Dr. Conrad Murray Prelim: Day 6 Part I

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9:20 a.m. Pastor is on the bench but we don’t have sound.

Deputy calls for us to get sound.

The PIO states that if/when this goes to trial.

Sound. People call Dr. Rodgers to stand.

#21 Christopher Rogers

Witness instruction.

Emoloyed LA Co coroner. position. Chief forensic medicine. Supervise doctors who work at coroner’s office, and occasionally do autopsies himself. Employed since 1988 as a forensic pathologist. Explains that job.

He determine the cause and manner of death in coroner’s cases and write reports.

Lists educational background.

How many autopsies have you performed or been invoved in?
I would estimate thousands.

Describes autopsy and purpose.
To determine cause and manner of death.

Did you perform the autopsy in this particular case in case? Yes. On June 26, 2009

2009`04415

Autopsy did show incedential findings however his overall health was excellent.

Prostate issue; vitillago, polop of the colon, inflammation and scaring of his lungs, and also had some arthritis of the spine.

He was 5’ 9” and 136 pounds.

What is BMI? Stands for body mass index. Often used to estimate if the person was in the normal weight range.

Was he a thin individual? Yes.
I thought his BMI was 20.1.
Where does that fall? That’s normal weight.

He did not have any abnormalities of the heart and he did not have any artherclerosis.

The vitality of his heart? He did not have any cardiac disease.

Did you observe and trauma or any natural disease that would have caused his death? No.

As part of your investigation as a medical dr in determining the cause of death, did you consider sources other than the observations of the body? Yes.

Did you review the transcript of Dr. M interview ? Yes.
Did you consult outside sources? Yes.
Did you review the toxicology reports of MJ time of death? Y

Based on your investigation, did you also seek out medical records of MJ in the months preceeding his death?

Did you or were you provided any medical records by Dr. M during this time of April May June 2009? No.

Based on phys autopsy and other resources you relied on ?
Manner of death?
Homicide.

Homicide based on what?
It was based primarly based on the info we had on the medical care MJ receded. The care was substandard.

And there were several actions that should have been taken and we don’t have any evidence that they were taken.

Such as.
1st would be physician should not use propofol as indicated. so the use of propofol was for insomnia
2nd when you give a drug such as propofol you have to be prepared for complications. Common, are, lowering of blood pressure, and you need to be prepared to treat that.
there can be difficulty in breathing and air way and have 2 be prep. to treat that via intubation.

The intubation

The dr. left Mr. Jackson while he was anethetistized. and that is something that you should not do.

Why souldn’t ysomething you should not do.
Under anethesia, you have to have someone there quickly, so if there is some bad side effect you can (attend?) to it.

In determinig that this was a homicide, did you determine cause of death.

Accute propolfol intoxication and benzodiazipine effect. The autopsy showed (mentions drugs. Mostly propofol but benzos in less amts.)

Both benzos and propofol are ? medications. (

So, this combined effect, they combined and worked together to create heightened sedation.

Yes, I would expect in combination they would have produced heightened than by themselves.

Cross by Flanagan.

You conclusion as to this being a homicide, assumes the admnistration of propofol by another? Yes.

You’ve made several findings in your conclusion of you is it a fact, you indicated that certain that benzo was administered by another. yes.
and that propofol was administered outside a hospital setting? Yes.
Miss next q.

In your conclusion, situation doesn’t support self administration of self treatment of propofol? Yes.

Did you come across any factors that were inconsistent with your conclusions. No, I don’t believe so.

Dr. I want to refer you to, I believe you have it in your autopsy report, it might be the second to last page? Do you have that in front of you? Yes.
Did you use this page in informing your opinion ? Yes.

Asks info about the heart blood. 3.2 propofol and 6.8 lidocaine see that? Yes.

Now tell me, how do drugs get in to the heart blood?
Well, in this setting, propofol has to be administered intraveinously, and so that blood circulates throughout the body.

Well I was asking generally. Well, there has to be some way to get in there. Through an IV or orally.

So, an injection? Yes. Iv? Yes. Orally, Yes.

Asks about the razapam in the heart blood. .162 razapam.

That’s a significant amount of razapam isn’t it? Y

It’s what we would call a therapeutic does? Yes.
So, someone who hadn’t built up a tolerance would be sleepy (?Y)
So that would be enough to put someone asleep as a sleeping aid isn’t it? Y

It’s not enough to kill someone is it? No, not by itself.

Asks about the proportions of propofol and lidocaine.
And then asks about the hospital blood.

Asks him to explain the differences in 4 to 1 and 8 to 1 ratio.
Explains that one of the things that propol does is go.....? Not understanding. Sorry.

During resusitation and during post motem period, there is time for the propofol to move from circulation into the tissues.

Questions I miss.

Now moving onto the femoral blood questions and other substances and asking about the relationship of the ratios.

Asks why they test from different areas (heart, femoral).

From those tests the lorazopam was fairly consistently distributed throughout (?) Yes, you could conclude that.

Viterous fluid question. He’s not sure why the toxicologist tested it.

The liver. You nalyzed te liver, a 12 to 1 ratio, correct? Yes.

Is that why the liver captures more of the propofol and that’s where it’s metabolized? (short answer, yes; I don’t get the long answer.)

The liver might capture a little bit of it and keep it? Yes.
Gastric contents.

Gastric contents discovered by you during autopsy? Yes.
Those gastric contents, were those the 70 grams of dark fluid?



The dark fluid, how did you get that out of the stomach? At autopsy, I removed the stomach and used a ladle ....missed rest of answer.

Did you have an opinion as to what that dark fluid was? (miss)
You would have known if it was blood? Well, it’s difficult to tell the difference from digested blood.

Do you know if the fluid could have been fruit juice? It could have been.
It could have been beet juice or grape juice? (?)

I did not specifically ask them to analyze the stomach contents, but they did.

Ratio of propofol in stomach.
Two mechanisms for things to get in the stomach. If there is bleeding in the stomach. Another is that things, drugs, can come in from the stomach through adjacent organs.

Is there also antoehr method? Speaking of these particular substances, I think it is possible to take lidocaine orally, I don’t think you could take propofol orally.

Why can’t you take propofol orally?

Well, from my understanding you need to take it via IV.

But in the event that propofol were taken orally, that’s one way it could appear in the stomach? Yes, that’s a way it could appear in the stomach.

When popfol is taken in the vein, it causes a burning sensation, it’s very uncomforatable isn’t it? Yes.

So, usually it’s usually mixed with some lidocaine, or lidocaine is put in ahead of it isn’t it? Yes.

But, if propofol was taken orally, it would have caused pain in the esophogus or stomach? I don’t know.

Miss question.

So, if like if propofol 4.5 to 1 , 8 to 1 and 3 to 1 and the rest of the body favored propofol over lidocaine, if the gastric contents came from the blood system, it would most likely favor propofol over the ????

I don’t know....( long explanation) Lidocaine could possibly be distributed in a different (indication?) than propofol.

Is it your info, propofol in it’s redistribution could go into that dark liquid in the stomach? It’s a possibility.

Also possibility, if propofol is taken orally, and lidocaine taken on top of it, is that also a possiblity? It is a possiblility , although in this case the amt in the stomach is so mall, they would have taken a small amt of propofal orally.

Propofol is a nasodialator? isn’t it? So it owuld have been absorbed quicly?

(miss answer)

So 150 ml of prop taken orally, and it caused a burning sensation, and it caused the need for some lidocane, for the eshop, and stomach, you would have found that porportion in the stomach correct? (answer about rations.

Do you ahve an opinon about how much propool would have to be in the blood stream, to reach those blood levels? No, I would need to rely on a toxocologist to figure those levels out.

The levels (found) were very high levels? You would see that in someone who was under full anethesia? Asks about body weight.

I can’t speak to those (levels?)

You don’t know how anyone gets to anethesia with propofol (levels??) ? No, I don’t.

Asks about millogram per kilogram weight.

The recommended dose would be 2 millograms per killogram weight. ans.


It would depend on extent on how rapidly the propofol is given and over the length of time... (ans)..

25 mil would not get you to those levels. No, it wouldn’t

25 mil of propofol would be cleaned out of the system within in 10 to 20 mnutes? That’s a likely yes.

So if the Dr. gave an injection of propofol of 25 mil, propofol acts really quickly doesn’t it? Yes, I would expect it would take effect within a minute of injection.

If no continuation, the person would wake up in xxx of minutes? (Yes?)

You read Dr. Murray’s statement as part of your, and you read that he gave 25 mg of propofol sometimes between

He never said he gave a drip did he? Well, my recolection of the statement is that he gave it over 25 minutes.. (more explanaton)

But he never said he gave a drip, on that day? No, he didn’t.

Now, the 25 mnutes, you’re relying on that transcription, Yes.

Now if it was 3 t0 5 mnutes, and that was a transcription error, you would expect for the patient to wake up? Obj sustained.

Now arguing over whether to play the transcript and then bring the doctor back.

Now wants to ask the dr. a hypothetical.

JP In order to do that, we have to have facts in evidence.

DW: Counsel has had the transcript in evidence for months now.

EC: If we can’t ask the hypothetical, then, we’ll have to play the tape.

JP: then, where’s the audio.



I’d like to ask him a hypothetical with facts that I think we can prove up.

DW: I don’t know how to respond. (more)

I’ll allow the question to be asked based on good faith, and subject ot motion to strike.

IF Dr M gave a 25 mil of propofol, over a period of three to five minutes, you would expect it to produce sleep. I would think it would produce sleep.

And the sleep would be very short lived wouldn’t it? Yes.

And then sleep would no longer be produced... Yes, I think that would be correct.

In the event a person were to wake up, after 5 ten minutes, and ingest enough propfol... first of all stomach ingestion is only about 3/4 effective at IV? Oral medication is the same mill dose, is only about 3/4 effective in the stomach as to an IV.

Based on propofol needs to be gien via IV I’m not sure what would happen.

So there are not a lot of studies on it right? No.

So if you ahd a totally untrained person, such as MJ, you would expect it to be absorbed into the blood stream wouldn’t it? I don’t now if it would be digested or absorbed.

Questions about injesting lidocaine, you would expect that to appear in the stomach? (Yes?)

Asks questions about ratio in the blood stream.
I’m not sure what would come out of the blood stream.

And if this is the hypothetical, of ingestion of propofol by the decedent, and ingestion of lydocaine, by the decdeent, this would not be a homicide?

I would think it would still be a homicide. Based on the qualit y of the medical of care, I would still consider it a homicide even if the Dr. did not give the propofol,

Just the fact that there was propofol there in the first place. This is not the accepted setting to administer propofol in the first place.

He was not prepared for any adverse effects.

You think the Dr. should be ? for ?

have you ever seen where a pateint self administered propofol? I have seen one case? And that was a Dr/ Yes.

Are you aware of one in LA county? I believe there is at lest one, I’m not sure whether it was in LA county or not. I know I heard of a case in???

When that nurse self administered propofol, did you call it a homicide? obj sustained.

Asks about anethesiologist consultation. Answered a question, could the decedent have given propofol himself, and based on that (ans?) you stated the death homicide. Yes.

She concluded (aneth. name I missed) the propofol could not have been self administered, due to the configuration of the IV set up.

The IV catheter was in the left leg. Yes. Do you know where it was? It was a little bit above the knee.

Asks about where the IV was in the body, the IV port next to the knee?

Depends on where the tubing was configured (ans).

Question, question, about the tubing from the leg and where how far the port is from the knee.

In the anes. explaining the difficulty of the IV set up, she goes onto explain how difficult and what position he would have to had been in a particular positon.

How difficult would it have been for him to reach his knee area? Obj sust.
Would you say that that area, would make it very difficult to use the port at that Y area.?
It’s not to difficult to touch your ankle, you can touch your ankle in bed can’t you? Well, for some people.

You just bend your leg don’t you?

Questions about how difficult it would have been for someone, not medically trained to start an IV.

In order for Mr J to administer the propofol himself. Certain things have to happen. The dr had to stop the drug. Then he has to leave. and Mr. J has to wake up. and you have to be sufficiently aware to be in some way to press the ? into the syringe...

Dr. told us he was in the bathroom for a very short time. and so could have all of those things happen in such a short time.

And you’ve come across facts that the doctor was on the phone... for about 40 minutes.

Never considered that he was on the phone for 30 minutes. No.
Or the phone call to the lady in Tx? no.
Or you would agree, if the patient was kept asleep and the only propofol given the patient was 25 mil then you would expect the patient to be awake in 5 minutes? Yes.

And after that five minutes, certainly within 20 minutes, he wouldn’t be under the influence of propofol. “Less likely.”

So there’s basically is two possibilities of self administration. is IV and orally. Yes.

The gastric contents tends to support the oral assumption. No, I don’t think the gastric contents support that. He mentions the small amount in the stomach.

How big is a microgram compared to a milligram. A microgram is one thousands of a milligram.

The 1.6 of lidocaine that would be 1600 micrograms wouldn’t it. Thats correct.

and 1600 in those stomach contents is way more than any organ that was tested? I couldn’t say that. the 1.6 pertains to the entire stomach and the other referrs to the.... miss rest of answer.

I can’t keep up.

Now going over ratios again. Sheesh.

I take a break. My fingers are tired.

A: The idea of someone taking 1.6 mg of lidocaine, I mean, that’s such a small amount.

Now goes over prior testimony with the coroner... testimony from the paramedics who thought MJ coded 1/2 hour before there arrival. And we have comments about the interrupted phone call...

Flanagan, is he rambling?

????

I’m just stopping typing now. He’s asking about space of time, etc.

Coroner goes over his notes of the Dr. statement to detectives. He reads from that.

Now, in event taht you get propofol that you get to the blood levels you see here, you would anticipte a rapid onset of sleep, deep sleep , you would expect a rapid onset wouldn’t you? Yes.

When we say rapid onset, what would you say that is. Well, rapid onset of (administer?) you would see within about a minute.

Now asking about the 2 milligrams per kilogram of weight.

I can’t take it anymore. My brain is hurting.

Even at those levels, that would quickly metabolize wouldn’t it? If taken in those ? you would expect (wake up)? ?? I’ve got this wrong.

Yes assuming his breathing was not supported. (ans to q I missed)

So, unless the Dr. left within 2 minutes, you’d see the patient stop breathing. But if MJ ingested (?) when Dr. is out of the room...

REDIRECT.

A large portion of Mr. F questions was on the assumption that the dosage that MJ received was 25 mg.

Well, what Im asking about the dosage, that was based on Dr. M statement. And one option is that’s not an accurate accounting of what Dr. Murray gave him. (correct?)

Hypothetical, that Dr. Murray was giving MJ propofol every night for weeks, for insomnia, ...I don’t get it all....

Let’s asume that Dr. left him alone with the patient and the patient self administered, (snip; I don’t get the full hypothetical) you would still (rule it a homicide based on the standard of care.) Yes.

Recross Flanagan

The evidence that Dr. M gave him 25 mil is his statement and you have to conclued that don’t you? Yes.

If MJ was given 150 mil. that would produce sleep within a minutes. yes, and he would also wake up from that unless he died wouldn’t he? Yes.

So, even if Dr. Murray gave more than 25 mg between 1040 and 10:50 we still have the same result that MJ would be awake at 11 oclock?

Yes, asuming there was a single dose.

And that he would also be dead by 11 oclock? ???

But when propofol wears off, you’re somewhat fully recovered aren’t you? (I think answer is yes???)

And somehow, if it’s accordng to the paramedics Mr J dies around noon or just before, these are the levels that would probably be in his system at autopsy, Yes, and those levels couldn’t possibly have come from a 10 40 or 10 50 injection?

No redirect.

Break now return 11 am.

God. That. Was. Painful.

I broke down and got some skittles at break. I had to get up and just move around. The plastic chairs are sooo hard. The other reporter’s sitting next to me are also complaining about the plastic chairs. We were spoiled the first week on those soft chairs in Dept. 110.

Some of the reporters found the testimony and cross to be interesting and supprisingly short this morning.

Back inside 109, waiting. We see the screen but we have no sound.

I see people standing. I think I see Dr. Murray sitting at the defense table.

11:02 a.m. Bailiff: Come to order!

#22 People call Dr. Richard Ruffalo?

Richard Lewis Ruffalo

What do you do? I’m physician and a clinical ???. What type? Anethesiologist.

And clinical ??? Individual that does peri medicine, before during after surgery, pain management.

And what’s a clinical pharmacologist? That’s someone who studies drugs and how they are used.

Can you give us educational background.

Bs, Ms, then degree in Pharmacology. Went back to medical school and completed his medical degree.

primarly my work is chinical practice and consult with companies from time to time.

Work at HOAGE. Largest hospital in orange county. Most of my time is a clinical anethesiologist.

Also a part time professor. Teaches at UCLA

Also assists medical board in medical investigations. Part time... made himself available to do that? For mant years, represented defendants investigated...

As it relates to medical board investigations, he usually works for the dr accused of providing insufficinet care. Thats corr.

He was asked to offer his consultation in the death of MJ? I was.

Received a letter from him, to review a body of materials and give an opinion. Yes.

281 page notebook. Did it include a number of reports, medical records, things of that nature? Yes.

In repsonse, did you write a report summarizing your findings Y
Did you note in your report materials that you had reviewed? Yes.
His report a 47 page document? It’s a lot of pages.

1st page, states reviewed coverletter from walgren.
go through all the materials reviewed, interview statemetns audio recordings of transmissions from UCLA

Lists all the UCLA doctors statements, UCLA records, phone records, photographs. He reviewed everything.

And regarding autopsy, rpt, did you speficially indicate, taht in The DA’s off providing autopsy to you, that the coroner’s anetheisolgist consultaton report. was removed.

So his review was completely independent.

COrrect.

And is that important that document was removed. Absolutely. it could have biased my opinions.

In your report, go through a nmber of topic areas. C orrect.

Did you cover toe toxicology in your rpeot? I did.

Made reference to the coroner’s tox report in your report? Yes.

People’s 68 for identifcation. Summary of positive tox findings.

One of the things he reviewed.

In reviewing those findings, based on your anethe background and the pharmicology background were you able to come to a conclusing. Yes I was.

Looking at the various blood samples, at the ones that were drawn. UCLA and at autopsy, based on my expertiese I was able to draw a conclusion as to what those levels meant.

As to propofol... unfortunately the numbers that’s most representative is the hospital number, that’s the true post mortem. because numbers change after time after death.
That is the most “colsely related” to antemortem. However it was drawn after the patient had recieved a significant amount of IV fluid. So that level would be lower than what would have been when the paramedics started resusitation.

When blood is drawn and put in a vial, propofol degrades over time. When we do cases in our literature, ...

We’re talking about half the 4.5?

Basically saying the time at death, would be even higher than that.

So for the basis of conclusion, the blood drawn at the hospital, would be the closest to antimortem...

Explain postmortem redistribution. It’s a misnomer, it means drugs can change their distribution. It also depends on where they were drawn, and how the blood was stored, and also the body temp, and issues of decomposition.

So all those things have various effects.

Some pharmologica drugs, ...change their effect. (ans.

Is there based on the drug looking at, do you have ways to predict or interpret redistrobution of these drugs in the body.? To some extent. (longer explanation about sample storage, etc.)

The more you know the better idea you can have.

Lot of variables that come into play that come into that analysis? A lot of variables, but luckily there is a lot of literature... (more ans)

Various benzodiazpines. Specifically, did you review the,
can you tell us generally, what observations conclusions you made as it relaes?

The most important was the lll know as adavan. clearly those levels are subject to a very small degree of difusion, it doesn’t have as much redistrobution. So it’s a little less susceptable to that. (more explanation)

So, it tiells us there was a significat amount of ?lorazapam in the blood. Significant degree of sedation.

So these levels of moraz, in the heart blood, are they ? ?

They were not being broken down like the propofol.....

He has such a low tone voice, it’s hard to follow him.

They are still 5 to 30 percent lower than what they would have been antimortem.

The readings on people’s 69 consistent with 4 milligrams given via IV. ? They are really high.... there is a lot. It’s about reflective of much higher (doses given).

So, he thinks the numbers of the benzodiazapams from the heart blood, he thinks reflect an injection/ingestion of a HIGHER dose than what Dr. Murray states he gave.

Explains the different states of sedation. Slight sedation, deep sedation, and under of anethesia general vs minor surgery.

Under general, they can obstruct theri airway even though they look like they’re breathing.

Asks to explain. So his airway is constricted, but his chest still rises and falls.

The breath is shallow, and not as often. (I’m thinking that the diaphram muscles keep working, but not necessarily air is moving.)

Talks about deeper and deeper sedation and how the air way can be constricted.

Asks about a pulseoxysemiter. It measures the saturaton of oxygen of blood cells.

Tells if blood is pushed through the thumb, then oxygen is being pushed forward. Tells you aobut how much oxygen is in the red blood cells. It’s an important thing.

Gives you heart rate, how much oxygen saturation, and profusing. (ans)

So it helps you to figure out a number of things.

Can it tell you if someone’s airway constricted? No, that’s the problem, You may stop breathing, but it may take a minute or two, before the oxysimeter tells that your oxygen has declined. There are much better ways.

Would a pulseoxsemiter be sufficient? It would be insufficient.

What would you need in the way of monitoring. One of the things would be you need blood pressure so you can track the base line over time.

When you say base line, that means some type of documentation over time? Yes.

All of thse things are affected by those drugs, (heart rate pulse rate, oxygen) so you need a monitor that measures all of that. (ans)

Even thoe the pusoxmeter gives you a heart rate, it does’t give you the spike (like on a screen). There’s no way to monitor ventelation. (with that equipment)

Another thing, a stethescope is attached to the chest to check the breathing... so you can listen to the breath sounds, in and out. You can monitor it that way...

But that’s hooked up to machinery. (yes explans)

Goes (above) over the many means you can moniter breath when no intubation.... (hand over nose mouth) real time, monitoring the breathing....

They give you depth, idea.... (ans)

Talks about the things that give you information so you can monitor, and predict, so if something goes wrong, you know what it is and what you can do.

If you combine administ. of propofol with benzodiazipones, does that require a hightened level of monitoring? It just means you have to know more of the blood interaction? The difficulty of drug interaction would be increased? (Yes?)

If you are giving a single dose of propofol, and you’re not going to continue, you may not need an expidoroxide monitoring.....because you might not need that monitoring, but when you’re giving it with other drugs...you need the extensive monitoring when you’re using long acting drugs.

More questions I’m having hard time getting.

You need to be prepared to do resussitative efforts, when giving the long acting drugs.

Guidelines regarding memoralizing, recording the patient sedation levels, etc.

Need to start to at basline, before you get to the drugs, (metions all the things equipment etc) an you need the anti? as well. Not only you get the vitals, but you get the continuation (of the state of the patient).

Brain wave monitor. If you’re trying to keep a patient in a steady state, you can look at all your non brain monitors, so this is a kind of crude EKG. It’s also another monitor that’s used as well. Those types of things, although not necessarily standard, all those things will give data points out and you follow those data oints over time.

Blood pressure, oxygen, heart activiities., etc. Things that tell you the level of sedation.
You can do a nmber of things. You can look at their pupils. These are all clinical things you can mark and that you can look for.

It tells you what things are changing over time.

Regards of level of consciousness, how often should those be noted... Counting everything, every five minutes.

Are they published guidelines, for non anethesiologists administering anethesia drugs? Yes, they’ve been around for al ong time.

For people who are using propofol in combo with other drugs. Those same monitor are incuded in to what we mentioned here.

and because of rapid cange, in continuim... on a monitor, how to monitor, the qualifications on ow to interven based on the data they see and receive.

11:48 am KFI’ Eric Leonard rushes off.

And must be trained in advanced cardiac life support.
what is ca life supp. In addition on basic, in addition how to determine data, you need to know how to intervene in a full arrest, and cardiac mycardia. Need to know how to do all the tools,

Would that include trachea intubation? Yes.
Would it include a defibulator? Yes.

And all the advannced cardiac medicaitons? Yes.
Focusing on the equipment.

In your review of the treamtent provided, what do you feel is necessar,

Airway equipment, if the patient is obstructed, you need ot know how to deal with that obstruction. you can do a jaw lift, you can pull the tongue out.... You can blow in one or both nostrils... if htatdoesn work you can try an oral airway, it’s one that goes in the mouth, if that doesn’t work, you can use insteand of a trackh tube, we have something called a low ridge mask airway. Describes.

But it creates, gets all the obstruction items out of the way.

Explains more techniques....

What is the jaw lift, and what is the porpose of that. Air way obst is more a combination of the tongue flling back into the throwat. solifting the jaw, that will cause the tongue to mve forward.

he’s showing how one lifts the jaw on both sides near the ear (medial attachment of the mandible?).

With two people, ...oh with soley an airway obstructon?

when you push back here, if ou do it youslefk it’s very painful and it can arouse you . But if they are in deep sedation, or under general anethesia.... that pressure and angle, it can be painful and cause them to wak up.

Shows the particular handling of the jaw and states that one should be trained in how to do that. (who monitors airway).

Would you also need to have advanced airway equipment on board in this setting?

.(??)... is also good to have and also an intubation tube, and you have to have training on how to do it.

Most of the time, if you’re unskilled, you’re going to get swallowing.

another thing that used to be used, is a combi tube. (com- bee?) Talks about where this tube goes, and how it’s used to inflate a balloon. Not used very much anymore.

Anything else for advanced airway equipment. Must be able to do an emergency tarco traciotomy. That gets you right into the windpipe .... and put a catheter in there.... and then put a very hard plastic piece that gets in there and pumps it back up.

Also mentioned in your report, to have various pharmological antagonists. What did ou mean by that, when you give (mentions opiates) ...you must have antagonists on hand.

If you don’t know what’s going on with the patient, you have those on hand. He mentions the drugs that reversse the benzodiazapines, and those other drugs that work to reverse common overdoses.

would it have caused any harm to give narcam (?)

Emergency ACL life support that should be present.? Are you now talking about the reversal agents...

I’m talking about the entire equipment (drugs, etc) that should be on hand to treat for ACL....

Mentions several drugs and what they do.

I stop taking notes on all these drugs and their actions and what they can do. All the ACLS (accute cardiac life support?) medications that should be on board and what they are used for.

Recess until 1:20 pm.

Lunch.
I got to court extra early so I could to talk to Beth Karas about what I didn't see with the exhibits of what Jaime Lintemoot testified to yesterday. CNN provided In Session with a remote truck and it was nice to step in there and see Beth's set up when she's not in front of the camera. Luckily, Beth WAS in the courtroom that afternoon and drew in her notebook a diagram of what she saw up on the ELMO. Bless you Beth. You're the best. Once I saw the drawing, it all made sense to me.

Recap first witness today.
The defense (in their cross of the coroner) this morning challenged Dr. Rogers as to what Dr. Murray told the detectives in his tape recorded interview. They are trying to get the witness to say that, in that interview, Murray did "NOT" give Michael Jackson a controlled drip of propofol in the early morning hours of June 25th.