Rival Experts Testify at Trial of Michael Jackson's Doctor

Mark Crane

October 27, 2011

October 27, 2011 — The testimony of 2 renowned anesthesiologists who have been colleagues and friends for 30 years, but are now on opposite sides, could determine the fate of pop star Michael Jackson's physician, who is on trial in Los Angeles, California, for causing the singer's death.

Dr. Conrad Murray

Conrad Murray, MD, a Houston cardiologist hired by Jackson at $150,000 a month to be his personal physician while the singer rehearsed for a concert tour in 2009, according to the Los Angeles Times, is charged with involuntary manslaughter. Prosecutors accuse him of administering a fatal dose of propofol, a powerful drug usually used during surgery, and then failing to properly monitor his patient. They also faulted him for botching resuscitation efforts and for lying to paramedics and emergency department physicians about the drugs he had given. If convicted, Dr. Murray could face a sentence of 4 years in prison.

Steven Shafer, MD, editor-in-chief of the journal Anesthesia and Analgesia and a professor of anesthesiology at Columbia University, New York City, spent 5 days as a prosecution witness lambasting Dr. Murray's care and use of propofol as a sleep aid, which he called "unconscionable." Dr. Shafer, who wrote the package insert for the drug, testified, "We are in a pharmacological never-never land here — something that was done to Michael Jackson and no one else in history to my knowledge," according to the Los Angeles Times and other media reports.

Paul F. White, MD, director of research at Cedars-Sinai Medical Center in Los Angeles and author of several journals and textbooks on anesthesiology, is expected to testify for the defense that Jackson may have either orally ingested or injected himself with the drug while Dr. Murray was in the bathroom. The trial was briefly delayed earlier this month when both physicians received awards at the American Society of Anesthesiologists conference in Chicago, Illinois.

The trial has caused considerable animosity between the 2 colleagues. Dr. White was allegedly overheard uttering an epithet during Dr. Shafer's testimony, according to E! Entertainment's online report. Dr. White denied making the remark but admitted accusing prosecutor David Walgren of being "unethical." Superior Court Judge Michael Pastor has ordered a hearing on November 16 at which Dr. White could face possible contempt charges for violating a gag order prohibiting witnesses from talking to the press. "You have no business making any of those comments," he told him.

Dr. Shafer testified he was "disappointed" with Dr. White's theories on the case. Dr. White responded in an interview with the network's Web site that, "I am going to take the high road, not the low road with him. I was his teacher when he was a medical student. The truth will come out. It always does." Dr. White was a professor at Stanford Medical School in California when Dr. Shafer was a student.

During his testimony, Dr. Shafer issued a scathing denunciation of Dr. Murray's care and said he was directly responsible for Jackson's death. He cited 17 "egregious" deviations from the standard of care and called Dr. Murray "clueless" about using propofol. When Jackson was found not breathing, Dr. Murray should have called 911 immediately, but instead allegedly left voicemails for members of Jackson's staff. "That is so completely and utterly inexcusable," Dr. Shafer testified, adding that Dr. Murray should have rejected the singer's requests for propofol as a sleep aid. "If a patient requests something frivolous or dangerous, it is the doctor's responsibility to say no."

Dr. Shafer said he was testifying without a fee because he wants to restore public confidence in physicians who use propofol, which he called a wonderful drug when properly administered. "I am asked every day in the operating room, 'Are you going to give me the drug that killed Michael Jackson?' This is a fear that patients do not need to have," he said, according to the Associated Press.

Dr. Shafer testified that he did not believe that Jackson could have injected the propofol himself and that swallowing the drug wouldn't produce sedation or any ill effects. He speculated that Dr. Murray gave the singer the drug intravenously.

Defense attorney Ed Chernoff attacked Dr. Shafer for speculating about what happened the night Jackson died. "You chose this out of thin air, you chose this example?" Chernoff asked. Dr. Shafer said he had to speculate because Dr. Murray kept no records. "You do know the difference between opinion and fact?" Chernoff asked, according to a video of the trial on MSNBC.

Dr. Murray has acknowledged giving Jackson propofol nightly for 2 months. The defense has suggested Jackson had used propofol for insomnia on and off for a decade before his death.

Defense attorneys have claimed that lorazepam levels found in Jackson's stomach contents suggested that he may have taken several pills before his death without his physician's knowledge.

Dr. Murray's attorneys will begin calling witnesses on October 28. They plan to call 15 witnesses, who will include police detectives, character witnesses, and Randy Phillips, the head of AEG Live, the promoter of Jackson's planned series of comeback concerts.

In a strange way, the attention the trial is receiving is having a positive effect by causing patients to ask more questions, 2 leading anesthesiologists told Medscape Medical News.

"Propofol was never designed as a sleep aid," said John F. Dombrowski, MD, chairman of communications for the American Society of Anesthesiologists and a practitioner in Washington, DC. "It's always administered in a medical environment, not in someone's home.

"As many as 40% of my patients now ask if I'm using propofol," he said. "Before the trial, patients rarely asked what drugs I'd be using. Now, due to this tragedy, we can reassure patients that the propofol is safe when it's used appropriately."

Patricia Brown, MD, past president of the New Jersey Society of Anesthesiologists and medical director of Children's Hospital Philadelphia Surgical Center in Voorhees, New Jersey, has had a similar experience. "Teens and parents are asking if there will be constant monitoring, and who will be at the head of the operating table," she said. "They are asking critical questions, which is great, and they understand that you need a qualified professional to administer propofol.

"Propofol is an essential drug in anesthesia, and it's a shame that it's getting a bad rap because of what happened to Michael Jackson," she said.

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