Jacksons vs AEG - Day 78 – September 3 2013 – Summary

No Jackson family members are in court today. 

Dr. Paul Earley Testimony

AEG direct

In the opening minutes – he talked about scant info on propofol and propofol abuse. In the summer of 2012 he told AEG he would like to do a study. By October he had a budget of $53,000 that AEG funded. CORRECTION – The budget was presented in the summer of 2012 for 6 months work. AEG Funded the project.The final draft was ready to be published in January 2013. Dr. Early testified that AEG had no information of study conclusions. Also in January 2013 Dr. Earley’s status changed from consultant to AEG to an expert witness. Now he could review MJ’s and court records. (ABC7) One of the issues the lawyers argued about this morning was related to Dr. Earley’s testimony about a study he published on propofol. Earley published a study based on more than 20 case studies of people addicted to propofol (they were all medical professionals.) AEG Live paid to have the study completed. Earley said he compiled some of the materials before his involvement in the case. After he began testifying, AEG Live defense attorney Kathryn Cahan asked about the study and how much AEG Live paid for its completion. Earley said in all, AEG paid about $53k for the study to get completed, including money to pay for a writer, statistician. AEG wasn’t shown an advance copy of the article, which was published in March 2013 in a medical journal, Earley said. Earley said he had treated about 25 cases of propofol addiction during his 30-year career _ all were medical professionals. Earley said AEG Live agreed to pay for the study because there wasn’t a lot of literature about propofol addiction. (AP)

Earley said despite AEG payments, he was giving an independent opinion. (AP)

Despite his 2009 blog titled "Michael Jackson: Addiction in the Privileged," Earley testified Tuesday that there "was insufficient evidence that he was addicted to propofol." "He was given propofol initially for appropriate medical procedures, but at some point he began seeking out physicians who would administer propofol to him," (CNN) Earley testified.Earley said he couldn’t offer an opinion on whether Jackson was addicted to propofol, but he saw signs of abuse of the anesthetic. (AP) Dr. said there was not enough evidence that MJ was addicted to propofol but he was seeking out doctors for the medication. And, the propofol was having negative effects on his life and on a medical scale of life expectancy he said MJ condition was grave. He used a slide in court to show the 4 reasons he felt MJ was grave. 1. inappropriate use of propofol. 2. Opioid Addiction 3. Drug synergy between the propofol and other drugs he used. 4. Obstacles for a successful recovery. (ABC7)

He also talked about Propofol used properly in a medical setting. Small changes in the dose can one can go from unconscious to death. That is why there must be a medical setting with and Anesthesiologist monitoring. If breathing stops adjust dose and no harm to patient. (ABC7)

Earley said he did believe that Michael Jackson’s life expectancy was reduced, but he couldn’t estimate by how much. He said Jackson’s prognosis for survival was grave due to his drug use, including propofol and use of opioids, other medications. The doctor said with propofol, small changes in the dose can make a big difference in the impact on the person, so caution was necessary. Earley was shown a slide contrasting how people receive propofol versus how they take an opioid medication. Propofol required 13 items for safe administration, versus a glass of water or a syringe for receiving opioid drugs. Earley reiterated that as long as the doctor knows what you’re taking and you’re monitored, receiving propofol is safe. (AP)

After Lunch, Direct Examination continues. Dr. Earley is asked about his work with propofol addiction with medical professionals. Even an Anesthesiologist can’t always control the dose themselves on themselves? True. They can be found blue on the floor. (ABC7)

After the lunch break, AEG Live defense attorney Kathryn Cahan asked Dr. Earley a few more questions about his AEG-funded study. Cahan asked Earley if he thought AEG funding his study was a conflict of interest. The doctor said no. (AP) The first version of his study was ready to submit the the medical journal in October 2012. The final version was 3 revisions later. The Journal Editors questioned Dr. Earley who AEG Live was after the submission. He responded an entertainment company he was doing work for. He testified no conflict of interest because he was doing research…on medical pros who were addicted to propofol, not MJ or his case. The research and the study were done by January 2013 when he was an AEG consultant. He became an expert witness in Feb 2013. That is when AEG sent Dr. Earley evidence to read in the Jackson case. (ABC7)

Throughout his testimony, Earley was shown a large timeline showing the various times MJ asked for or received propofol in non-med settings. One of the instances noted was the time Jackson received propofol in a German hotel room in 1997. Earley said one could argue that while that wasn’t an appropriate use of the medication, it was administered properly because of the supervision, equipment used. The chart also included four times Jackson sought out propofol for sleep: in 98/99 from Dr. Christine Quinn, in 2002 from Dr. Van Valin and two instances in 2009 from nurse practitioner Cherilyn Lee and Dr. Allan Metzger. Dr. Earley said Dr. William Van Valin II testified that in 2002, Jackson brought him a box of propofol and asked him to give it to him. Earley said this was evidence that Jackson had the drug. Van Valin refused, saying propofol was dangerous, according to the slides. (AP) The next exhibit showed a Propofol Timeline 1998 or 98 – Dr. Quinn asked and refused. Dr. Van Valin in 2002 or 2003 asked and refused. Finally, Nurse Cherylin Lee the morning of 4/10/2009 asked to find an anesthesiologist for MJ and she refused. Earley says he continued to seek. (ABC7)

Earley said there were several risks to Jackson receiving propofol in his home, including his risk to stop breathing due his large tongue. Jackson’s tongue could block his airway, as it did several times when Dr. David Adams gave Jackson propofol during dental procedures. Dr. Earley also said Jackson had a high risk for blood clots because, at least on the day he died, propofol was being given in a leg vein. The doctor said there’s a higher risk of clots or embolism anytime a leg vein is used to administer a drug such as propofol. (AP ) Earley said the size of MJ’s tongue also could play a role. He had a large tongue and with Propofol the tongue could cover wind pipe. Earley saw the autopsy report. There was no sign of a breathing tube on his body or at his house. He also talked about inexperienced administrator of the propofol with the IV in his leg that is greater risk for air bubbles to the lungs. (ABC7)

Dr. Earley likened Jackson receiving propofol in his home to playing “Russian Roulette” each time he did it. (AP) Michael Jackson's drug addiction gave him "a grave prognosis" for a long life, and each dose of an anesthetic his doctor gave him to help him sleep was like playing "Russian roulette," an addiction expert hired by AEG Live testified. (CNN)

Finally Dr. Earley talked about MJ addiction to opioids from 1993 until his death. He did go to rehab in 1993 but there was no real follow up. He spoke about his own battle with addiction 30 years ago and his medical license and the legal system became more important than drug. He outlined 7 factors obstacles MJ faced – duration of addiction – no evidence of him saying no to pain medication- failed attempts - secrecy – hard for celebrities to get into treatment and then have the support after rehab – continued pain and available prescriptions. Finally it was MJ’s access to drugs with his relationships with doctors and his continued medical problems…. (ABC7) Earley was asked about Jackson’s opioid use, and he said Jackson had legitimate pain issues and that had to be considered. However, Earley said he didn’t see evidence that Jackson had appropriate follow-up treatment for his addiction. “Unfortunately because of his pain related problems, he was re-exposed to the drugs over and over again,” Earley said. Earley told the jury he wasn’t “saying that it’s Mr. Jackson’s fault that he became addicted to drugs.” (AP)

The doctor said he is himself a recovering opioid addict, and that it was a challenge to keep the disease in check. For instance, Earley said when he had surgery, he had to explain to the doctor not to give him opioid medications. Giving opioids to an addict, Earley said, turns on a switch in their brains and makes it very difficult for them to refuse the drug.(AP)

Just after the afternoon break Dr. Earley said he is surprised when someone is addicted to both opioids and propofol. The propofol is not easy to get and not easily administered. He said although about 70% of addicts have insomnia propofol is not a cure. (ABC7)

Jackson cross

Cross examination begins. Jackson Attorney Kevin Boyle asks Dr. Early about a blog he wrote on his website several weeks after MJ died. Dr. Earley titles his blog MJ: Addiction in the Priviledged. Dr. Earley claims it was not written about MJ but used to open discussion. He also wrote that because MJ was taking propofol – he wrote that they were mainlining at the Jackson home. Bad connotations. Dr. Earley claimed there were many terms in the addiction field that had bad connotations when it came to drug use. (ABC7) Boyle’s questioning was quite spirited _ he pointedly questioned Earley on AEG funding the propofol study and his writings on Jackson. Earley wrote a blog post in 2009 titled, “Michael Jackson: Addiction in the Privileged.” Boyle showed the post to the jury. Boyle questioned if Earley had already made up his mind about Jackson before AEG called him to be an expert in the case. The doctor said no . Earley said he wrote his blog in the hopes that the Jackson family would see it and use it to underscore the dangers of addiction. (AP)

Boyle also used a modified timeline that AEG used during its examination, adding the date of May 6, 2009, when AEG exec Paul Gongaware wrote that Conrad Murray’s deal was “done at $150k a month.” That was a couple weeks after Jackson asked for propofol from Lee, Metzger. Boyle asked if there was any evidence MJ asked for propofol after May 6. “No evidence,” Earley said. “Sounds like he got it.” (AP)

Boyle then asked Earley to confirm that MJ found his propofol from “the doctor hired by AEG Live.” The question was immediately stricken. Several of Boyle’s questions and comments were stricken by the judge as argumentative throughout his 45-minutes of questioning. For instance, Boyle asked if Earley was glad Mrs. Jackson wasn’t in the audience today. The question was stricken. Earley said that his blog (still just a Google search away...) doesn’t imply that Jackson was an addict. Boyle was incredulous and asked Earley if he was really saying that with a straight face. That comment was stricken. (AP)

Dr. Earley was also questioned about the propofol study he conducted. He said he did not think it was a conflict of interest. Earley was contacted by Mr. Punam at O’Melveny and Meyers because they wanted more information about Propofol addiction. Dr. Earley told him there wasn’t much written about propofol. The law firms need for information and how own curiosity got him to do study. The Law Firm agreed to fund it. He said he did not see the conflict or a disclosure problem because the subjects were in healthcare. Dr. Earley continued to stress though under tough questioning that he was doing research for the law firm, not the MJ case. (ABC7) Boyle also showed the jury Earley’s article that was paid for using AEG Live’s support. The attorney asked several questions about it. He noted that the first page states the authors didn’t have a conflict of interest. Earley re-iterated he didn’t think one exists. Boyle questioned Earley on whether he told his research partner (another doctor) that he was being paid as an expert in a lawsuit. Earley said he told his research partner that he was doing research for AEG Live and may have mentioned it was a case. The doctor said his partner didn’t express any concern about Earley’s role in the case or AEG Live’s payments to get the article done. (It's important to note that Earley's discussion with his research partner would have come before AEG designated the doc as a trial witness.) AEG apparently didn't inform Earley he would be called to testify until March 2013. Article was accepted for publication 2 months before. Boyle asked Earley how many medical journal articles are funded by concert promoters. Earley said he wasn’t aware of any others. (AP) Earley insisted in his testimony that AEG Live's funding did not influence the conclusions of his study or his testimony in the trial. But the Jackson lawyer hammered the doctor about the lack of disclosure to the scientific journal and his collaborator that he was being paid to be an expert witness in the trial. He informed them that he was doing research for the company, but the trial aspect was "irrelevant," Earley said. "It's irrelevant to health careprofessionals," he said. "It wouldn't affect their understanding of the paper." (CNN)

Around this time, the court recessed for the day.