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Trial of Michael Jackson's doctor becomes battle of experts By Alan Duke, CNN updated 3:58 PM EST, Thu October 20, 2011
Los Angeles (CNN) -- Michael Jackson could not have given himself the fatal doses of sedatives and anesthesia that killed him, the prosecution's anesthesiology expert testified in Dr. Conrad Murray's involuntary manslaughter trial Thursday. The level of drugs in Jackson's blood also were far higher than what would be expected based on the dosages Dr. Murray told detectives he gave Jackson in the hours before his death, Dr. Steven Shafer said. The Los Angeles County coroner ruled that Jackson's June 25, 2009, death was caused by a combination of sedatives with the surgical anesthetic propofol, which Murray admitted he used to help Jackson sleep. Toxicology results indicated Jackson was given 10 times the dosage of lorazepam and several times the amount of propofol that Murray described giving him, Dr. Shafer testified. Murray, in a police interview two days after Jackson's death, said he gave Jackson a total of four milligrams of lorazepam in two separate doses starting 10 hours before his death. The level of lorazepam in Jackson's blood at the time of his autopsy show "this did not happen," Shafer said. Instead, the blood levels suggest he was given 40 milligrams -- not four -- in a series of 10 doses, he said. Blood levels also disprove Murray's claim that he injected only 25 milliliters of propofol into Jackson more than an hour before he stopped breathing, he said. It would take an injection of 100 milliliters within minutes of his death to create the level of propofol found in Jackson's blood, he said. Murray's defense is built around the theory that Jackson self-administered the fatal overdoses, but Shafer said science and common sense disprove that possibility. The defense claim that Jackson swallowed eight lorazepam tablets while Murray was away was based on testing of his stomach contents. But Shafer discredited the defense lab tests, saying a new test showed the equivalent of only "1/43rd of a tablet" of the sedative in the stomach. The defense explanation for the high level of propofol in Jackson's blood also involves a self-administration theory. They say Jackson, desperate for sleep, woke up while Murray was away and used a syringe to inject himself. Dr. Shafer said the theory makes no sense. "People just don't wake up hell bent to grab the next dose in a syringe, draw it up and shove it in their IV again," Shafer said. "It's just a crazy scenario." Although the defense recently abandoned the theory that Jackson may have swallowed propofol, the prosecution still worked to use their old theory to discredit Dr. Paul White, the anesthesiologist who will testify soon for the defense. A report prepared by Dr. White last March concluded oral ingestion of propofol could have killed Jackson, but Dr. Shafer testified it ignores the "first pass effect" that is taught to first-year medical students. The liver is a "powerful mechanism" for filtering propofol from the digestive tract so that only a very small percentage can reach the blood, Shafer said. Shafer cited several studies on rats, mice, piglets, dogs, monkeys and humans that he said proves swallowing propofol would have no effect. "There was no sedation at anytime following oral consumption of propofol," Shafer said, describing the results of research he commissioned on university students in Chile over the summer. The human study was done not only to prepare for the Jackson trial, Shafer said, but also to counter an effort by the Drug Enforcement Agency to consider tighter restrictions on propofol. The drug is not currently a controlled substance, but publicity over the theory that Jackson's death might have been caused by oral ingestion prompted federal regulators to considered a new requirement that "it to be handled almost like morphine," he said. "Patients will be hurt if it is restricted," he said. "Anesthesiologists have to have ready access." The new study assures that if the drug is abused, it would only be done with the intravenous route, which only health care providers have, he said. Dr. Shafter testified Wednesday that Jackson "most likely" died because his tongue blocked the back of his throat, but that he could have been saved if Dr. Murray had used "a simple chin lift" when he realized the pop icon had stopped breathing. Murray was "totally clueless" about how to treat Jackson in those critical minutes, leading to the singer's death, Shafer said. A cardiologist previously testified that he thought Jackson died of respiratory arrest, but Shafer expanded on the theory, saying, "The most likely thing that happened was airway obstruction." "Michael Jackson was trying to breathe, but the tongue had fallen in the back of the throat," Shafer said. "Either a simple chin lift, just that alone, or an oral airway to move the tongue out of the way might well have been all that was required to save his life." Shafer said Jackson would be alive now but for 17 "egregious deviations" by Murray from the standard of care required of physicians. Murray's use of propofol almost every night for two months to help Jackson sleep was so unusual, there is no documentation on the dangers, Shafer said. "We are in pharmacological never-never land here," Shafer said, "something that's only been done to Michael Jackson." The trial, in its fourth week, is expected to conclude with the start of jury deliberations near the end of next week. http://edition.cnn.com/20...cnn_latest "When Michael Jackson is just singing and dancing, you just think this is an astonishing talent. And he has had this astounding talent all his life, but we want him to be floored as well. We really don´t like the idea that he could have it all." |