Murray Trial Day 4 September 30 2011

Morning session

Bob Johnson Testimony 

Walgren Direct

Employed by Nonin Medical, designs noninvasive medical equipment such as pulse oximeters. Johnson states he is the Director of Regulatory Affairs Clinical Research and Quality Assurance. Johnson states his responsibilities are to get product approval with the FDA and Worldwide Health Ministries. Johnson states that the clinical research entails both animal and human research. Johnson states again that Nonin Medical designs pulse oximeters.

When prompted, Johnson states that pulse oximeters detects both pulse rate and red blood cells that have oxygen attached to them, basically determined oxygen saturation and a pulse rate, called SPO2. Johnson states that Nonin probably makes ten or models of pulse oximeters.

Walgren asks if Johnson if familiar with model 9500, Johnson states yes. Johnson describes the "onyx 9500" is a fingertip oximeter, which displays both heart rate and SPO2. Johnson is asked to identify a pulse oximeter that was in MJ's bedroom at the time of death, he does. Johnson is asked to identify two numbers on the oximeter, Johnson explains that the "92" is the heart rate, and the top number is the percentage of red blood cells that have oxygen attached. 

Walgren then asks if the Nonin 9500 oximeter has an audible alarm, Johnson states no. Johnson also states that this particular model is used for spot checking. A doctor would use this if a patient were to come into their office to have their heart rate and pulse checked. Johnson then states that this model is not used for continual monitoring and that it is specifically label not to be used continually. 

Walgren then asks Johnson if Nonin makes oximeters that have an audible alarm, Johnson states yes. Walgren asks how much this particular model of oximeter costs, Johnson states $275 retail value. Walgren asks if Nonin makes a model of oximeter 2500A, Johnson states yes. Johnson states that the 2500A displays the same functions as the 9500, but also has visual and audible alarms. Johnson states that the alarm at its loudest, can be heard outside. Johnson states that the retail value of the 2500A model is $750. Walgren asks if Nonin makes a 9600 tabletop pulse oximeter, Johnson states yes. Johnson states that the readings are the same, heart rate, then moves to retail value, $1250 in 2009. Johnson also states that Nonin makes pulse oximeters that display capnography, which is the C02 coming from a person's breath. Walgren asks Johnson if all of these models are available to lease, Johnson states that yes they are. When asked how much one of the most expensive models costs to lease, Johnson states about $40 a month.

Defense Cross

When asked if the model 9500 (the one found in the room MJ died in) is accurate, Johnson states yes. Johnson is asked if someone to monitor a patient for 15 minutes, would that model of oximeter be adequate, Johnsons states perhaps. Johnson is then asked if the pulse oximeter detects change, Johnson states yes. Johnson is asked if someone were there with a patient, under the influence of propofol for five or ten minutes, would there be a constant change in the pulse oximeter, Johnson states no. Johnson states that it is very difficult to constantly monitor the numbers, so it is not recommended for continuous monitoring. When asked what Johnson means by continuous monitoring, he states something other than a spot check or to take vital signs. Defense asks if it would be safe in monitoring every five minutes, Johnson states yes. Defense asks if it would be safe continuously for fifteen minutes, Johnson says only if the doctor is constantly monitoring the screen. 

Johnson states that it takes about five or ten seconds to get an accurate reading on the oximeter. Defense states that after the five to ten seconds, does the reading change, Johnson states yes. Defense then states that it can be used for constant monitoring, Johnson once again states that it cannot. 

Walgren Redirect

Walgren asks if the difference between the audible versus the nonaudible pulse oximeter models is a big difference, Johnson states that it is a huge difference. Walgren states that it's the difference between life and death, Johnson states yes. Walgren states that if in another room, the inaudible oximeter is useless, Johnson states yes.

Flanagan (Defense) Recross

Defense once again asks if a doctor is constantly monitoring, is the pulse oximeter useless, Johnson states no. 

Robert Russell Testimony

Deborah Brazil, Prosecution Direct

Russell states that he had a heart attack in 2009 in Las Vegas. Russell stated that he met Dr. Murray in the emergency room in the hospital. Russell Murray reviewed what had happened, and ultimately inserted stents to the heart to repair it. Russell states that this was the first time he had ever met Murray. 

Russell states he went into the emergency room, and then went into a surgical room, where Murray and an anesthesiologist performed heart surgery. Russell states that he was awakened during the surgery, because he had been give too much medicine for his blood pressure, by the hospital staff. Russell states that after he was awakened, Murray said "here's your heart (on a screen), stay awake", and that Russell did not want to see it. Russell states that Murray installed three stents in his heart. Russell states that he wanted to leave the hospital that night, but that Murray was stern with him, told him he was minutes from death, and that if Russell left the hospital, he was a dead man. Russell was released from the hospital on approximately March 12, 2009.

Russell states that he went to a follow-up visit on March 16, 2009, and that Murray advised him that he needed to have a second procedure to insert more stents into his heart. Russell states that Murray told him that because of the problems with the first surgery, Murray told Russell that he was unable to put all the stents in his heart, therefore Russell needed another surgery to finish inserting the stents. Russell states that he felt Murray treated him very well. Russell states that Murray told him that he had an opportunity to go to the UK, and take care of one person as a physician, but did not tell him who the one person was. Russell states that he made an appointment for the second surgery, and that he had the surgery in April of 2009. Russell states that the procedure was the same as the first, but that it was an outpatient surgery. Russell states that an anesthesiologist was present in addition to Murray and other medical personnel. Russell states that he went home the same day and had scheduled meetings for follow up care. Russell states that he went to the follow up visit, Murray told Russell that he had made a decision to take care of the one patient and that patient was Michael Jackson. Russell states that he has not told his staff, and that he was going to tell them after Russell and his wife. Russell states that Murray inferred that he had had an ongoing professional relationship with Michael Jackson. Russell states that he was very happy for Murray, and that Murray seemed highly excited and pleased that he would be working for Michael Jackson. Russell states that Murray advised that Russell needed further therapy for his heart and that it was important to his recovery. 

Russell states that the therapy for his heart began mid-April 2009 on a daily basis. Russell states that Murray is only there occasionally. Russell states that Murray advised him that he would not be there. Russell states that he asked the staff, and Murray called him at home to answer them. Russell states that he completed the therapy in early June, and had a follow-up visit on June 15 to get the results of therapy to see how Russell's heart was doing. Russell states that this visit was very important to him, but Murray did not keep the appointment. Russell states that he was notified by mail that Murray after June 15, mailed out to all patients, that Murray would be leaving his practices temporarily in order to take "a once in a lifetime opportunity". The letter stated that Murray would manage the practice, and would find a suitable replacement. Russell states that he was not surprised.

Russell states he had a second follow-up visit on June 22, because Murray cancelled the appointment. Russell states that the June 22 appointment was also cancelled and was frustrated. Russell states that he felt he was dependent on Murray, because he had no referral, rescheduling and that Murray had all his medical records. On June 25, 2009, Russell calls Murray's office early in the morning. Russell states that he had formed a relationship with Murray's staff members because during the therapy, he had seen the staff members more than he saw Murray. Russell stated that he expressed his frustration to the staff members, he felt desperate, he threatened legal action, and that he felt abandoned. Russell received a voicemail later that morning from Murray on June 25, 2009. 

The voicemail played is Conrad Murray stating that Russell's therapy went very well. Russell states that he felt grateful that he took the time to call him. Russell felt that the statement was odd, because Murray stated that the heart was repaired, when months earlier Murray said it could never be fully repaired. Russell also stated it was odd that Murray had stated he was going on sabbatical, when all along Russell knew that Murray was going to take care of MJ. 

Russell stated that although at first he felt Murray's care was excellent, he also felt that he was abandoned.

Chernoff Defense Cross

Chernoff establishes that Russell and Chernoff have never met. Russell states that the medical care he received was unlike any he had never had before. Russell stated that Murray was adamant about how serious Russell's condition had been, and that Murray saved his life. 

Russell states that Murray knew his wife. Russell states that his heart attack was on March 9, 2009, and that now, his heart is in good shape, according to his new cardiologist. Russell stated that his new cardiologist stated that the stents had been inserted properly.

Paramedic Richard Senneff (RS) Testimony

Brazil Direct

RS is a paramedic at Los Angeles Fire Department. RS explains his training and experience and certification. 

June 25th, RS was working at fire station 71. They received a call to go to Carolwood. "Cardiac arrest. CPR in progress. 50 year old male. Patient not breathing" They went to Carolwood. RS was the team leader and the radio man and he gather information and write records. Senneff rode in Ambulance 71 with Paramedic Blount. Fire Engine 71 followed them with engineer, fire fighter, fire captain and additional paramedic.

Brazil goes over People's Exhibit 43 and what's written on it. 

Print out information

Line 1 : Engine 71 Rescue Ambulance 71
Line 2: Address 100 Carolwood
Line 3: Incident number 5-12 Cardiac Arrest 12:21 call time 50 year old man
Line 4 : code cardiac arrest not breathing at all
Line 5: the phone number call came from
Line 6 : dispatch time the time they got the call at station 12:22
Line 7 : 911 call from a cell phone , caller is still on the phone with the dispatcher
Line 8 : Where the call is originated and transferred 

At the end there's a patient identification sticker at the UCLA assigned to MJ when he was brought in. 

Mid morning break 

They arrived at 12:26. Rescue ambulance entered the residence, fire truck stayed on the street. RS got his equipment the starter kit and followed the security guards up the stairs and in the bedroom. RS saw CM, MJ and a security guard in the room. 

RS describes the patient. MJ was wearing pajama bottoms and a top. The top was open. Surgical cap on his head. He appeared to be thin. 

RS describes CM. CM was leaned over MJ and was holding his torso and was moving MJ from bed to the floor. 

RS also saw a security person helping to move MJ to the floor. 

According to RS, CM was frantic. 

When entered the room RS asked if there was an advanced DNR (Do Not Resuscitate) order. No one answered initially. RS repeated the question CM said no. RS saw an IV stand with a saline bag hanging and saw an oxygen tank. RS was trying to gather information to understand what was happening. RS asked three times if there was an underlying health problem. CM finally said nothing. According to RS this didn't make sense as there was a physician at the house and a IV stand. 

RS asked how long the patient been down. CM said "just happened right I called you". RS says that ambulance got there very quickly and if they were called right when the event happened, they had a good chance of reviving MJ and starting his heart. 

12:26 is the time RS was in the room and making observations. RS states that they were in the room within 5 minutes. RS says that a firefighter and himself moved MJ from side of the bed to the foot of the bed because there was not enough space to work on the side of the bed. RS was still trying to gather information from CM. Firefighter Herron was doing CPR. Paramedic Blount was starting ventilation. Paramedic Goodwin was hooking up the EKG. Fire Captain was helping with anything needed. RS was busy and didn't look to see the patient was MJ. He later learned that it was MJ. 

EKG showed flatline/ asystole. 

MJ had an IV on his leg. RS checked to see if it was working and then gave MJ atropine and epinephrine - those are drugs used to start the heart. RS saw no change in MJ's condition after administering the started drugs. RS asked CM if MJ was taking any medicines and was he given any medicines. RS had to ask that question multiple times. RS told CM that he's seeing an underweight patient, with an IV stand and medication vials on the nightstand. At that point CM said MJ wasn't taking anything and CM only gave MJ a little bit of lorazepam for sleep. CM said he was treating MJ for dehydration and exhaustion. 

By this time MJ was hooked on the machines and had received one round of starter drugs. Blount incubated MJ quickly to give air directly to his lungs. RS was monitoring MJ's situation. RS was also communicating with UCLA Base Situation reporting to them. RS told the age, the situation, how long he was down, what they did. RS was talking to the radio nurse and radio nurse was communicating with the doctors. 

When RS looked to the MJ, he didn't believe that MJ was "just down". RS observed that MJ's skin was cool to the touch; MJ's eyes were open, dilated and dry; EKG was flatline, and capnography reading was low.

They gave MJ a second round of starter drugs through left jugular vein (left neck). Paramedic Goodwin tried to find a vein in MJ's arms to locate a vein 5 times to start an IV but he was unsuccessful. RS says it's significantly difficult to locate a vein when the blood is not circulating for a while. 

After RS first contacted UCLA and told them what they administered the first round of starter drugs, UCLA asked them if they wanted to continue or stop. RS said they wanted to continue. After the second round, RS talked to UCLA again. UCLA was ready to announce MJ dead. 

Brazil asked what happened to the IV on MJ's leg. RS says CM pulled the IV from MJ's leg and that's why paramedics needed to find another vein and finally found jugular vein. 

CM says he felt a pulse at right femoral (right groin). RS looked to heart monitor and he saw a flat line with CPR (lines were only moving due to CPR). RS told his crew to stop CPR to check for pulse. The heart monitor was a clear flat-line, it means that the heart wasn't functional and there could not be a pulse. RS and another paramedic checked for pulse, they did not felt a pulse. 

People's 43 exhibit again. They are going over handwritten notes. 

call time 12:21, glucose levels, EPI 3.5 mg at 12:40, Allergy : florazen, another EPI and atropine. 12:57 the time UCLA wanted to call MJ death. Box on the right hand side : Hydration and lorazepam what CM told RS. Second bicarb - another starter drug given to MJ. RS says the time is wrong. He wrote 14:00 but it was actually at 13:00 PM

RS's call to UCLA is played. CM assumes control. 

CM asked paramedics to do a central line. RS says they don't have any training or equipment to perform it. CM asked paramedics to administer magnesium, RS says they didn't have it. Brazil asks if CM provided them the materials to perform these tasks. RS says no. 

People's exhibit 46

902-M. The document contains comprehensive information about the care provided. Starter drugs provided from 12:27 to 12:50. Readings are also written in the document. Medication information and RS's own notes are written. 

They gave MJ sodium bicarb before transportation. All of the paramedics and firefighters took MJ downstairs on a backboard. Some of them were carrying the backboard and the others were still performing resuscitation efforts. When downstairs MJ was put on a gurney with wheels. RS turned back to go upstairs to get their equipment. 

RS sees CM with a bag in his hand picking up items from the floor near the nightstand. 

Blue ambu bag on the floor. RS says it's not paramedics. 

RS collects the items, go down the stairs and go to the ambulance. CM was still inside the room. CM joined them later. RS was sitting close to MJ's head in the ambulance and was observing MJ. There was no changes. MJ was given another round of starter drugs on the ambulance. No change. RS saw CM on his cell phone. RS says he never saw any sign of life at MJ and there was no change in MJ's situation for the 42 minutes he was with him. They arrived UCLA at 13:13 PM. 

Brazil lists monitoring equipment and asks RS if he saw them in the bedroom. RS says "No" to them all. Brazil asks if CM ever mention Propofol to RS, RS says No. RS says CM was alone in the bedroom for a while after he left the room with their equipment.

Defense cross by Nareg Gourjian 

RS says they got the call 12:22 and left at 12:22. Gourjian mentions the call was placed at 12:20 and transferred from Beverly Hills. RS was not aware of it. 

Gourjian reminds of RS's preliminary hearing description of MJ: pale, underweight, so thin that you can see his ribs. Gourjian asks if MJ looked real sick to him. RS says he looked like he had a chronic health problem. 

Gourjian asks if it was the physical characteristics of someone that has been a drug addict for a long time. RS says he cannot say that and he has seen drug addicts that are overweight and underweight. Rs says he just thought it was a chronic illness. 

Gourjian asks about MJ being on the bed. RS says MJ was in the process of being moved, his feet on the ground and his upper torso still on the bed. IV tubing on his left calf. 

Defense asks if RS asked CM if MJ was on recreational drugs. RS says it's a common question that he asks but he doesn't remember if he asked it or not. Defense asks RS about Lorazepam. RS says he's not that knowledgeable about it. 

Defense asks about CM not answering the questions right away could be because he was busy. RS says there was a lot of things going on and he was busy. 

Defense is going over what each paramedic doing. RS repeats what he previously said. Gourjian mentions Paramedic Herron doing CPR and Paramedic Blount managing ventilation. And if CM asking for help as well it acceptable. RS answers yes you wouldn't want to do it alone. Defense reminds American Health Association (AHA) guidelines which says people should work collaboratively. 

Lunch break


Murray Trial Day 4 September 30 2011

Afternoon Session

Defense cross by Nareg Gourjian continued 

Defense asks if the CPR should be performed where the patient is found. RS says that’s wrong. Defense reads from American Heart Association (AHA) guidelines. RS agrees with it. Defense asks if MJ had IV connected to him. RS says yes. RS says he didn’t see anything else connected to him. Defense asks if things connected will be a factor when moving a patient, RS answers yes. Defense asks if the chest comprehensions are adequate, would be irrelevant if the patient was on a bed or floor. RS says correct. 

Defense asks questions the pulse CM felt at MJ’s femoral artery. RS says he didn't suspect what CM said. Defense reminds of RS’s preliminary hearing in which he said that it’s common to get femoral pulse from CPR. Defense asked would it be likely that CM actually felt that pulse. RS answers yes. 

Defense asked why RS didn’t pronounce MJ dead as UCLA said. RS said he preferred to go to the hospital as it was a VIP patient and as he was told it was a recent arrest. CM took the control and he needed to ride in the ambulance with them. After getting MJ down to the ambulance, RS went back to the room to pick the medical equipment left behind. CM was also picking up items in plain sight. Defense asks if it's normal practice to pick up medical items, RS says yes. Defense asks if CM could have been picking up his glasses and wallet. RS says he didn't see anything and the bed was blocking his view. RS goes back to the ambulance. CM came to the ambulance in a minute or so. Defense asks about the phone call CM did at ambulance, asks RS if he heard anything. RS said he didn't hear anything. Defense asks if CM was trying to help the paramedics with anything they needed when they were at Carolwood. RS says correct. 

Defense asks is fractured ribs is a show of good CPR. RS says it is common occurrence. RS wasn’t aware that MJ sustained fractured ribs. Defense asks if RS is familiar with Propofol, RS says no. 

MJ was a combination of P.E.A (Pulseless Electrical Activity) and asystole (flat lined). Defense asks if there are certain protocols to follow if someone is P.E.A. They wouldn't shock (defibrillate) a person with P.E.A. They would give CPR and give atropine and EPI and sodium bicarbonate. Defense asks if they knew MJ was given Propofol, they wouldn't be able to anything different. Objection. Sustained. 

Brazil redirect

Brazil asks if there was any confusion and chaos when RS’s team attempted to save MJ’s life like the defense claimed. RS says it was not the case. 

Brazil asks if RS knows the IV tubing had been replaced, removed or placed again prior to his arrival. RS says no. 

RS says that it’s accurate that they believed the femoral pulse that CM felt to be due to comprehensions and not a real pulse. 

RS says by the look of CM's face he was surprised to see him come back in the room. RS says it was "deer in the headlight" kinda look. RS says CM had a trash bag in his hand. 

Defense recross

Defense asks RS's time of estimate for the cardiac arrest. RS says it is hard to speculate. Gourjian reminds of RS's preliminary testimony which said "at least 20-25 minutes before we arrived there". Gourjian asks if the time of arrest could have been 12:01 -12:05PM. 

Defense again asks if CM could have been getting his wallet. Objection. sustained. Defense asks if CM asked RS to close his eyes or step outside the room. RS says no.

Brazil re re direct

Brazil reminds of the preliminary hearing and asks if it's correct that RS said the arrest could be anywhere from 20 minutes to 1 hour ago. RS says correct.

Defense re re cross

Defense asks if CM stopped doing what he was doing when RS walked into the room. RS says no CM continued to do what he was doing.

Martin Blount (MB) Testimony

Brazil direct

LA Firefighter paramedic. Worked for 20 years. Became a paramedic in 1999. Trained by UCLA doctors and nurses. Every 2 years they are required to take 48 hours of trainment. Works at firestation 71. 

MB drived the rescue ambulance. RS was sitting next to him. He came to Carolwood and parked the ambulance and went into the house. Fire truck accompanied them and parked outside the street. Fire Captain Mills, Paramedic Goodwin and Herron was on the fire truck. 

MB saw a man lying on bed. He was on the bed fully. MB saw 2 rescue personnel getting MJ to the floor. CM was sweating profousely, he was aggitated. CM said "He needs help could you help him please". 

MB has the designated role as a driver. His job is initial treatment and assessment of the patient. RS is responsible for communications and obtain information. 

MB immediately recognized it was MJ when he came in the room. MB went to the head of the patient and started basic life support. MB's job was to provide air to MJ. 

Tongue suppressor so the tongue would not go back of the throat and wouldn't block the airway. 
Head tilt back - to make airway open and unconstrusted
Ambu bag - artificial air. More efficient than mouth to mouth. Tied it to an oxgyen tank that he brought. 
It took him a minute or so do these all

Then he did advance life support which is endotracheal tube - 100% of the air is going into the lungs. It's better than ambu bag. He did did it in 45 seconds. 

According to Blount, MJ wasn't breathing, he wasn't moving, his eyes was fixed and dilated. MB felt that MJ was dead. 

MB observed an an oxygen tank and saw a long tube and nasal cannula attached to it. Nasal Cannula was on MJ. MB also saw an IV on MJ's leg and saw an IV bag on IV stand. He did not see any monitoring equipment in the room or on Michael. 

While MB was doing his tasks, MB was able to see the heart monitor. He saw no movement. He believed MJ was flat lined. 

RS's duty was to gather medical information. MB heard RS asked about the medications MJ took. MB heard CM said no. For previous medical condition CM said no. CM said he was a healty 50 year old man. CM said he was providing normal saline. CM said MJ was rehearsing for 16 hours and was dehydrated. MB heard RS asking if MJ was taking recreational drugs. CM said no. 

Brazil asks about stater drugs. Atropine and EPI. Paramedic Goodwin made multiple attempts to find a vein in the arms but he was unssuccessful. RS found a jugular vein on the neck to administer another round of starter drugs. 

MB saw 3 open vials of lidocaine on the floor when he was helping MJ. Lidocaine is a heart drug. Paramedics do not carry lidocaine and did not administer it. CM did not mention of giving MJ any lidocaine. MB did not hear CM mentioning Propofol. 

MB says he did not hear anyone saying they felt a pulse. Brazil reminds him of his preliminary testimony. MB then remembers that CM said he felt a pulse on MJ's groin area. They stopped the comprehensions to check it (comprehensions can create artificial pulse). When they checked, no one else felt any pulse. 

RS was communicating with UCLA base center. MB heard UCLA was ready to announce him dead. MB never saw any signs of life and did not believe MJ was alive. CM took over the control of the patient. MJ was put on a backboard and paramedics took him down to transfer him to UCLA. Before they were taking MJ down, MB saw CM taking Lidocaine vials from the floor and put them in a black bag. MB never saw those lidocaine bottles again.

MB rode with MJ to UCLA. He was sitting towards his head. They administered another started drugs to MJ on the ride. There was no change to MJ's situation on the ride. MB saw and heard CM on the phone. MB heard CM say "It's about Michael and it doesn't look good" on the phone. MB doesn't know who CM was speaking to on the phone.

MB saw MJ had condom catheter. It allows urine to be collected in a bag. It's typically used when someone not able to get up and go to the restroom. 

RS asked how long the patient was down. MB heard CM say "he's been down about 1 minute". MB felt MJ's skin,when he was on the bed he was warm. On the floor MJ felt cold to the touch. MB looking at MJ's condition believed he was longer than one minute. 

mid afternoon break

Defense cross by Gourjian 

MB parked the ambulance, got his equipment went upstairs to the bedroom. MB says MJ was still on the bed. MJ looked pale and thin.

Gourjian shows MB a picture and asks what the black thing on the bed is. 

MB doesn't know what it is. 

Gourjian asks what are recreational drugs? MB gives examples such as heroin, cocaine. CM answered that question as no. MB says he didn't hear CM mentioning lorazepam to RS. 

Defense asks if MB heard CM said "he has been down about a minute prior calling for help". MB says he didn't hear that , he only heard "about 1 minute". 

Gourjian goes over the AHA guidelines :comprehension first, airway next, breathing last. MB mentions in 2009 the rules was airway first but now the rules have changed. Gourjian asks is asking for assistance during CPR is normal, MB says yes.

Gourjian asks about Lidocaine bottles. Lidocaine wasn't hidden, they were out in the open and in plain sight. 

Defense asks if MJ was P.E.A. MB says MJ was never P.E.A., he was flat-line the whole time.

Dr. Richelle Cooper (RC) Testimony

Walgren direct

UCLA Board Certified Emergency Physician. Explains her medical background, training, education in detail.

RC explains what is a base station: Nurses with specialized training. They answer radio calls from paramedics, help paramedics, consult with doctors to provide further information to the paramedics. 

June 25th RC was consulting with the paramedics through base station nurse. Nurse called RC after receiving the call from the paramedics after the resuciation effort were unsuccessful. RC knew the patient was incubated and received starter drugs but still asystole for 40 minutes. LA protocol say if rescuaiation efforts are unsuccessful for 20 min person can be announced dead. After receiving the information RC authorized paramedics pronounce MJ dead at 12:57. 

Nurse called RC back said there was a physician on scene requesting paramedics provide another medication. It was sodium bicarbonate. RC said if that was a physician with an active licence they can administer it but the physician need to take over the control and the patient needs to be transported to the local hospital.

When MJ came to the hospital, the care became RC's responsibility. RC knew patient was on the way so she was waiting for the ambulance.

She assigned a team of 14 people. It included :
- Richelle Cooper and 4 residents
- at least 2 emergency technicians, 
- a respitory therapist, 
- a scribe nurse to record information and make calls to get consult, 
- 2 circulating nurses, 
- a pharmacist, 
- a social worker to contact/assist family members, gather information from physicians and 
- a charge nurse who assigns other staff as it's needed. 

Additional doctors were consulted and came as needed. Administrative people came down after a while as it was MJ. 

RC's main goal is to manage MJ's care. While paramedics was transferring MJ to the trauma bay. RC was speaking CM and asked what happened. CM told MJ was working very long hours, CM believed MJ was dehyrated, CM gave him IV and gave MJ 2mg lorazepam , later gave another 2 mg lorazepam and saw MJ go into cardiac arrest. CM reported MJ had not been ill. RC asked about medications MJ has been given. RC was told MJ was given 2 doses of 2 mg lorazepam through IV. 

Walgren asks "Did CM tell any other medicines other than lorazepam?" RC says "No". 

CM said witnessed the arrest. What does it mean? RC says it's an observed arrest and the critical event happens when you are with the patient. It's when the patients heart and breathing stops. It means you are on site and saw it happen. 

RC asked for MJ's routine regular medications. She was told Valium and Flomax. Valium - anti anxiety medicine. Flomax is given for prostate or kidney stone. CM did not mention any other medicines. 

RC asked past medical history , if he had a heart problem, blood clot or drug use. CM said no to all. RC asked if he saw any seizures and if MJ had complained about chest pain, CM said no. 

RC did not see any physical trauma. 

RC says MJ was clinically dead, he didn't have a pulse. There was signs of a dying heart (heart might still send some signals), pupils were dilated. Despite this they made attempts to revive MJ. They confirmed the breathing tube was in correct place and they were breathing for the patient. They checked for pulse, there was no pulse. They started CPR and tried to resuscitate MJ. They used an ultasound to examine the heart. 

Walgren shows pictures of trauma bay and asks RC to go over all of the medical items in the trauma bay. RC identifies items one by one. 

Court adjourned till monday