Murray Trial Day 22 November 1, 2011

Dr White Testimony

Flanagan redirect

Flanagan again mentions the variability in the models. 

Flanagan shows the Lorazepam model that includes 16 mg oral consumption which is based on 0.0013 mg in the stomach content. If you move the oral intake to 8 AM, the amount of free Lorazepam in the stomach would equal to the 0.008mg found in the autopsy and the concentrations find in blood. 

Flanagan goes over the 0.3 free Propofol in the urine. In a model about 100 ml Propofol infusion over 3 hours the level of propofol would range from 1 to 3 mg in urine. 1 mg is the 10 times the amount found at autopsy.

Flanagan mentions the burn feeling of propofol will be increased by small veins, the concentration of the drug and the speed of the injection. Lidocaine is given before the infusion, or at the beginning. White says given the half life of lidocaine and with a 3 hours infusion there shouldn't be lidocaine found at autopsy, and there was 0.84 mg/ml at autopsy.

White says if there were 2 injections, Lidocaine would have been given twice and White would expect the lidocaine to be around the levels found at autopsy. 

Flanagan mentions standard of care versus standard of practice. White says standard of care is the ideal that they would seek for every patient but it's not always possible. 

Flanagan goes over minimal sedation. There would be normal response to verbal simulation. Flanagan asks if he took an ambient if White would be able to wake up by talking to him. They discuss 25 mg Propofol. White sys it would reduce anxiety and generally would not produce sleep. White says it could create a restful state if the patient is very tired. White also says that any noise in the room would wake the patient up. White says with minimal sedation airway, breathing and cardiovascular functions will not be affected.

Flanagan’s redirect of Dr. White is over. Walgren does not recross. 

Off camera judge asks Dr. Murray if he will testify. Murray says that he won’t testify. 

Judge gives a 30 minute break so that the prosecution can decide whether they would do a rebuttal. 

After the break Walgren calls Dr. Shafer for rebuttal. 

Dr. Shafer Rebuttal Testimony

Walgren direct

Walgren asks if Lorazepam is given IV would some of it go to the stomach. Shafer says yes and it has nothing to do with post mortem distribution. 

Walgren asks and Shafer agrees that there’s no way to differentiate between MJ taking oral Lorazepam and CM giving MJ oral Lorazepam.

Walgren brings up Shafer’s 100 ml Propofol infusion over 3 hours. Shafer says it doesn’t show when MJ died and it was not necessarily at 12:00PM. Shafer says it was basically to show that MJ died with infusion running. 

Walgren asks about the IV setup. Shafer says controlling the rate with the clamps are commonly done with some medication that you don’t need to precisely set the rate but a pump is required for Propofol.

Shafer says the Lidocaine levels found at autopsy is not inconsistent with 100 ml infusion over 3 hour simulation. Shafer says Lidocaine could have been mixed into the Propofol bottle. 

Walgren asks about the main risk of Propofol and Shafer says its failure to breath and the lack of oxygen in the heart kills the heart. 

Walgren brings up the article the defense used in their simulation about the unchanged Propofol in the urine. Shafer says he researched the literature. 1988 article that the defense used says they found very little (0 to 0.3) unchanged propofol in the urine but they didn’t know if it was free propofol or its metabolite. 

Shafer says there are newer articles on the subject. The most detailed one is a 2002 article. 2002 article measured the actual unchanged propofol and the level was between 0.002% to 0.004%.

Autopsy urine propofol was 0.15 mg/ml . 500 ml of the urine = 82.50 micrograms of propofol . 

Walgren shows a table from the 2002 article. The average Propofol found is 70.71 micrograms of propofol in the urine; it corresponds to a dose of 2000 mg.

Shafer says this absolutely rules out Dr White's theory and it actually suggests that MJ received more propofol that what even Dr Shafer thought.

Walgren asks about standard of care such as for an anesthesiologist providing care in a remote location (ex: radiology suite, etc..), . Shafer says you have less tolerance for error, because you have no back up. You should not take short cuts. Shafer says if there was such a thing as bedroom based anesthesia, if you have an error, you have mortality. So the standards of care would actually be higher.

Flanagan cross 

Flanagan argues with Shafer about what he wrote in his report about lidocaine. Shafer thinks Flanagan misunderstood what he wrote. Flanagan asks Dr Shafer to read a paragraph from his report.

Flanagan goes over the 2002 article and if the 25 mg propofol dose was a sub anesthetic dose. Shafer says in most patients it's a sub anesthetic dose and it depends on what other medication is on board. Flanagan is trying to say that the article didn't mention sub anesthetic doses.

Walgren redirect 

Walgren tries to clear the issue about the article and the use of sub anesthetic dose, Shafer says the use of a larger doses makes the result more precise, that's all.

Both sides work on a stipulation. Stipulation 52a says that Peoples 52 reflects the accurate phone numbers.

Both prosecution and the defense rest their cases. Judge informs the jurors that both sides asked for a day to prepare for their closing statements. Judge excuses the jurors. In a not televised afternoon session judge and the both sides work on jury instructions. 

There will be no court on Wednesday November the 2nd. Closing statements and jury instructions are set for Thursday November 3rd. Court would start at 9 AM.