Steven Shafer, a prominent Columbia University anesthesiologist and scientific researcher, is the 33rd and probably the last state witness in the trial of cardiologist Conrad Murray. Murray has pleaded not guilty to a charge of involuntary manslaughter, the least serious form of homicide in California. If convicted, he could face a sentence of up to four years in prison. Murray's defense contends that it was Jackson who self-administered the surgical anesthetic propofol and the sedative lorazepam in his bedroom in June 2009 while Murray was away from the bedside.
Shafer cited research studies to support his opinion that Jackson would have suffered no effects from swallowing propofol, which, he said, works on the brain to cause sedation only if given intravenously. It's a point the defense conceded last week at a hearing with the jury not in the courtroom.
Shafer moved on to dismiss defense scenarios contending that Jackson swallowed eight tablets of lorazepam, which according to the defense combined with self-given propofol to create a "perfect storm" that killed the entertainer. Shafer said a defense-commissioned analysis of Jackson's stomach contents gave a falsely high figure for lorazepam. Most of what the lab found actually was a metabolite of lorazepam — a breakdown drug the liver creates to enable the kidneys to remove lorazepam in urine. The amount of the actual drug lorazepam was "rather trivial," he said, only one-43rd of a lorazepam tablet. And rather than being swallowed, Shafer said, that sedative was intravenously infused liquid that "sloshed" into Jackson's stomach from the liver.
Murray told police detectives in an interview two days after Jackson died that he had administered two small, 2-milligram doses of lorazepam to help Jackson sleep, one dose at 2 a.m. on June 25, 2009, and the second three hours later. Shafer calculated that to produce the blood level of lorazepam found in the coroner's autopsy of Jackson, Murray must have given 10 intravenous doses of 4 milligrams each — 10 times the amount the defendant described to police. The total of 40 milligrams is the amount contained in one vial of lorazepam, Shafer said.
Shafer devoted lengthy testimony to taking the jury of seven men and five women through his mathematical models simulating various scenarios of propofol use. The coroner's toxicology analysis of blood in Jackson's veins recovered in the autopsy revealed 2.6 milligrams of propofol per milliliter of blood. Jackson could not have reached that level, Shafer said, by receiving the single 25-milligram intravenous dose of propofol that Murray told police he had delivered. Not even a 50-milligram dose, or even a whole 100-milligram syringe of propofol, would have produced the amount found after Jackson's death, the witness calculated.
Shafer went on to reject possibilities that Jackson gave himself multiple syringe injections of propofol, repeatedly falling asleep and waking up to reinject himself over periods that would have to extend from 90 minutes to three hours. Even six self-injections of 100 milligrams each, an entire syringe full, over three hours, by the end of that process still would not produce 2.6 milligrams of propofol per milliliter in Jackson's blood, the anesthesiologist said.
In any case, Shafer said, "it's a crazy scenario. People just don't wake up from anesthesia like that — wake up, hell-bent on grabbing a syringe and sticking it in again."
Shafer will face cross-examination by a defense attorney before leaving the witness stand. The defense could begin calling its own witnesses Friday.
Earlier, Shafer, a Columbia University anesthesiologist told the jury that Murray's treatment of Jackson for insomnia with a "polypharmacy" of multiple drugs was "a pharmacological Never-Never Land" that had never been tried on any patient and was potentially fatal.
Under questioning by Deputy District Attorney David Walgren, Shafer, at times in angry tones, said Murray had committed 17 separate "egregious violations" of medical standards. Four of those mistakes were "egregious, unethical and unconscionable," he said. But all 17 were direct causes of Jackson's death, he said.
The worst offenses, in Shafer's view, were a failure to keep medical records on Jackson, failure to get Jackson's informed consent in writing for the sedation methods, failure to document Jackson's vital signs during sedation and giving emergency responders incomplete and misleading information on drugs he'd given and on Jackson's collapse.
Shafer said he doubted Murray's statement to police detectives two days after Jackson died that he had left Jackson's bedside for only two minutes to use the bathroom, returning to find him not breathing. More likely, Shafer said, was that Murray was distracted by 45 minutes of phoning, texting and e-mailing. From a distance, it would have been hard to tell that Jackson was not breathing and Murray wouldn't have realized it for "a considerable period of time," Shafer said. "I actually believe that is what happened," he said.
Shafer said that in his opinion, Murray also had understated to police detectives the amounts of propofol and the sedative lorazepam he administered. Though Murray told the officers that for about 80 nights he had given Jackson 50 milligrams of propofol, ending with a smaller, 25-milligram dose on the day of the death, Shafer said the evidence indicated nightly 100-milligram doses.
Shafer said he'd found it "curious" that Murray told police he had given flumazenil to reverse the effects of lorazepam after he found Jackson not breathing. Murray said he'd given only two, 2-milligram doses of lorazepam hours earlier, an amount that would have worn off by the time the singer was stricken, Shafer said. So Shafer said he believes Murray "knew he had given a lot of lorazepam."
If Murray, lacking resuscitation equipment, had called 911 at once instead of delaying a call for about 20 minutes, Jackson would have survived but with some brain damage caused by about 8 minutes of loss of oxygen, Shafer said.
If Murray had used resuscitation equipment on the scene, "Mr. Jackson would be alive and uninjured," Shafer said.
Propofol is unsuitable for insomnia and no amount of it was safe to give Jackson in the home setting, especially considering its "unpredictable" interaction with the sedatives, Shafer said. Perhaps Jackson had grown dependent on propofol or was on withdrawal from large earlier doses, but it's impossible to know, Shafer said.
"We are in pharmacological Never-Never Land here — something that has only been done to Michael Jackson and to no one else in history, to my knowledge," Shafer said. "So any dose of propofol is potentially a dangerous dose."
Shafer said Murray had abandoned his medical judgment, acting like an employee of Jackson rather than a doctor. Above all, Shafer said, Murray violated the "hallowed relationship" between patient and doctor dating back to ancient Egypt. The fundamental tenet of that relationship is that "the patient comes first," Shafer said.
Murray should have told Jackson to find another doctor rather than accede to his "silly or reckless" demands for propofol, Shafer said.
"When Dr. Murray agreed to treat insomnia with propofol, he put Dr. Murray first, not Michael Jackson," Shafer said.
Source: usatoday