Jacksons vs AEG - Day 51 – July 18 2013 – Summary

(source : ABC7)

Dr. Emery Brown Video Deposition Testimony

Dr. Brown is an anesthesiologist and practices in Boston, Massachusetts.He detailed his extensive background in the medical field. Dr. Brown is a practicing anesthesiologist, works at MIT in Massachusetts. Among many of his current jobs, Dr. Brown is an Associate Director at Institute for Medical Engineering Science at MIT. He's also on the faculty of Sleep Medicine Dept at Harvard, did his medical thesis under Dr. Czeisler, who testified earlier in the case. Dr. Brown is board certified in anesthesia. He belongs to several professional societies and publications in the field. The first 20 minutes of Dr. Brown's testimony was detailing his qualifications. He has written around 140 or so articles for professional journals on medical matters.

Dr. Brown billed $1,000/hour and asked to donate the funds to Mass General Hospital. The total: $75,000 donated to Mass General Hospital. Dr. Brown has given depositions before, but has not testified in court. 

Anesthesia can be different, Dr. Brown said: general anesthesia/sedation and regional anesthesia. In MJ's case, it's a general anesthesia/sedation case. Dr. Brown: General anesthesia consists of 4 behavior and physiology status: unconscious, analgesia (no pain), not moving, amnesia. Dr. Brown said the heart rate, blood pressure, breathing and temperature are under control in order to go into surgery. "General anesthesia is a type of coma, it's a reversible coma," Dr. Brown said. Dr. Brown said coma is a state where patient is unable to receive and respond to stimulus. He said you give drugs to induce coma, more to maintain it during the surgery, then reduce to have patient come back. Dr. Brown said there's tendency to call general anesthesia sleep, but it's not sleep, you wouldn't be able to tolerate surgery under sleep.

Propofol is one of the anesthetics Dr. Brown uses. He reviewed MJ's autopsy and the drug was found in his system. Dr. Brown uses Propofol in almost all the patients he has. It's the most commonly used anesthetic all around the world. 

Dr. Brown explained:
Induce anesthesia - put person in coma
Maintain anesthesia - as infusion maintains it
Sedative - manage level of pain

Dr. Brown said Propofol is quite potent on a cc to cc comparison with Valium and benzodiazepines. 

He has been studying Propofol for the past 7 years. Dr. Brown doesn't think there's any other person who has studied the drug more than him. Dr. Brown said he published a paper regarding guidelines of use of Propofol.

MJ autopsy indicates the amount of medication (Propofol) is similar to what is found in general anesthesia.
Michael Koskoff: Do you agree with that statement?
Dr. Brown: In terms of levels that were there, I do.
Dr. Brown: The infusion rates found in MJ's autopsy are the same infusion rates when given Propofol for major abdominal procedure.

Dr. Brown is not board certified in sleep medicine. He said Dr. Czeisler is world renowned in sleep medicine and circadian rhythm.Dr. Brown studied the effects of Propofol in relation with sleep. One of the articles is "General Anesthesia, Sleep and Coma." No one had taken the time to put general anesthesia next to sleep next to coma to compare the relationship of the states, Dr Brown explained

Koskoff: Is the state of the brain under Propofol sleep?
Dr. Brown: It is not sleep

Dr. Brown said it's easy for doctors to tell patients they are going under sleep, but his article was exactly to clear up the language. 
Koskoff: How about doctors using Propofol as an agent to produce sleep?
Dr. Brown: They would be tremendously mistaken

REM: eyes are moving, brain somewhat in a wake state, body somewhat paralyzed, heart beat irregular
Non-REM -- heart rate slower, breathing a little more regular
Sleep is two states: rem and non-rem
When you sleep, you go into non-REM stage 1, then stage 2 non-REM sleep, stages 3 (slow waves) and 4 sleep non-REM sleep and REM sleep.

Dr Brown: During sleep you have natural oscillation of states. On general anesthesia we bring you to a stage and hold you there for surgery. Dr. Brown said there's no way in the world that you can have the normal sleep patterns while under sedation. 

Dr. Brown explained medical coma: you give enough drugs to go down to a state, hold you there to give a chance for the brain to heal.Dr. Brown: Once you are done, you bring them out of induced coma. Dr. Brown said sedation, general anesthesia, medical coma is not sleep. There's no REM or non-REM sleep under sedation or general anesthesia, Dr. Brown explained. Patients don't go under regular sleep patterns. Dr. Brown drew a picture how the sleep circuit works. To be conscious, you have to be awake and have to be able to process, Dr. Brown said. 

In order to fall asleep, Dr. Brown said you need to shut the brain down. Dr. Brown: To REM sleep, all the circuits shut down. The control center tells the entire system to shut down; cycle takes roughly 7-8 hours. 

Propofol will not produce sleep, Dr. Brown said. Dr. Brown: When you give Propofol, it comes in, knocks out all of the circuits, including respiratory circuit, and the cortex. "It overwhelms the sleep and respiratory circuit, cortex," Dr Brown explained. He said it's not possible to go between REM and non-REM sleep. 

"The first criteria of being under sedation is to be unconscious that you can't be awaken," Dr. Brown said. Dr. Brown: You achieve unresponsiveness with Propofol. Dr. Brown: With Propofol you get unconsciousness, you get amnesia, you can't remember. For pain, you need an analgesic. Dr Brown explained for light procedures Propofol is sufficient to produce mild muscle relaxation. For surgery they add muscle relaxant too. "Propofol produces the unconsciousness state of general anesthesia," Dr. Brown said. "To be clear, Propofol can produce a small part of it (analgesia), makes you unaware," Dr. Brown explained. For colonoscopy, for example, the procedure is not that painful but uncomfortable, Dr. Brown said. The mild sedation makes patient unconscious, unaware, you can be unaware to pain, provides some component of analgesia, Dr. Brown said. "For surgery, need to add drug for pain," Dr. Brown explained. 

Dr. Brown said patients commonly report feeling good, feeling refreshed after being administered Propofol. Propofol causes release of dopamine, Dr. Brown said. Dopamine is kind of like endorphin we hear, it gives you this good feeling.Brown: Propofol releases dopamine that can be interpreted as refreshed sensation of natural sleep. But Propofol cannot produce natural sleep. 

In cross examination, Kathryn Cahan asked about the difference between euphoria and good feeling after using Propofol. Dr. Brown said he's trying to give a lay explanation of what the sensations are, so lay people can understand it. Dr. Brown said release of dopamine can cause what some people could interpret as refreshed, invigorated, some people say euphoria. Only now studies have been able to determine the release of dopamine associated with Propofol. The study was done in rats, not human. "Good feeling" reaction is a well-known effect of the Propofol, Dr. Brown said.

"He was not having a restful sleep if he was using Propofol as a sedative for sleep," Dr. Brown said. Dr. Brown said his understanding is that MJ was using Propofol for many days, so MJ must've had some perceived benefit. He said there have been a number of sources for this information, such as the press, high levels of Propofol in his blood at time of death.

"I was under the understanding the night he died was not the first night he used Propofol," Dr. Brown testified.One of the things Dr. Brown reviewed was Dr. Murray's interview with LAPD, in which the doctor said MJ was taking Propofol for 60 days. Dr. Brown said he believed Dr. Murray's statement that he only gave a small amount of Propofol to MJ the day he died to be false. The doctor said Dr. Murray's statement was not consistent with the autopsy levels. 

Dr. Brown said he read Dr. Czeisler's trial testimony and in there the figure of 60 days, or two months, was mentioned. Dr. Brown said he doesn't know what the source was for Dr. Czeisler's 60 days figure. He also noted he's not a sleep expert. 

Dr. Brown: One of the reasons I agreed to become part of this case was that I wanted to make it clear what the anesthetic does the brain.Dr. Brown: And I think I've done that. The effects of anesthesia and sleep are not under my purview. Dr. Brown said he has not queried his patients about their sleep pattern after anesthesia.

Dr. Brown explained the typical anesthetic has at least 10 drugs. To try to ascribe the effects of Propofol would be exceedingly naive. The implication of anesthetics as something that has implication on a patient's sleep if not under my purview, Dr. Brown explained. 

Dr. Brown: I noticed some inconsistencies of what he (Murray) said we administer (Propofol) and what he said wasn't correct. Cahan asked if Dr. Brown believe Dr. Murray gave MJ Propofol for 60 days prior to his death, according to the LAPD interview. "I have no way of knowing what Dr. Murray did every night when he treated Michael Jackson," Dr. Brown said. Cahan: Have you been able to determine how much Propofol MJ was given in the months prior to his death? Dr. Brown: That's not something I've looked in to

Dr. Brown said he was asked to help understand the mechanism of how Propofol work, not asked to analyze Mr. Jackson's behavior.
Cahan: Can someone be in a profound coma and live?
Dr. Brown: Yes, many years, there are many cases of that
Cahan: And those people don't die as lack of sleep?

Dr. Brown said there's a difference between anesthetizing someone into a coma and someone being in coma from head injury. "You can be there for several days," Dr. Brown said regarding induced coma. In order to maintain sedation, Propofol is given to induce and retain sedation, then decreased to bring the person back, Dr. Brown said. Dr. Brown: You may have different levels of being awake. Dr. Brown: The person may not be the same as they went in. In fact, you don't want the patient to be awake like before a painful surgery. The effect of anesthesia could last several days, Dr. Brown said, and that's currently under study.

Dr. Brown doesn't know how much dopamine is released, but said he could check the numbers.

Dr. Brown said Jacksons' attorneys never told him to testify to something he wasn't comfortable with.

Koskoff talked about the police report where Dr. Murray said he gave MJ Propofol every night for 60 nights up until June 21st. On June 22nd, he started to wean him off, Koskoff said. That seems to be more accurate description to what was in the report, Dr. Brown said 

Peter Formuzis Testimony

Jackson direct

Brian Panish did direct examination.

Dr. Formuzis has a Ph.D in Economics. He described his extensive background and qualifications in the field. Dr. Formuzis is a former Cal State Fullerton professor. He worked at the Federal Reserve in various capacities. Dr. Formuzis has consulted for the Los Angeles commission, several private banks, attorneys involved in wrongful death cases for 40 years. Dr. Formuzis has been qualified as expert witness in at least one thousand cases and had cases in several states in the US. 

Dr. Formuzis has worked with Panish before. He testified for Panish between 20-30 times, was retained between 50-100 by Panish's firm. Has been retained against Panish's firm too, Dr. Formuzis said. Panish asked if he knows anyone more qualified than him to testify in his field. Dr. Formuzis said no.

Dr. Formuzis was asked to take the income projection created by Mr. Erk and to take those projections and discount them to present value

"Most individuals have capacity, or ability, to earn money," Dr. Formuzis explained. Dr. Formuzis: Some people have the power to make money, ability to make money, but are not doing so. 

Dr. Formuzis is not giving an opinion on what loss would be regarding movies and other things Erk didn't calculate. Dr. Formuzis has been doing present value calculation for almost 50 years, about 40 years in wrongful death cases. Dr. Formuzis is only assessing present value of economic loss, not non-economic, like love, companionship. For present value calculation, Dr. Formuzis said you subtract interest and personal consumption to arrive at current figure. Dr. Formuzis used 7-10% discount rate. Panish said AEG has an expert calculating 18% discount rate. 

AEG had invested approximately $34 million, so they had confidence they would get that money back, Dr. Formuzis said. The lower the discount rate, the more net money left. The lowest discount rate Formuzis used was 7%. He calculated 10, 15 and 18% as well. 

Present value:
$108 ticket price
7% - 919,366,479
10% - 856,002,240 -- Dr. Formuzis chose
15% - 768,026,177
18% - 723,523,742

Total includes tour earnings, merchandising, endorsement, Las Vegas show, LV royalty, professional fees (at 15% rate), personal consumption

Tier 1 Range
$919,366,479 - $723,523,742 (7% to 18% discount rate)

Tier 2 range:
$187,564,227 to $101,639,514 (7% to 18% discount rate)

Dr. Formuzis did not calculate how much the loss of love, companionship to the children and Katherine Jackson.

AEG Cross

In cross examination, Sabrina Strong asked if Mr. Erk's projections are wrong, whether his calculations have no meaning. Dr. Formuzis said it depends how wrong the numbers are. "It would be a proportional degree of errors," he said. Strong then said she had no more questions to Dr. Formuzis. Cross examination lasted a couple of minutes.