.  Murray said that he monitored Mr. Jackson for a while, until he felt comfortable with Mr. Jackson’s condition; he then left the patient.

According to Murray, he went to relieve himself in the restroom in Mr. Jackson’s bedroom.  Dr. Murray said he was gone approximately two minutes.  After Dr. Murray returned from his two-minute absence, he was stunned to see that Mr. Jackson was not breathing.

Once he noticed that Mr. Jackson was not breathing, Murray started chest compressions and performed mouth-to-mouth resuscitation.  Mr. Jackson was still on the bed.  The 6-foot 5-inch, 220-pound Murray was unable to move Jackson – who, according to the autopsy report, weighed 136 pounds – to the floor by himself.  Murray described that he had one hand under Mr. Jackson’s back – supporting his back – and the other hand on top of his chest.  At this point in time, Dr. Murray explained that he did not call 911 because he was caring for his patient and did not want to interrupt it.  Had he made that call, the 911 operator would have asked what this was all about; responding to the operator’s questions would have interfered with Murray’s care.

The irony about Murray’s concern with the 911 operator’s interference is self-evident when one considers that Murray’s timeline has been totally undermined by his phone records.

On June 25, 2009, Dr. Murray had two cellular phones – one with AT&T service and the other with Sprint/Nextel service.  Therefore, prosecutors had two phone company witnesses detail Murray’s extensive telephone use while Mr. Jackson lay dying.

Harry Dhaliwal, an AT&T employee, discussed Murray’s cell phone activity on June 25th, 2009.  Beginning at 12:04 am and continuing every hour, on the hour until 6:04 am, Murray received data.  In addition, at 6:25 a.m., 9:00 a.m., 9:11 a.m., 10:26 a.m., 12:03 p.m., 12:04 p.m., 12:53 p.m. and 1:23 p.m., Murray received or sent a text message.  He received data at 7:03 a.m., 7:20 a.m., 8:14 a.m., 8:35 a.m., 8:54 a.m., 10:04 a.m., 10:15 a.m., 10:24 a.m., 12:13 p.m., 12:18 p.m. and 2:19 p.m.

In addition, he had several phone calls on June 25th, 2009:

• 9:23 a.m. incoming call lasts 22 minutes (Bioni)
• ·10:29 a.m. incoming call lasts 22 minutes[1]
• ·11:07 a.m. incoming call lasts 1 minute (Ruggles)
• ·11:18 a.m. incoming call lasts 32 minutes (Global Cardiovascular)[2]
• ·11:26 a.m. incoming call lasts 24 minutes (Russell)
• ·11:49 a.m. outgoing call lasts 3 minutes
• ·11:51 a.m. outgoing call lasts 11 minutes (Anding)
• ·12:12 p.m. outgoing call lasts 1 minute
• ·12:15 p.m. outgoing call lasts 1 minute

Jeff Strohm is a custodian of records for Sprint/Nextel.  He detailed the phone calls Murray made from that phone:

• ·7:01 a.m. outgoing call lasts 25 seconds (Butler)
• ·8:49 a.m. incoming call lasts 53 seconds (Guild)
• ·10:22 a.m. incoming call lasts 111 seconds (Dr. Prechad)
• ·10:34 a.m. outgoing call lasts 8 ½ minutes (Ruggles)
• ·11:26 a.m. incoming call lasts seven seconds (Morgan)
• ·1:08 p.m. outgoing call lasts 2 minutes (Alvarez)

Further undermining Dr. Murray’s timeline was testimony by Stephen Marx, a computer forensic examiner.  He conducted an examination of Dr. Murray’s iPhone, which was recovered on July 28, 2009, to track when Dr. Murray reviewed incoming or created outgoing data.

Mr. Marx recovered a 5:54 a.m. incoming e-mail, with the greeting of “Hi Conrad,” with signature, Bob Taylor, of Bob Taylor’s Insurance of London.  The e-mail specifically inquired about Mr. Jackson’s health.  Mr. Taylor also needed to confirm that Dr. Murray was the only physician consulted during that period, and that his records dated back to 2006 when he first met Mr. Jackson.  Conrad Murray responded to Mr. Taylor’s e-mail at 11:17 a.m.  In a lengthy e-mail, Dr. Murray denied Taylor access to Michael’s medical records.  Murray wrote, however, that press reports about Michael’s health were false to say the least.

The most fateful call was one made to Sade Anding.  Anding was a cocktail waitress that Murray met in Texas.  He had begun referring to her as his girlfriend.  Murray called her at 11:51 a.m. and began telling her how things were going.  According to Anding, “Then I cut him off and I started talking.  I said, ‘Well, let me tell you about my day.’”  At some point, she realized, “He wasn’t on the phone no more.” “There was commotion – I heard noise as though the phone was in his pocket.  I heard coughing and mumbling.  It went on about five minutes.” She said, “hello, hello, hello.  Are you there?  Are you there?”  She received no response.  “I called and called and texted him and never heard back.”  She did not believe the mumbling she heard came from Murray.

In a February 3, 2011, interview, responding to how she felt when she heard that Mr. Jackson had died, Ms. Anding said, “It made me sad.  I felt like it was my fault.  But I really felt like, if [Murray] wouldn’t have called me, then maybe all that stuff that happened wouldn’t have happened.”

The most astonishing aspect of Anding’s testimony is that she heard mumbling that did not come from Murray.  This suggests that Mr. Jackson may indeed have been alive at 11:56 a.m., yet Murray did not request that anyone summon help from medical professionals until 12:21 p.m., twenty-five minutes later.  Once called, paramedics were on scene within four minutes.  Considering responding paramedic Richard Senneff’s testimony that his team had successfully revived patients who had been “down” for fifteen minutes, Murray’s delay was lethal.

The testimony of Strohm and Dhaliwal is relevant for several reasons, the most important of which was the fact that Murray was taking phone calls, communicating with his office, his girlfriends and former patients when he was being paid to watch Michael Jackson sleep.  In the period between 1:30 a.m., when he began treatment, and approximately 12:00 p.m., when he discovered his patient was not breathing, Murray spent three hours on phone calls, with the heaviest call activity beginning at 10:29 a.m.  Considering Senneff’s testimony that Mr. Jackson may have been dead for up to one hour before his 12:26 p.m. arrival, Murray’s phone records, which show three overlapping phone calls at 11:26 a.m., demonstrate unequivocally that Murray was not paying attention to his patient in the last moments of his life.  The records are relevant for one other outstanding reason; none of Murray’s numerous calls was to 911.

Mr. Jackson was pronounced at 2:26 p.m. at UCLA medical center.  According to the autopsy report, Mr. Jackson suffered “respiratory arrest” while under his physician’s care.

Conrad Murray has been charged with involuntary manslaughter, which, under California Penal Code 192(b) is defined as an unlawful killing that takes place:

1. during the commission of an unlawful act (not amounting to a felony), or
2. during the commission of a lawful act which involves a high risk of death or great bodily harm that is committed without due caution or circumspection.

In response to the charges, his attorneys will be mounting a defense that (1) Michael Jackson was a drug addict and (2) that while Conrad Murray was out of the room, Michael Jackson self-administered Propofol, resulting in an overdose.

Many will recall Ed Chernoff’s initial diatribe that Murray did not know what other drugs Michael was taking.  Problematic with the addict theory is that, according to the toxicology report, Propofol, Lidocaine, Lorazepam, Midazolam, Nordiazepam and Diazepam – all drugs prescribed and administered by Murray – were found in Jackson’s blood samples.  No other drugs were found.  Therefore, the first defense is a dead end.

Murray’s attorneys must have mounted the second defense – that of Jackson self administering Propofol – once the phone records demonstrated that Murray did not leave his patient alone for two minutes as he told police investigators.  But, as the records show, Murray spent up to two hours on the phone before discovering Michael in distress.

According to Murray, Michael Jackson told him that while treating with other physicians, he had “pushed” the IV line into his veins.  Even if he had inserted the IV line on previous occasions, that does not change the fact that a physician always monitored him.  Indeed, for Murray to be acquitted, his attorneys would have to convince a jury that a man who understood how Propofol worked, who had stated on other occasions that he knew he needed to be monitored while using the drug, would have self-administered the medication while the doctor he was paying $150,000 per month to watch him was chatting with girlfriends, business associates and other patients.

To advance such a defense, Dr. Murray would have to take the stand.  If he takes the stand, he will have to explain (1) why he didn’t keep medical records, (2) why he didn’t perform a physical examination before administering new medication to his patient, (3) why he did not understand the dangers in combining benzodiazepines with Propofol, and (4) why he delayed in calling for help.  Then, Murray will have to find other doctors willing to admit that Michael Jackson self-administered Propofol in their presence.  This, of course, is a double-edged sword for the defense; even if they can elicit testimony about self-administration, the defense team is highly unlikely to find a doctor who will say that he, too, left the patient unmonitored while under sedation.

Should he take the stand, Murray’s conduct in hiding, destroying and concealing evidence may prove to be the most damning evidence against him.

About 12:17 p.m. on June 25^th, security guard Alberto Alvarez received a phone call from Michael Amir Williams during which he was told to go to the house.  Alvarez noticed Dr. Murray standing at the top of the stairs, but leaning over the railing.  Alvarez raced upstairs and saw Murray walking towards Michael Jackson’s room.

When he first walked into the bedroom, Mr. Jackson was flat on his back with his hands to the side and his eyes and his mouth were wide open.  Alvarez then asked Dr. Murray what happened.  Dr. Murray said, “He had a reaction!  He had a reaction!” Alvarez was frozen.  He surveyed the scene and noticed that Murray had grabbed a handful of bottles from a nightstand.  Murray then instructed Alvarez to put them into a bag.  After the bottles and vials had been cleared from the room, Murray instructed Alvarez to remove the IV bag.  At the bottom of the IV bag was a milk-like substance.  Alvarez does not know what happened to the IV bag.  Once everything was cleared away, Murray told Alvarez to call 911.  Obviously, Dr. Murray’s actions delayed emergency treatment by paramedics.

Paramedic, Richard Senneff described a similar scene.  After administering emergency care at the home, on Murray’s orders, Mr. Jackson was to be transferred to the hospital. Mr. Jackson was placed on a gurney and all of the attached equipment was taken to the ambulance.  Senneff returned to the bedroom to make sure that he had all of his equipment.  While there, he observed Murray standing on the far side of the bed and, using a white plastic trashbag, picking things up.  Senneff was not looking hard enough to see what Murray picked up.

Given Murray’s elusive conduct, is it too far a stretch to suggest that he could have used Michael’s postmortem hand to place fingerprints on syringes and medicine bottles found at the scene?  In either case, Murray will have to explain what he did from approximately 11:56 a.m. – when Sade Anding heard mumbling and coughing – and 12:17 p.m. when Alberto Alvarez arrived.

Regardless of which aspect of Dr. Murray’s treatment is examined, it all falls short and is the very epitome of a lawful act committed without due caution or circumspection.

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[1] This telephone call occurred during the time Murray claims he was administering Propofol to Mr. Jackson.

[2] It is unclear how this call lasted as long as the records reflect when other calls overlapped.