Murray Trial Day 15 , October 21 2011

Dr. Shafer Testimony continued

Hearing starts with 221 - A stipulation . The term "tab handle" on Propofol bottleis defined.

Walgren direct continued

Walgren asks if Shafer reviewed 8 page toxicology report by the coroner. Shafer says yes and that it showed pure true level of drugs , it doesn't include the metabolites. Shafer evaluated the procedures that is used by the coroner. 

Shafer mentions that he made his simulations available to the defense and volunteered to help

Walgren asks if dying eyes open mean anything. Shafer says it doesn't mean slow or quick death.

After Walgren's question Shafer says it's a possibility that MJ woke up and manipulated the infusion line and that would mean CM left MJ alone. Shafer also wrote this in his report. 

Walgren asks if this had happened would Shafer's opinion change about CM. Shafer says no and even if MJ woke up and opened the rubber clamp, it will still be CM's responsibility and CM wasn't available and let this happen. It's still considered abondonment. 

Chernoff cross

Chernoff goes over what Dr. Shafer does and his models. Shafer can determine concentration from dosage. Shafer says he usually knows what dose is given. 

Shafer says that as people are different his models are built to give ranges. The median is the representative of the half of the people's response to a particular drug. 

In this case Shafer only had the concentration and he had the calculate the dose from the concentration. 

Chernoff mentions that there was only one IV line found at the scene. Chernoff asks if Shafer's theory of what happened is a bold statement. Shafer responds as he believes it to be an honest statement. 

Chernoff asks if there's any particular reason Shafer brought a different IV line for the saline bag. Shafer contacted Sea Coast medical to get theexact line but the shipping would have taken 2-3 weeks so he brought the other line. Chernoff shows the exact IV line to Dr. Shafer. (The IV line Chernoff shows is dirty and has brown stuff on it. Shafer wonders if it's blood, Chernoff says it's not).

Chernoff then asks why Shafer brought a vented IV line for the Propofol. Shafer says that a vented line is needed to get Propofol out. Chernoff asks why Shafer assumed CM used that IV line. Shafer says that SeaCoast reports shows that Murray ordered that line and it shows he intended to use it.

Chernoff asks how Shafer could know if CM used it in MJ's room. Shafer says because he needed a vented IV line. Shafer says the bottle had a spike tear but there was no needle hole in the Propofol bottle. If there had been a needle hole, CM could have used another IV tubing. Shafer says that as this bottle only had a spike tear, there had to be a vented IV line. Shafer says that this is the only vented IV line he saw in CM's orders and he had it shipped to California. 

Chernoff says perhaps there was no tubing at all. Shafer responds how would you draw the Propofol then? Chernoff says that LAPD did not find a vented line. Shafer says it's easy to hide and take with a person. Chernoff asks why wouldn't a person also take the bottle and the needles. Shafer says that needles can hurt and bottles are bulky.

Chernoff tries to emphasize that this is all Dr. Shafer's opinion. They discuss back and forth about what's an opinion. Shafer says what he says is based on medical knowledge and some are facts and some are his opinions. Shafer says "It's my opinion that one should not lie to UCLA doctors".

Chernoff mentions that CM said that he used a 10cc syringe but Shafer used a 20cc syringe. Shafer says the size of the syringe was irrelevant. Chernoff again goes over that Shafer used a different IV tubing for saline bag, a different shape Propofol bottle and a larger syringe. Shafer answers yes. Chernoff asks about the tear on the saline bag. Shafer says it peaked his interest and he bought 3 IV bags for $150 and estimated the tear on the bag. 

Chernoff mentions that Walgren called Shafer on March 31st and then sent him statements and reports. Chernoff goes over Dr. Shafer's report and that he used "might" to describe what happened. Shafer also referenced Alberto Alvarez's statatement and that he saw a propofol bottle in a bag. Chernoff asks if Shafer ever met or talked with AA and if he made the assumption that AA was telling the truth.

Chernoff says that the handle on the 100ml Propofol bottle found on the scene was not used. Shafer says it's irrelevant and that whether the bottle was in the bag or hung on the pole it wouldn't make a difference. Chernoff asks if it's reasonable that rather than hanging the Propofol bottle by the handle, CM would go all the steps to empty and cut the bag and put the propofol bottle inside it. Shafer says it's reasonable. 

Chernoff says that CM is on trial for his life and there's a sidebar. 

Chernoff asks about the medical malpractice lawsuit that Dr. Shafer testified 10 years go and if he didn't like the doctor in that case. Shafer says he didn't like the doctor. Shafer says he testified once before but he consults on trials twice a year. 

Chernoff goes over Dr. Shafer's resume. When Shafer was a medical student at Stanford University, Dr. White was an assistant professor in anesthesia. Shafer published papers with Dr. White. Shafer wrote the software and helped with mathematical models for Dr. White's study in 1888. 

Chernoff goes over the Propofol insert and asks Shafer to show which parts was his contribution. Shafer circles and underlines the parts he did. 

mid afternoon break

Chernoff goes over other studies / articles and books Dr. Shafer worked on. Chernoff mentions the work Shafer and White did together. Shafer and White has known each other for almost 30 years and in 2009 Shafer nominated White for an award. 

Chernoff mentions Dr. Shafer's statement when he said "he was disappointed" with White about saying oral consumption. Shafer says he was disappointed and that's how he felt. Chernoff asks if Shafer knows this trial is on TV and shown internationally. Walgren objects. Chernoff asks if Shafer knows the circumstances of the letter Dr. White sent to Flanagan and that it was rushed in 2 days due to threats of contempt. Objection and Sidebar. 

Chernoff talks about Propofol found in MJ's stomach. Shafer sent the piglets study to Walgren and told Walgren there's was no human study. Shafer then contacted Chilean professors for the human study but Walgren didn't ask for that study. 

Chernoff says that defense paid for a study on beagles and White did that study.

Chernoff asks who paid for the Chilean study. Shafer says he paid $600 for the propofol and the students volunteered. The study was also presented in an international conference. Chernoff asks why would he do a 2 month student, write a paper and present it at a conference if Propofol not being orally bio-available was something that 1st year student will know. Shafer says it's better to have human data because it's not ambiguous and there would be no question about humans.

During questioning we learn that Dr. Shafer himself swallowed 20 ml Propofol before he did the study.

Chernoff asks if Shafer knew White wouldn't say MJ swallowed Propofol. Shafer says he didn't and stull doesn't know what Dr. White is going to say.

Chernoff shows the 40 mg Lorazepam graph. Shafer says that it shows repeated bolus injections (10 injections) for every 30 minutes frim midnight till 5 AM. Chernoff says in his model the first shot was at midnight but MJ was still at rehearsal then. Shafer offers to do another simulation. 

Chernoff asks why he removed the "responsive to painful stimulus" , "not responsive to painful stimulus" lines from his graphs. Shafer says he wanted to make it as easy as possible for the jurors. 

Chernoff says based on his simulation MJ would be sleeping from 2:30 AM to 11:00AM. Shafer says as MJ was exposed to benzos for 80 nights, it's impossible to predict MJ's reaction to Lorazepam. Chernoff asks how he knows MJ had benzos for 80 nights. Shafer answers based on Murray's statement and pharmacy orders. Chernoff says that benzos being bought doesn't mean that they are used. Shafer says that he stand by his statement that says "information suggests a higher dose possibly 40 mg". 

Chernoff asks if Shafer did a simulation for oral Lorazepam. Shafer didn't do a simulation for it. Chernoff asks Shafer to tell what happens if a person swallow a tablet. It goes to the stomach, half of the pill absorbtion is in 22 minutes, it would then go to the liver subject to first pass, it would have 92% bioavailability and then it would go to the blood and to the tissues and brain. Metabolite would go to the bile and to intestines and stomach. The process is same for the IV lorazepam as well.

Chernoff shows a graph that combines 2 injections of 2mg Lorazepam injections and 40 mg dose graph. Chernoff and Shafer goes over that MJ could not have swallowed Lorazepam in his last 4 hours. 

Chernoff mentions the Midazolam simulation and the numbers match to what CM said he gave.

Chernoff shows the 25mg Propofol injection graph and another graph that Shafer did for White. This second graph shows 25 mg being given over 5 minutes. Shafer says the induction dose is given over 2 minutes because it's less painful to the patient. 

Chernoff asks what's the danger of a rapid infusion. It's apnea. 

Chernoff tries to go over the graph using the blood level, Shafer says he need to look to brain levels. Chernoff asks what was MJ's brain concentration of propofol. There was no measurement for that in coroner's report.