Thursday, January 6, 2011

Dr. Conrad Murray Prelim: Day 3 Part II

Thursday, January 6 notes, edited and ed. notes by Caligirl9 on January 7, 2011 @ 6 p.m.
Correction edit by Sprocket 1/8, 9 p.m.

Afternoon session.

When I got in the elevator to go down to lunch, Mona, the excellent sketch artist who’s inside the courtroom, was in the elevator too. I asked her what family was in the courtroom. Faux pas! She said, “Well there’s one family member.” One of Michael’s brothers was in the elevator standing right beside her. I was so embarrassed! I apologized. I said, “I didn’t recognize you.” He smiled and said, “Sometimes I don’t recognize myself.” So kind. I still don’t know who it was, since the man didn’t look like any media photos of Michael’s brothers that I’ve seen. Oh well.

1:12 p.m.: Back inside the courtroom.
The binder in front of the camera is removed but we have no sound. Pop quiz on the numbers from the morning session tomorrow.

The exhibits are not actually being entered into evidence at this time. They are always clarifying that this is “for reference only.”

Still don't have sound and Judge is on the bench. The deputy leaves to go get the sound turned on. Picture, but no sound. Ah—sound.

Witness #10—Dr. Richelle Cooper: UCLA Emergency medicine physician.

Been an attending since 2008. She details how long she was a resident. June 25th 2009 working at UCLA as an ER physician.

Deputy District Attorney (DDA) Q: Remember being consulted by a bay station call-in?

Dr. Cooper: There is a care nurse, assigned to answer radio calls.

DDA Q: That nurse is charged (to) radioing back to the care for the patient to be given?

Dr. Cooper: Yes.

(Note: We can barely hear this doctor.).

Dr. Cooper details what she learned when she was first made aware of the radio call. She goes over the base hospital form. “My understanding that the arrest was around 12:18.” She needs to review her records.

The time is the “estimated” time of cardiac arrest. This information came from the radio nurse relayed to her. While this bay station call was continuing, she was only being consulted as needed.

Dr. Cooper: “I was told that reputation (at the scene) did not pronounce ay response. I gave permission to pronounce at 12:57 p.m.”

She told that for transport, the personal physician would have to take (control?) and would have to arrive with the patient. She was there when the ambulance arrived.

“I had already prepared a team. As the patient rolled past, I was introduced to Dr. Murray.” Dr. Cooper identifies him for the record. “…Asked him what happened. Dr. reported that the patient a (?) state of health, not ill, had been having trouble sleeping, that he was dehydrated and had not been sleeping. He reported that he had given the patient 2 mg of lorazepam [Ativan] and then later another dose. Did not mention that he had given the patient any other drugs.”

Murray stated he witnessed the arrest.

Dr. Cooper continued: “I asked about reported past drug use that he may have been taking other than the Valium and flomax. There was no seizure activity or if the patient had any chest pain before the arrest. Murray reported no seizure activity preceding the arrest.

Murray told her he [Jackson] took Valium and Flomax. It’s for urinary flow problems. Describes what Valium is.

DDA Q: Dr. Murray stated there was no report of chest pains or anything of that nature?

Dr. Cooper: Correct.

The patient had no sign of life. The pupils were fixed and dilated. The patient was dead on arrival to UCLA. Despite that condition, they attempted to revive the patient. No pulse; no other signs of trauma. Proceeded to administer other drugs. Patient is still being ventilated and CPR is continuing and cardiac monitors on the patient.

DDA Q: Did you ever note or feel or observe a pulse on the patient?

Dr. Cooper: “I did not. There was report of a pulse being felt on the nurse call sheet.”

She lists the “starter drugs” that were additionally given to Michael Jackson. They were not effective. Time spent on the patient, 1 hour, 26 minutes. She made the decision at 2:26 p.m. to call the patient deceased (stop treatment).

Blood was drawn from the patient for later medical testing. When Jackson arrived at UCLA, he was given a medical record number/name to track everything until the patient is formally registered. Gershwin was the name given to Michael Jackson, so that things can be recorded and labeled immediately so they can perform care.

DDA Q: What is a urinary catheter?

Dr. Cooper: Urinary catheter, it’s put on the penis. For those that are incontinent or when they are sedated.

She observed that when he came in, he had on a condom catheter.

DDA Q: At any time did Dr. Murray indicate that he had administered Propofol or any other benzodiazepine?

Dr. Cooper: No.

DDA Q: Have you ever been involved in or witnessed or was present in a situation where a medical doctor was administered in a home setting?

Dr. Cooper: No.

DDA Q: Are you familiar with Propofol?

Dr. Cooper: Yes, I’ve used it before. Used it for a procedural sedation. To like, set a broken bone. Also use it sometimes when patients are intubated, and we don’t want them to wake up. So, in a surgery situation where you want to put the patient under. Yes. I’ve seen it used in outpatient setting, but not in a home setting.

CROSS: Defense Attorney Flannagan.

Q: Do you yourself use Propofol?

Dr. Cooper: Personally, I’ve administer it patients.

As an ER physician, she doesn’t need to be licensed to use it. Any doctor can use any medication.

She pronounced the patient originally at 12:57 p.m.

There was a report by Dr. Murray that he had detected a pulse which was in conflict so she made the decision to attempt.

Q: There was one other person who said that they detected a pulse?

Dr. Cooper: “I can not confirm.”

Q: Was it Dr. Wang? Do you have your medical records with you? Did you write in the name of the person who felt the pulse?

Dr. Cooper: “No I did not.”

Q: Do you have BATE stamp 2132. I left mine in the car. Mr. Walgren is complying.

Dr. Cooper: “This is a nurse-scribed note” (about the feeling of a pulse).

I don’t know who reported the pulse. Dr. Murray was in the room and did have gloves on.

Q: Was Dr. Murray hands-on in the room?

Dr. Cooper: “When he arrived, yes.

“I was never able to confirm a pulse. Sometimes, people feel a pulse that isn’t there.

“I began questioning him as soon as he came in the door. He reported to me that he was there when the patient stopped breathing.”

Q: What is it that you see, when you witnessing an arrest? (snip)

Dr. Cooper: I heard him to mean that he saw the patient stop breathing, and administered CPR.

Q: Explain what she would consider “witnessing an arrest.”

Dr. Cooper: “It’s a common phrase that we would use regarding.... if I was in the room.

“My recollection, from my notes, that’s what I was told, that Dr. Murray witnessed the arrest.”

Q: Does it have the same meaning for all medical people?

Dr. Cooper: “I can’t speak for all people. But I would say for all physicians, they would say, ‘witnessed arrest.’” [Ed. note: Yes, a witnessed arrest is pretty much a universal term; any U.S.-educated physician, RN or other educated health care professional knows what this means. It is significant because you have a more accurate idea of how long the patient has been without pulse or spontaneous respirations.]

She did not ask Dr. Murray to elaborate what he meant.

She asked Dr. Murray if Jackson used recreational drugs.

“I had a 50 year old male that was dead. I didn’t know why. This is a common question.”

Q: Did not ask Dr. Murray what time he gave the lorazepam.

Dr. Cooper: “The exact time, no.”

She didn’t ask and wasn’t given any time frame.

[Defense attorney questions about drugs given to Michael Jackson]

Q: Isn’t the timing of the dose important?

Dr. Cooper: (She pauses before she answers) “I suppose you could say the timing would be important, if I was administering more sedative medication.”

Q: Which situations Propofol is used?

Dr. Cooper: (Amount used for procedural sedation, witness asks back). “Every patient is a little bit different.”

Q: Defense attorney mentions MJ’s weight—136 pounds, and asks how much for that weight.

Dr. Cooper: (Generally) 60 mg. is what she usually starts with.

Q: Asked if that is a little conservative.

Dr. Cooper: In MJ, it could produce sedation. Sometimes we have patients (where that happens).

Q: Defense attorney asks about 25 mg. dose

Dr. Cooper: Generally 60 mg would last 10 to 20 minutes. You wouldn’t expect a sedation (of) more than 5–10 minutes on only 25 mg. (of lorazepam).

“I don’t know how long that dose would last. A dose usually takes 20-30 minutes to wear off. Everyone’s different.”

“I wouldn’t know why someone would use that amount. I would not expect that 40 minutes later that medication would have an effect.”

Q by defense attorney, talking about 25 mg infusion over 3 to 4 minutes of time.

Dr. Cooper: I would not expect... (Illegible).

Q: “What if” scenario... that if gave that medication at 10 a.m., and at noon, the patient stopped breathing, you would not expect that it was the medication that caused it would you?

Dr. Cooper explains that if she was administering a sedative... she would be concerned...(illegible).

If you’re not giving continual medication, then the meds clear within 10 to 20 minutes.

Q: What is it that lets you wake the patient up so quickly? Asks if she had known Propofol was administered would she have treated any differently?

Dr. Cooper states she was treating a cardiac arrest.

[I think I have this next part correct.]

IF there was no other medication given (between the sedative and the arrest) she would not think the events that were related.

“If there is more than one sedative, there is an additive effect.”

If a one time dose of Propofol, I would not expect (an hour later) the Propofol would have any effect.

REDIRECT DDA

DDA Q: Mr. Flannagan wanted you to assume that Dr. Murray gave Propofol around 10:40 to 10:50 [a.m.], only 25 mg. However if that was not a truthful statement, your answer would (differ significantly).

DDA Walgren asks if the drugs on top of drugs were given to Jackson, would that be an accumulative effect?

Dr. Cooper replied that protocol requires certain monitoring to administer Propofol. There needs to be equipment available to monitor the airway. There must be heart monitoring. There has to be a staff person available as their only job to monitor the equipment/patient.

DDA Q: So that the patient doesn’t die?

Dr. Cooper: “Yes.”

RECROSS (defense)

Q: When (a physician) takes a history, it is for purpose of treatment?

Dr. Cooper: “Yes.”

She clarifies that when she asks for history of drug use, it’s relevant to the treatment at hand. She tries to get a medical history of the treatment at hand. (I don’t think I’m explaining this correctly. Editor’s note: Yes you are.)

Q: If you had known that Dr. Murray had been giving Michael Jackson Propofol all this time, that would not have made and difference as to the medical treatment you had given him?

Dr. Cooper: “No.”

REDIRECT DDA

Answering defense attorney’s question, Dr. Cooper said she would want to know about “any medication that was given to the patient. It would have been helpful. It would have given me a (fair) interpretation as to what had occurred.”

Witness #11—Dr. Thao Nguyen, cardiologist fellow, UCLA

DDA takes Dr. Nguyen through her credentials. Working as a cardiologist fellow on 6/25 for cardiac intensive care unit. How long?

Dr. Nguyen: Three and a half. In June I had finished my fellowship.

I am the one responsible for the whole unit the entire staff.

DA asks her role on June 25, 2009.

Dr. Nuygen: She was called to the ER by Richelle Cooper. When she came down Dr. Cooper was working on the patient. Dr. Cooper introduced her to the defendant. She met Dr. Murray in the ER. Asked Dr. Murray what happened.

“He told me he was the physician for the patient. The patient was preparing for a tour in England and had some difficulties sleeping and had been giving some medications for sleep. Asked him what did you give? He said, ‘4 milligrams of Ativan (lorazepam) via IV.’”

DDA Q: At that time were you aware of the condition of the patient?

Dr. Nuygen: “Yes.”

DDA Q: What follow up questions did you ask?

Dr. Nuygen: Asked him if he gave any other medications.

DDA Q: What did he tell you?

Dr. Nuygen: “No.”

DDA Q: What did you ask him next?

Dr. Nuygen: Did you try to reverse the effect of the Ativan? He said no.

Physician asked Dr. Murray what happened after he gave the medication. “He told me that he later found the patient not breathing. “Asked him when he found the patient not breathing. He said he did not know the time.

DDA Q: Did you ask him when he had the patient “down” [ed. note: not responsive, not breathing, possibly pulseless] when he made the 911 call.

Dr. Nuygen: “He said he did not have a watch and he did not have the time.”

(He didn’t know the time lapse.) Not able to give her any kind of time estimate as to when the drug was injected as to when the patient went down or when the patient was found not breathing.

DDA Q: Were there any other questions directed at Dr. Murray or does that sum it up?

Dr. Nuygen: Dr. Murray did tell us, he asked me to try to save the patient.

DDA Q: Did he ever mention giving the patient Propofol?

Dr. Nuygen: No.

DDA Q: Did he ever mention giving the patient other benzodiazepine medications?

Dr. Nuygen: “Absolutely not.”

She did [place] the balloon pump, after the time [of death] was already called. She didn’t think it would work based on all that had been done already. So, an agreement was made with Dr. Murray that if the balloon pump failed, then they would call the time of death.

When the time of death was called, she looked at her pager; she noticed the time was 1:35 p.m.

The afternoon break is called. More to come....

2:55 p.m.: Back in side the overflow room.

I see on the video Dr. Murray coming out of the jury room. He must have used the restroom in there. This is not unusual. During the Brown case, when the jury was not in the courtroom, court personnel, attorneys, etc. often used the jury room bathroom.

CROSS of Dr. Nuygen by defense attorney Flannagan (sp?)

Q: In your practice do you use the drug lorazepam?

Dr. Nuygen: “Yes sir.”

Q: Four milligrams of the drug, in a 136-pound patient, how long would it keep him to sleep.

Dr. Nuygen: It takes about 15 minutes or so (to put him to sleep?)

Q: How long would that last?

Dr. Nuygen describes the type of drug it [lorazepam/Ativan] is. It is used for anxiety. Also used to induce sleep.

Q: If use it to induce sleep in 136-pound patient, how long should it induce sleep for?

Dr. Nuygen: It’s half-life is about 14 hours [ed. note: Physicians’ Desk Reference states half-life of Ativan is 12 to 15 hours]. But you also have to take into consideration the (prior use of the drug in this patient.) She describes what half-life is. The time it takes for the medication to have 1/2 of the effect. [Ed. note: Dr. Nuygen is not totally accurate here. Half-life is the amount of time it takes for the body to metabolize and excrete the drug. Knowing a drug’s half-life helps doctors know how often to prescribe a medication. The drug may not have an effect on the patient at this time, but can contribute to an accumulative effect.]

Q: Defense attorney tries to give Dr. Nuygen a hypothetical. She comes back with questions of her own, saying she needs the information. We all laugh.

Dr. Nuygen replies that she would start with a very small dose, 1 mg. She would not start with 4 milligrams.

Dr. Nuygen: “I do not know anything about Dr. Cooper’s report.”

Q: So, you would start with 1 mg, possibly 2?

Dr. Nuygen insists that she would need to know about prior use of the drug with the patient.

She states if you keep using the same medication, you would have to use a higher amount because you reach a higher concentration. If the medication is given IV, depending on the metabolism through the liver.

“I am not aware of the blood level of this patient.”

Q: Would you expect the blood level 169, to produce sleep? (Obj. sustained.)

Dr. Nuygen: We usually do not measure that.

(Sprocket note: With her accent, it’s hard to understand her, even though she is speaking as clearly as she can.)

Dr. Nuygen: When you are given lorazepam or/and benzodiazepine, you are expected that you give a certain dose per weight. I thought I explained that it’s not known in relation to blood levels.

Q: Do you know anything about blood levels?

Dr. Nuygen: “Again, that’s not how we measure.”

Q: When you were taking to Dr. Murray, you said he had no concept of time. (Obj. sust.)

Dr. Nuygen: It’s not my conclusion. I am not saying as to how he appeared. This was his answer to my question.

Q: Did you have an impression of his emotional state?

Dr. Nuygen: “Do you want my opinion of his emotional state? He appeared devastated.

Q: What do you mean?

Dr. Nuygen: You want the definition of devastation?

(Laughter)

Q: What was it that caused you to believe that he was devastated?

Dr. Nuygen: His facial expression.

Q: What about his voice?

Dr. Nuygen: “His voice was normal. He appeared calm. The voice was calm.”

Q: That facial expression, that just caused you to determine he was devastated.

Dr. Nuygen: “Yes.” (snip) The body language.

I did not ask him if he gave lorazepam. I asked him what drugs he gave.

I asked him what time and he could not give the time. He could not give an estimate.

This was the time I saw on my pager that I started talking to him 1:35 p.m.

The other doctors, I recognized Dr. Cooper. (There may have been other residents.)

Q: Was there a lot of confusion?

Dr. Nuygen: There was no confusion.

Q: Not at UCLA?

(Judge Pastor, I think states there was activity.)

Q: This questioning of Dr. Murray took place at 1:35 in the room where there were five or six people working on Michael Jackson.

Dr. Nuygen: Correct.

Q: And you’re asking him what time he gave what drugs. (Withdrawn).

It was at this time, did you think you had his full concentration?

Dr. Nuygen: Yes. He was not watching the patient while he talked to me. He had established eye contact with me throughout the conversation.

Q: How long was the conversation?

Dr. Nuygen: “About 2 minutes. He was standing at the left leg of Michael Jackson. The size of the room was about a quarter of this room.

“Dr. Cruz did not arrive until I asked him to come down.”

Q: Dr. Cruz was the one who used the balloon pump?

Dr. Nuygen: Dr. Cruz and I operated the balloon pump.

Q: And whose idea was it?

Dr. Nuygen: Dr. Cruz.

Q: You did the balloon pump?

Dr. Nuygen: “Yes. We continued on the request of Dr. Murray. He did not want us to give up.”

Q: When you learned there was Ativan in the patient, did you use any drugs to reverse the lorazepam? Just talking about this case. Did you use any drugs to reverse the effects of the lorazepam?

Dr. Nuygen: I asked why. Before I decided not to use, I asked Dr. Cooper, if lorazepam had been used/reversed. She said no. (So the time of reversal was lost.)

At the first time of distress, that’s when the drug needs to be administered.

Q: Dr. Murray didn’t give the order for the balloon pump did he?

Dr. Nuygen: “No. It was not his advice, to put in the balloon pump. Yes.”

Q: Without any indication?


Dr. Nuygen: The indication was cardiac failure.

Q: Did the balloon pump, that was the purpose, to reverse the drug induced cardiac arrest?

Dr. Nuygen: No sir. That’s not what I said. The indication of the balloon pump is to assist the heart when it was failing. But it doesn’t reverse the drug. It only assists the heart.

“Only when the window of time will allow (to use the reversal medication).”


Defense has no further questions.

REDIRECT DDA

DDA Q: When you were presented with a number of hypotheticals by Mr. Flannagan. When you would give 1 “p.o.” that would be giving it by mouth, orally, because it would be safer?

Dr. Nuygen: “Yes.”

DDA Q: A few more questions.

Dr. Nuygen clarifies that she clearly heard and understood Dr. Murray (when questioning him at the hospital).

That’s it for this witness

Witness #12—Dan Myers: Detective LAPD

Judge: Heard previous admonitions?

Myers: Yes your honor.

Background: Employed at LAPD. Currently work in Robbery-Homicide. Lead investigators.

DDA Q: Examination of Dr. Murray’s cell phone calls. Dr. Murray had 2 cell phones in his name. Is that correct?

Myers: “Yes.”

He examined the cell phone records provided by the vendors.

DDA Q: Focused the phone activity of June 25th 2009, from midnight 6/24h through the conclusion of 6/25.

Myers: Yes I did.

DDA Q: What was the purpose of contacting the phone numbers?

Myers: To identify the person or persons who were dialed.

Exhibit 20 on ELMO

DDA Q: First call—7:01 am call from 3747 (Dr. Murray) to 0266? Did you call that number 11/17th.

Myers replies 0266 belongs to Andrew Butler.

DDA Q: Important question. How long employed (by LAPD)?

Myers: A little over 23 years.

DDA Q: Did he verify was in fact his residence phone number? Did you ask him if he knew Conrad Murray?

Myers: He identified him as his friend and doctor.

DDA Q: Asked him (Butler) if he received a phone call...

Myers: He said he did not recall receiving a call from Dr. Murray. He said Dr. Murray was the physician.

DDA Q: 8:49 a.m. (702) 683-5217 from to 3747 . Did you dial that number?

Myers: Angelette Guild. Myers spoke with Ms. Guild. Asked if she knew Dr. Murray. She said he was a friend and her doctor. She said that she had received a letter in the mail that he would not be in the office and she called the doctor to inquire.

DDA Q: 9:23 a.m. 2909 from to Murray 0973. Who used the number 2090?

Myers: Spoke to a M. Bioni. Marissia, A friend of a daughter of her friend. Asked if her knowledge of Dr. Murray. She said that’s my friend’s father. She said, yes, that’s girlfriend Chanelle, in California.

DDA Q: 4955 to 9073 to Dr. Murray’s phone?

Myers: Called that number to identify the owner of the phone. Belonged to Acres Home and Cardiology Clinic in TX.

DDA Q: 10:22 a.m. 0124 phone call from to Dr. Murray.

Myers: Talked to a Dr. Prechad (sp?). She indicated that she in post-op room in hospital and ready to perform a procedure and she needed to know what kind of medication that patient was receiving. She needed to know if she should continue medication. She did talk to Dr. Murray and they discussed the care for this patient.

DDA Q: Was Dr. Murray able to assist her with the information?

Myers: He recalled the patient by memory. The patient was a few months post-op from a stent. Dr. Murray recalled the patient and the amounts of the medication. She indicated that in her short telephone call of less than 111 seconds, Dr. Murray was able to recollect the patient, provide her with necessary information as medications as well as info on the procedure conducted 2 months earlier.

DDA Q: 10:34 a.m. From Murray 3747, (619) 994-3223.

Myers: Called around the same time/date, called Stacey Howel-Ruggles. She said she knew Conrad Murray, and that she was his personal assistant.

DDA Q: Did you ask Ms. Howel-Ruggles if she had a conversation?

Myers: She said that she did remember the conversation, because it was an anniversary. DDA Q: Ms. Ruggles told you that Dr. Murray directing her, requesting of her, drafting a letter concerning the upcoming tour in London.

Did you ask her if he seem distracted during the phone call?

Myers: She did not indicate that he appeared to be distracted or tired.

DDA: Did you ask her directly—did Conrad Murray appear distracted? And what was her response?

Myers: That he did not appear to be distracted.

DDA Q: 11:07 a.m. Same Ruggles phone number. 11:18 placed call to 6802.

Myers: contacted that number 32-minute phone call.

DDA Q: Who was that? What is that location?

Myers: It’s Dr. Murray’s practice in Las Vegas. (Detective physically went to that location.)

DDA Q: That call duration to Global Cardiovascular.

11:26 another call to Conrad Murray.

Myers: A Miss Morgan. She confirmed that was her number.

Another call from Dr. Murray to a Robert Russell. It was his number. Dr. Murray was his cardiologist.

11:51 a.m. from Murray 093 to 3832. Myers contacted that number.

DDA Q: Who did you speak to?

Myers: Ms. Saday Adinie. She knew Conrad Murray.

(Objection to the conversation, but what the conversation was about is not relevant.)

She did in fact receive a phone call, and she spoke to Dr. Murray on the telephone.

DDA Q: 12:12 pm from Murray to Michael Admir Williams, and that we had testimony from him.

1:08 p.m. to 8070 from Murray to Ms. Nicole Alvarez.

Myers contacted Ms. Alvarez.

DDA Q: Did you determine how she knew him?

Myers: He is the father of her child.

DDA Q: How old is the child in common? (Sustained objection.)

End of direct.

Judge Pastor asks if defense had a few questions, no more than five minutes or if this would be a good time to take a break. They take a break. Pastor asks to see counsel at the bench.

9:30 a.m. resume tomorrow, January 7.

5 comments:

Anonymous said...

I am reading all of your reports. They make me feel like I'm there.

David In TN

KZ said...

Reading each of your installments with great interest! I know you're probably very tired, but please know how much your efforts are appreciated! (I won't rant and rave today about Murray's incompetence, I promise! I'll just read quietly.)

Kimberly said...

I want to thank you providing us with such detailed coverage of the hearing. While this is very hard to hear, we are finally getting to know what really happened. Thank you very much.

Anonymous said...

You are wonderfull, a big hug!

susan said...

thank you so much for all your efforts...Please keep up the good work It is so important to all of us that cannot be there what you are doing....
Thank you again